Surrogacy

For many people struggling with infertility, a surrogacy arrangement may be an option. Surrogacy involves having another woman carry and deliver your baby for you. If you can’t get pregnant, a caring surrogate may be able to help you have a healthy child that’s biologically yours.

What Is Surrogacy?

Surrogacy is when another woman carries and delivers a baby for a couple or person. The person who carries the pregnancy is the surrogate. The people who raise the child are the intended parents.

There are many reasons someone may choose a surrogate to give birth. You may have fertility problems or medical conditions that make it impossible to carry a child to term. You might be single or part of an LGBTQ+ couple and want to start a family.   

Intended parents can arrange surrogacy privately or through a qualified agency. In most cases, the intended parents compensate the gestational carrier financially for the service she provides. They also pay any expenses related to the pregnancy. 

Is surrogacy legal?

Surrogacy isn't legal in all 50 states, and laws may vary in the states where it is legal. Before you begin to consider surrogacy as an option, get legal advice in your state. 

Types of surrogacy

There are two types of surrogacy: gestational and traditional.

Gestational surrogacy

Gestational surrogacy is when doctors transfer an embryo, typically created by the egg and sperm of the intended parents, to another woman. The embryo could also come from donor eggs or sperm.

The gestational carrier, or gestational surrogate, is the woman who agrees to carry the developing embryo. The gestational surrogate isn't the biological parent of the child.

If you and your partner choose gestational surrogacy, you’ll typically undergo in vitro fertilization (IVF) to produce an embryo that’s biologically yours.

IVF involves extracting eggs and fertilizing them with sperm in a laboratory. After the egg becomes fertilized, doctors transfer the resulting embryo into the surrogate’s uterus. The gestational surrogate carries and delivers the baby.

Gestational surrogacy is by far the most common type today — and is becoming more popular as a way to build families. From 2010 to 2019, the most recent numbers available, embryo transfers to gestational carriers in the U.S. more than tripled. They increased from 2,649 in 2010 to 9,195 in 2019, and experts expect that trend to continue.

Traditional surrogacy

Traditional surrogacy is surrogacy without an egg donation. The surrogate undergoes artificial insemination with the intended father’s sperm. Because the surrogate uses her own eggs, she's the baby’s biological mother.

Traditional surrogacy is usually less expensive than gestational surrogacy because IVF isn't involved. But because of the legal and emotional complications, doctors usually don’t recommend it. In some states, traditional surrogacy isn't legal.

Why Would I Need a Surrogate?

Couples (and singles) choose surrogacy to build a family for many different reasons.

You may:

• Be of an age where it’s unlikely you could carry a pregnancy to term.
• Be part of a same-sex couple who wants to start a family.
• Be single and want to start a family.
• Have had a hysterectomy or other uterine issue that makes carrying a child impossible, even if you can conceive.
• Have had recurrent miscarriages.
• Have had several failed IVF attempts.
• Have medical issues that prevent you from becoming pregnant or carrying a pregnancy to term. These include heart disease, high blood pressure, cancer, lupus, or type 1 diabetes. 

Is surrogacy right for me?

You should discuss surrogacy with your doctor, your partner, and a lawyer experienced in surrogacy matters. For many people, it’s a wonderful way to grow your family. But it’s also a medically and psychologically complex experience, and can be very costly. 

What Are the Risks and Complications of Surrogacy?

There are unique challenges and rewards to building your family through surrogacy.

Common risks for the intended parents include:

• The emotional toll of possible complications with fertility treatments or other unforeseen events.
• The financial risk of surrogacy. It's an expensive process with no guarantee of results.
• The pregnancy will not be successful or carry to term.
• Feeling disconnected from the pregnancy and developing baby.

The gestational carrier also faces risks.

They include:

• Pregnancy-related risks, such as infections, gestational diabetes, and preeclampsia (high blood pressure in pregnancy).
• Complications with family, including challenges for their own children and partner.
• Feeling attached to the growing baby, and sadness after delivery. 

What Should I Expect From Surrogacy?

Surrogacy is a complex process but can ultimately be rewarding for the intended parents and the gestational surrogate. Here are the basic steps to surrogacy.

Finding a surrogate

To locate a gestational surrogate, most people go through a full-service agency that matches intended parents with carriers. Agencies screen candidates to make sure they meet the stringent criteria for surrogacy.

Some people choose to find a friend or family member to be a gestational surrogate. This reduces the cost of surrogacy by cutting out the agency. However, it also creates potential complications and legal issues. 

UPMC doesn't recruit gestational surrogates.

Steps before surrogacy can proceed

There are many steps, both legal and medical, along the journey to surrogacy.

As intended parents, you'll need to:

• Agree to the keeping of genetic records from both contributors to the embryo, with the outcome of each IVF cycle recorded. This will be a future medical resource for any children produced.
• Go through counseling by a qualified mental health professional throughout the process.
• Have a complete medical evaluation, including a detailed questionnaire. 
• Share financial information.
• Undergo genetic screening.
• Undergo a psychological evaluation that includes screening for depression.

To become a gestational carrier, you need to:

• Agree to a clinical interview that covers educational, psychiatric, social, work, legal, and financial history.
• Be at least 21 years old, and preferably younger than 45.
• Be financially stable.
• Be willing to undergo a complete medical history, including a detailed obstetric history, lifestyle history, and physical exam. This will include medical evaluation of your uterus, and a urine drug screen.
• Have a stable family environment with enough support to deal with the stress of pregnancy.
• Have delivered at least one child born live, at term, with no complications.
• Have no more than five previous deliveries, or three deliveries via caesarean section.
• Have your blood type and Rh factor tested.
• Undergo a psychological evaluation and extensive counseling. It’s important to be aware of the impact of the surrogacy arrangement on your children, other family members, and employer. 
• Undergo infectious disease screening for syphilis, gonorrhea, chlamydia, HIV, and hepatitis B and C.
• Undergo screening for immunity to rubella, rubeola, and varicella. 

Legalities

One of the biggest challenges to surrogacy is the matter of legality. Each state has its own laws regarding surrogacy, so it’s essential you have legal help from the beginning of the process. To protect everyone involved, both parties must enter into a gestational carrier contract.

A gestational carrier contract details both parties’ rights, obligations, intentions, and expectations regarding the surrogate process.

These contracts can be:

• Compensated agreements — Where the gestational carrier will receive a surrogate fee for carrying the pregnancy. They'll also receive compensation for expenses incurred during the pregnancy, such as medical costs, legal fees, and lost wages.
• Compassionate surrogacy agreements — Where a surrogate (usually a close friend or family member) agrees to carry the pregnancy. The intended parents still cover medical and other expenses during pregnancy but no financial compensation is offered to the surrogate. 

The gestational carrier contract addresses such items as:

• Any necessary childcare during doctor’s appointments.
• Availability of medical history and personal medical information on the gestational carrier.
• Custody issues.
• Financial considerations, such as the gestational carrier’s compensation and expenses, including lost wages.
• Future contact between the intended parents and the surrogate.
• Health and life insurance.
• Parental rights.
• Where the surrogate will deliver the baby.
• Whether or not the intended parents can go to doctor’s visits and be at the delivery.
• Who has control over medical issues during the pregnancy.
• Who has liability for medical complications.
• Who pays for maternity clothes.
• Who pays legal fees and medical bills. 

Both the intended parents and gestational surrogate must have legal representation through the negotiation process of the contract. This ensures everyone has a clear understanding of their rights and responsibilities to the other party. 

The attorneys will handle negotiations. Their expenses are typically paid for by the intended parents.

Intended parents must also get a court order determining the baby’s legal parents. The court order directs the hospital where the baby is born to place the intended parents’ names on the birth certificate. 

The intended parents should start the process for this court order once a gestational carrier has completed the first trimester of pregnancy. That should allow enough time for the paperwork to be in place once the baby is born. If you don’t have the court order by the baby’s birth, the intended parents may need to legally adopt the child.

In the absence of a court order, the surrogate’s name may get placed on the birth certificate as the legal parent. Having the proper paperwork in place protects everyone. 

Costs and insurance

The out-of-pocket costs of surrogacy vary dramatically but can reach well over $100,000.

Costs include agency fees, surrogate fees, legal fees, and fertility treatments to create embryos (fertility treatment often isn’t covered by insurance). You may also need to pay your surrogate’s insurance and medical fees, as well as the costs of bringing a baby home.

Some health insurance plans cover surrogacy, but most private plans don't. You may be able to purchase a plan that covers surrogacy, but it will also be an expense.

Do ask about all financing options. Some fertility centers offer in-house financing, payment plans, or cash discounts to help families.

The Medical Aspect of Surrogacy

Once you’ve found a carrier and have gone through the medical, financial, and legal aspects, you can begin the IVF and embryo transfer process.

IVF is a complicated procedure. Here are the basic steps:

1. Ovarian stimulation — Doctors give you medicine in the form of injections in the lower belly. This medication helps your eggs mature.
2. Egg retrieval — Doctors remove mature eggs from your ovaries with a needle guided by ultrasound.
3. Fertilization — Doctors place sperm with the egg in a culture dish. If fertilization is successful, the embryo develops for a few days.
4. Embryo transfer to the surrogate — Doctors insert a long thin tube into the gestational carrier’s vagina and place one or more embryos in the uterus.
5. Pregnancy — Occurs if any of the embryos attach to the lining of the carrier’s uterus. After the embryos transfer, she'll need to wait about two weeks to take a pregnancy test to see if IVF worked.

Why Choose UPMC for Surrogacy?

At UPMC, we provide up-to-date medical expertise for people as they explore ways to deal with infertility. Our cutting-edge technology can give you the best chance to build your family.

We also understand that infertility can add extra stress to daily life. In addition to the best medical care available, UPMC offers emotional support for people building their families through surrogacy. We recommend and offer counseling to all parties involved in a surrogacy arrangement.

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Last reviewed by a UPMC medical professional on 2024-09-05.