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The idea of one person carrying a baby for someone else isn’t new—it’s been used since ancient times. It’s mentioned in Bible verses, Babylonian history, and Hindu mythology alike and is just one of many ways to grow a family.
There are many reasons why a person might choose to use a surrogate or become a surrogate themselves. Surrogacy can take many different forms and include the use of donor sperm and donor eggs.
It can also involve a financial arrangement or happen on a volunteer basis. It’s important to consider the many legal, medical, and emotional implications that surrogacy can carry.
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What is surrogacy?
The basic idea of surrogacy is that one woman goes through pregnancy and has a baby for someone else. There are two main types of surrogacy:
- Traditional surrogacy is when the surrogate goes through artificial insemination of her own eggs. In this case, the baby will be genetically related to the surrogate.
- Gestational surrogacy is when the egg and sperm both come from donors (whether those donors are the intended parents or not). The egg is fertilized with sperm in a laboratory before the resulting embryo is transferred to the surrogate’s uterus. In this case, since the sperm and the egg came from other people, the baby won’t be genetically related to the surrogate.
For legal reasons, gestational surrogacy has become more common than the traditional method. About 750 babies are born each year in the United States through gestational surrogacy (Patel, 2018).
Many people use surrogates who live in the United States, but others choose to use people who live abroad because it’s often less expensive.
Reasons for considering surrogacy
There are several reasons for considering a surrogate––some medical, some personal. These include (Patel, 2018):
- Difficulty conceiving or repeated miscarriages
- Same-sex male couples
- Having a medical condition that can make pregnancy dangerous
- People who have a genetic condition that they’re concerned about passing on to a child
That said, anyone can choose to look into surrogacy regardless of their medical or personal needs.
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Who is eligible to be a surrogate in the United States?
Each state has different requirements to become a surrogate. Some of the main stipulations include (Rumbold & Siedelman, n.d.):
- You must be between the ages of 21–45.
- You must have had at least one successful, uncomplicated pregnancy.
- You must complete a medical and psychological evaluation.
- You must retain an independent attorney throughout the process.
- You must give informed consent and be aware of medical and psychological risks.
In order to work with a professional surrogacy agency, there may be more requirements like (Sensible Surrogacy, 2022):
- United States citizenship or legal residency
- Good health, including maintaining a healthy body weight
- No history of mental illness
- Not smoking, vaping, or using illicit drugs
- No criminal history
- Not dependent on financial support from the government
Before starting the process, both the surrogate and the person providing the sperm (and egg, if relevant) undergo a process called genetic counseling. This is where healthcare providers test their genes to see if they carry any genetic medical conditions that they might pass on to a child.
The psychological and social implications of surrogacy are also discussed at length. When done through an agency, both the intended parents and the surrogate will sign legal contracts regarding the scope of their involvement during and after the pregnancy.
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How does surrogacy work?
If the surrogate is impregnated using donor sperm and her own eggs, she’ll undergo a process called artificial insemination. During this process, semen from an intended parent or donor is inserted into the surrogate’s uterus while she’s ovulating. If all goes well, the egg released during ovulation will be fertilized, and pregnancy will follow.
If donor eggs are being used, they can be taken from an egg bank or retrieved from a donor. New donors must go through a process that involves hormone injections before their eggs can be retrieved. The sperm is then mixed with the egg in a laboratory to allow for fertilization.
When an embryo is created, it’s evaluated in the lab and eventually transferred to the surrogate’s uterus. This fertilization process is fast and takes less than a day. While the actual transfer of sperm or embryo is relatively quick, the process of retrieving eggs can take weeks or even months and involve rounds of hormone treatments for the egg donor.
What’s included in pregnancy care for a surrogate?
In some cases, the surrogate can choose to stay in a specific surrogate house or their own home for the duration of the pregnancy.
During this time, standard pregnancy care is often covered, along with any medical care necessary. This includes an assessment by a doctor every 20 days, along with ultrasound scans between 6–8 weeks, 11–13 weeks, 20–22 weeks, 28–29 weeks, and 34–36 weeks.
The party desiring parenthood is usually sent updates about the surrogate’s weight, vital signs of the baby, fetal growth, and ultrasound scans. The surrogate is also often entitled to medical care as needed for a minimum of 15 days after the baby is delivered (Patel, 2018).
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Risks of surrogacy
There are several physical and mental health risks to consider regarding surrogacy.
These include pregnancy complications such as high blood pressure, gestational diabetes, preeclampsia, and more. There is also the risk of the potential emotional trauma of having to give a child away.
Some research has shown that for most parents, the quality of their marital relationship is not negatively affected by the surrogacy process. In most cases, the surrogate, child, and parents don’t have any negative psychological effects afterward (Patel, 2018).
One study that examined the emotional relationships between each party found no negative feelings between the surrogate and new parents (Jadva, 2012).
The cost of surrogacy ranges significantly from one country to the next. In the United States, surrogacy costs between $40,000–150,000 plus the cost of any agency fees and other expenses (Wilkinson, 2016). These prices can drop significantly if you use a surrogate in a developing country.
Fees can also add up for multiple births, Cesarean sections, or other medical issues that arise. If you go through an agency, fees often include screening costs, support services, marketing, legal counsel, and health insurance plans for the surrogate and baby (American Surrogacy, 2022).
Prices also range depending on the state where you reside. In California, for example, surrogacy costs between $70,000–120,000, with the surrogate receiving roughly $2,700 per month along with having their medical costs, insurance, clothing, and necessary transportation costs covered (Aznar, 2019).
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How to find a surrogate or become one
There are many ways to search for a surrogate or become a surrogate. Some people use professional agencies in the process, while others prefer to search for someone directly using social media.
Agencies have a quick pre-approval process beforehand, making everything quicker and safer for both parties. They also help surrogates with legal representation.
Some people opt for surrogates who live outside the United States, while others serve as surrogates for their own family members free of charge (American Surrogacy, 2022). There are many different ways to bring children into the world, and surrogacy is one of them.
- American Surrogacy. (2022). Where Can I Find a Surrogate Mother? Retrieved from https://www.americansurrogacy.com/parents/where-to-find-surrogate-mothers#:~:text=The%20best%20way%20to%20find,of%20by%20your%20surrogacy%20specialist.
- Aznar, J. & Martínez Peris, M. (2019). Gestational Surrogacy: Current View. The Linacre Quarterly, 86(1), 56–67. doi:10.1177/0024363919830840. Retrieved from https://journals.sagepub.com/doi/10.1177/0024363919830840
- Jadva, V., Blake, L., Casey, P., et al. (2012). Surrogacy families 10 years on: relationship with the surrogate, decisions over disclosure and children’s understanding of their surrogacy origins. Human Reproduction (Oxford, England), 27(10), 3008–3014. doi:10.1093/humrep/des273. Retrieved from https://academic.oup.com/humrep/article/27/10/3008/750058
- Mayo Clinic. (2021). Egg Freezing. Retrieved from https://www.mayoclinic.org/tests-procedures/egg-freezing/about/pac-20384556#:~:text=Egg%20retrieval,-Egg%20retrieval%20is&text=A%20common%20approach%20is%20transvaginal,the%20egg%20from%20the%20follicle.
- Patel, N. H., Jadeja, Y. D., Bhadarka, H. K., et al. (2018). Insight into Different Aspects of Surrogacy Practices. Journal of Human Reproductive Sciences, 11(3), 212–218. doi:10.4103/jhrs.JHRS_138_17. Retrieved from https://www.jhrsonline.org/article.asp?issn=0974-1208;year=2018;volume=11;issue=3;spage=212;epage=218;aulast=Patel
- Rumbold & Seidelman. (n.d.). Requirements for Surrogacy in New York and New Jersey. Retrieved April 4, 2022 from https://adoptionlawny.com/reproduction-law/become-a-surrogate/surrogacy-requirements/
- Sensible Surrogacy. (2022). Surrogacy in the United States. Retrieved April 4, 2022 from https://www.sensiblesurrogacy.com/surrogacy-in-the-united-states/
- Wilkinson, S. (2016). Exploitation in International Paid Surrogacy Arrangements. Journal of Applied Philosophy, 33(2), 125–145. doi:10.1111/japp.12138. Retrieved from https://onlinelibrary.wiley.com/doi/10.1111/japp.12138
Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.