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6 Differences Between Gestational Surrogacy & Traditional Surrogacy

There are a lot of major differences between gestational surrogacy and traditional surrogacy. Before you start down the path of your own surrogacy journey, you need to be aware of how these two arrangements differ.

An Introduction On Surrogacy

Surrogacy is one type of assisted reproduction technology. In a surrogacy arrangement, a woman agrees to carry a pregnancy for someone else who will be the child’s parent or parents after birth. It’s used when the intended parents are unable to carry a child on their own, often due to medical issues. Members of the LGBTQ community and single individuals who wish to be parents can also pursue parenthood via surrogacy.

Surrogacy can be a wonderful path to modern family building, but there are several decisions you’ll need to make. The first big question: will you pursue a gestational or a traditional surrogacy? Let’s define these two types of surrogacy arrangements.

Traditional Surrogacy

Until the 1980s, the only way to have a child via surrogacy was through what’s called “traditional surrogacy.” With traditional surrogacy, the surrogate is inseminated with the sperm of the intended father, and her own egg is used. Obviously in this case, the child would be genetically related to the surrogate. As you can imagine, this has the potential to create all sorts of legal and emotional complications.

Traditional surrogacy is much less common in the United States these days, with many states explicitly outlawing the practice. Several fertility clinics and others in the field will not work with traditional surrogacy arrangements. Still, it remains an option in certain circumstances.

Gestational Surrogacy

Gestational surrogacy is far more common than traditional surrogacy. With gestational surrogacy, intended parents use IVF (in vitro fertilization) to create embryos which are then transferred to their gestational carrier’s uterus. The surrogate mother has no genetic ties to the baby, so it’s considered less legally and emotionally complex.

The women who step up to help intended parents realize their dreams of parenthood are incredibly special people! Learn more about what it takes to become a gestational surrogate.

1. Process & Procedures

Your journey will look different depending on which route you choose to take. Here is a brief overview of the process and procedures for gestational vs. traditional surrogacy. In both cases, you will need to decide if you’ll work with a surrogacy agency or if you’ll go the independent route.

Gestational Surrogacy Process
A gestational carrier, which is the medical term, or gestational surrogate is not genetically related to the child she carries. Modern technology allows the gestational surrogate to become pregnant with and carry a fetus that’s genetically unrelated to her by transferring embryos to her uterus formed via in vitro fertilization (“IVF”) using donor eggs or the eggs of the intended mother.

Traditional Surrogacy Process
A traditional surrogate, also known as a genetic surrogate, becomes pregnant and carries a fetus genetically related to her by either having embryos formed via IVF using her eggs and the intended father’s sperm or donor sperm transferred to her uterus, or by achieving pregnancy by intra-uterine insemination using the intended father’s sperm or donor sperm. A traditional surrogate is a biological mother, but she intends to become pregnant and carry a child with the intention of relinquishing potential parental rights to the intended parent(s) upon birth. She never intends to become pregnant to have her own child. Genetic/traditional surrogacy is traditionally not achieved by sexual intercourse.

2. Required Medical Tests

Before a woman can become a surrogate, she must meet certain qualifications. The medical tests required of gestational and traditional surrogates are essentially the same. These tests include:

  • Pap smear
  • Vaginal ultrasound
  • Blood tests for infectious diseases
  • Drug screening
  • General physical exam

The surrogate and intended parents may also choose to have genetic testing done to screen for potential hereditary issues. The main goal with any medical screening is to make sure the potential surrogate is healthy and likely to have a successful pregnancy.

If the intended parents are using their own genetic material, they will need to undergo some medical tests as well. These include screening for infectious diseases and possibly genetic testing.

3. Required Psychological Tests

Both traditional and gestational surrogacy candidates will need to undergo psychological screening. The purpose of this screening is to make sure the candidate fully understands the process and is emotionally stable.

Psychological screenings for surrogates include two main components:

  • The clinical interview, during which a trained psychologist observes and evaluates a candidate’s responses to questions about her background, motivations, and expectations.
  • Psychological test, a research-based standardized test to assess and identify any abnormal human behavior, typically the Minnesota Multi-Phasic Personality Inventory-2 (MMPI-2), or the Personality Assessment Inventory (PAI).

Because of the added emotional complexity involved with traditional surrogacy, additional evaluation and counseling may be required by the agency or clinic before proceeding.

Intended parents will also complete, at a minimum, a psychological screening to make sure they are emotionally ready for the surrogacy process.

It’s highly recommended that both surrogates and intended parents receive ongoing mental health counseling to help navigate the often complex surrogacy process, no matter which path they choose, traditional or gestational.

4. Success Rate

Success rates for both gestational and traditional surrogacy vary based on several factors, including the age of both the surrogate and the individuals supplying the egg and sperm. In general, success rates for gestational surrogacy is estimated to be around 75%. Once a surrogate is pregnant, there is a 95% chance of having a live birth.

Because traditional surrogacy is quite rare in the United States, it’s difficult to determine an average success rate. However, there is some belief that a successful pregnancy is more likely given that the surrogate is using her own eggs. In traditional surrogacy, it’s easier to repeat the process after a failed attempt, as IUI (intrauterine insemination) does not require surgery and can even be done at home in some cases.

You can visit the SART website (Society for Assisted Reproductive Technology) to enter your information into their Patient Predictor. It’s designed based on their extensive research and data collection and will take into account your personal details to give you an idea of your chances for a live birth.

5. Legal Process

One of the biggest differences between traditional and gestational surrogacy is in the legal process. In both cases, you will need to work with an experienced attorney to draft a legal contract. This important document addresses subjects such as:

  • Parental rights
  • Custody issues
  • Location of delivery
  • Future contact between the parties
  • Insurance (both health and life)
  • Control over medical decisions during the pregnancy
  • Payment of medical bills
  • Liability for medical complications
  • Intended parents’ presence during doctor’s visits and at the delivery
  • Compensation and expenses for the surrogate

Traditional surrogacy is more legally complex because the surrogate is the biological mother of the child. When the child is born, she will be recognized as the legal parent, and she will have to take legal steps to have her parental rights terminated. She is also legally allowed to change her mind and keep the child. Because she is genetically related to the baby, it would be very difficult for the intended parents to gain full custody, regardless of what the contract states.

In most traditional surrogacy cases, the intended parent who does not have a genetic link to the child will have to undergo a stepparent adoption.

There is no federal law regarding surrogacy in the United States. That means each state, and sometimes each county, is left to create or interpret the legality of surrogacy arrangements. You can check the US Surrogacy Map for more details on your state.

There are currently three states where gestational surrogacy of any kind is illegal: Michigan, Nebraska, and Louisiana.

Traditional surrogacy is specifically permitted in the following states: California, Connecticut, Delaware, Maine, New Hampshire, Nevada, North Dakota, Oregon and Rhode Island.

Always consult with an experienced family formation attorney before proceeding with any surrogacy arrangement.

6. Compensations

The average cost for a compensated gestational surrogacy journey in the United States is $110,000-$200,000. This includes medical costs, agency fees, and surrogate compensation. You can decrease the cost by working with an altruistic, or compassionate, surrogate who requires little or no compensation. Usually this occurs when a friend or family member volunteers to carry for you. Another way to save on costs is to pursue an independent journey, cutting out the agency fees. Learn more about how to prepare for an independent surrogacy journey at SurrogacyRoadmap.com.

Some intended parents consider traditional surrogacy as a way to save on overall costs. While this can save money, it also comes with several layers of legal and emotional complexity. On average, intended parents can expect to pay at least $20,000-$30,000 less. The biggest factor is that you won’t be paying for an egg donor or an IVF cycle.

The Best Surrogacy For You

Ultimately, the decision to pursue a traditional or gestational surrogacy is up to you and your partner, if you have one. You will need to consider your unique circumstances, expectations, and local laws as you weigh the pros and cons of each. Always consult with an experienced attorney regarding the legal issues involved with each arrangement.

In need of a surrogate mother? Learn how Family Inceptions can help you!

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Eloise Drane
Eloise Drane, Founder

"I believe that we are all placed on this earth for a purpose. Each one of us has a specific calling in this world and although it is different for everyone, we are here to serve one another. My purpose is to help women who wish to become surrogates and egg donors and the hopeful parents who wish to partner with them. I feel very lucky to be living my purpose."