One of the first decisions you will want to make after choosing to pursue parenthood via surrogacy is whether or not to work with a surrogacy agency. The right agency can be your best resource in helping you navigate the complicated and often overwhelming waters of surrogacy. On the other hand, the wrong agency can cause you to waste precious time and money.
Our team at Family Inceptions has compiled a list of nine vital questions you should ask before choosing a surrogacy agency.
1. What’s The History Of The Surrogacy Agency?
The first question to ask a potential surrogacy agency is about the history of their business. How long have they been operating the agency? Unfortunately, there have been cases of fly-by-night agencies that pop up and prey on the vulnerability of hopeful intended parents. These cases are few and far between, so try not to dwell on this possibility. Instead, use this as motivation to do your due diligence.
You should look for an agency that has been well established for several years. Ask if they have ever operated under a different business name. Has ownership transferred hands, and if so, who is the current owner? Reputable agency owners should be able to provide their credentials, experience, and an overview of their mission and values in running their agency.
One thing to keep in mind: if you do happen to come across a newer agency, this might not be a red flag on its own. Find out about the history and experience of the owner. You may learn that someone with decades of experience in the industry has recently opened a new agency. In that case, look into their previous work and reputation in their former roles in the field.
While any good agency should be able to provide you directly with details about their history and track record, it’s important to look into their history via outside sources. Check with the Better Business Bureau, local chambers of commerce, published reviews, and other surrogacy professionals. Surrogacy agencies work closely with fertility clinics, family law attorneys, and other professionals in the assisted reproduction field, so be sure to ask them for their recommendations and feedback on the agencies you are considering.
An agency’s business history and reputation is an important piece of the puzzle, but their statistics and success rate is vital as well.
What Is Their Success Rate?
Potential agencies should be able to readily provide you with statistics about their success rate in working with surrogates and intended parents.
Some key statistics include:
- The number of intended parents worked with
- The number of surrogates worked with
- The percentage of successful first-time matches
- How many babies have been born with the help of their program
- How many surrogates and/or IPs have returned for subsequent surrogacies
Of course, even the best agency can’t guarantee the medical process will have a favorable outcome. In large part, this is dependent on the quality of the fertility clinic and medical team. However, the agency plays a large role in facilitating a successful surrogacy by properly screening and matching surrogates and following best industry practices.
If an agency lacks transparency or is unable to produce statistics for you to review, consider this to be a red flag and cross them off your list.
2. How Big Is The Agency?
Next, you will want to find out about the size of the agency. How many employees are there? Do they operate from a single location, or do they have additional offices in other locations? The size of the agency shouldn’t necessarily be a deciding factor in and of itself, but this information can help you as you determine what you want your surrogacy journey to look like.
A smaller agency may offer more personalized, hands-on experience. On the other hand, you may want to dig a little deeper. A small staff that is spread too thin handling multiple surrogacies won’t be as responsive as a larger agency with a smaller staff to IP ratio.
Ask them what you can expect in terms of responsiveness. Will you be assigned a dedicated contact person? If so, what is their availability? What is the protocol for after-hours emergencies and other urgent matters?
Finally, ask about other support staff. Is there in-house legal counsel, for example? Is there an RN on staff to help coordinate the medical side of the process? Overall, you want to feel assured that the agency is staffed well enough to meet your needs and expectations.
Do They Provide Services In Your State?
The location of your surrogacy agency may seem like an important factor, but in reality, it doesn’t matter very much. With the wide availability of video conferencing and virtual meeting options, most agencies work with surrogates and intended parents from all over the country, and even internationally in some cases.
Find out if your agency has handled surrogacy cases in your particular state. You will want to be sure they are familiar with your local laws and regulations, and that they will be able to refer you to and coordinate with your other fertility professionals throughout the journey.
Of course, some intended parents choose to work with local or regional agencies in order to have a more hands-on experience. Regional agencies can ensure that you are matched with a surrogate who lives relatively close to you. If you want to have a close relationship with your surrogate and/or wish to minimize the cost of travel to bring your surrogate to medical appointments, etc., then choosing a local agency may be right for you.
3. What Are The Services Provided For Intended Parents?
The level of service provided by a surrogacy agency can vary from one agency to another. Ask about different levels of services, inclusions, and any options for customizing the types of services you will be using.
In general, the role of a surrogacy agency is to manage and help facilitate a surrogacy journey for intended parents and their surrogate. There are full-service and partial-service agencies, but each agency can define what each service entails and how deeply they provide support. Be sure to ask plenty of questions to clarify your potential agency’s services.
Full-service agencies typically offer the following services to intended parents:
- Matching services to connect intended parents with compatible, qualified surrogates.
- Screening services for all parties. The goal of screening is to make sure everyone is mentally, physically, and emotionally ready to embark on a surrogacy journey, and also to make sure everyone is entering into the process with informed consent and transparency.
- Counseling services throughout the surrogacy, beyond initial screenings and evaluations.
- Coordination of services between other fertility and surrogacy professionals, including coordination with the fertility clinic, attorneys, escrow company, and more.
- Assistance in planning travel for the surrogate to and from the clinic, as well as for delivery.
- Guidance and assistance in planning post-birth travel for the intended parents and their new baby.
Some full-service agencies also have an in-house egg donation program. This is often seen as an advantage for donors and intended parents who wish to choose who they work with. It can also create a more seamless experience for both donors and IPs.
Some agencies are considered partial-service agencies. This means that there are more limited services provided to intended parents, and the depth of support is not as great as with a full-service agency. This type of agency can work for intended parents who are comfortable handling some aspects of the journey themselves, such as finding and hiring a lawyer, arranging escrow payments, etc.
The most common type of service offered by an agency like this is helping intended parents find a surrogate to match with. Find out details on what they include with this. Does the service include a full application process, 1:1 consultation, and mental health screening? Or will you be expected to find and schedule the mental health consult on your own?
Surrogacy agencies in the United States will typically only provide services to people who are pursuing gestational surrogacy. If you are considering a traditional surrogacy arrangement, you may be quite limited in the agencies that are available to you.
4. What Are The Costs Involved?
All reputable agencies will be able to provide you with detailed, thorough explanations of all the costs involved, including potential and optional costs. What does the agency fee include? An agency fee should be a fixed sum that covers all of the services the agency provides to you, but be sure they can provide you with an itemized list of what that includes. Beware of agencies that advertise low-cost agency fees – they may actually have a practice of tacking on additional costs down the road.
Agency fees may cover the following:
- Full management and coordination of your surrogacy journey from start to finish
- Matching and screening your egg donor and surrogate
- Support from a dedicated case manager
- Legal support, including the drafting of your contract and assistance with orders of parentage
- Insurance evaluation and medical billing assistance
In addition to detailed explanations of what is included in the agency’s fee, they must be able to provide you with an overall budget, with clear costs outlined in each category. You should expect these to be estimates, as many times, it’s impossible to predict the final cost. Your agency professionals should be able to provide you with advice about how much of a buffer to plan for and when you should expect certain costs to come due.
Ask for a breakdown of the following surrogacy costs before agreeing to work with any agency:
- Surrogate mother base compensation & incidentals
- Legal fees (if not included in the agency fee)
- Egg donor fees
- Medical screenings, medications, and embryo transfer fees
- Medical care for the surrogate: prenatal, labor and delivery, and postpartum
- Travel expenses
- Health insurance for the surrogate
- Mental health screening and ongoing support
Again, most of these numbers will be estimates, not actual figures. Ask them to share how often their estimates match reality with their clients. If they are evasive in their answer, this could be a red flag.
5. What Is The Screening Process Like?
One of the most important questions to ask is regarding the agency’s screening process for surrogates. You will want to choose an agency that follows all current best practices for screening and evaluating potential surrogates. While there are very few federal guidelines pertaining to gestational surrogacy, ethics in the industry are guided by the evidence-based organization ASRM, or the American Society for Reproductive Medicine.
Click here for their guidelines on gestational surrogates: Recommendations for practices utilizing gestational carriers: an ASRM Practice Committee guideline
Any agency that cuts corners in the screening and qualification process should be avoided. Ask the agency to walk you through the surrogate screening process step-by-step. Each agency has their own method and set of criteria for determining who qualifies and who doesn’t.
Some common screening information includes the examination of medical records, including records from the surrogate’s previous pregnancies and deliveries, background and credit checks, an on-site home visit, current medical workup including bloodwork and Pap smear, and a self-disclosure of medical, social, and drug (prescription and illicit) history.
Some questions to consider asking about how the agency screens its surrogates:
- At what point is a personal interview required, and who conducts this interview?
- What types of background checks do they perform on applicants?
- What is their average rate of applicants accepted?
It can be telling to learn what their acceptance rate is for their surrogate program. A high acceptance rate could be a red flag, meaning that they accept too many applicants that might be only marginally qualified.
In general, you need to feel assured that the agency has a solid process in place to vet potential surrogates’ emotional, mental, physical, and financial fitness to serve in this important role.
6. How Does The Matching Process Work?
The next important topic to bring up with your potential agency is the matching process. As an intended parent, you want to be sure the agency will take your preferences into account while also guiding you to a solution that fits an appropriate timeline.
One of the most common causes for a lengthy matching period is when intended parents insist on several highly specific traits in a surrogate. A good agency will be able to listen to your preferences while also being transparent with you about how certain choices can delay the process.
Ask them to describe how they get to know you and your desired profile for a surrogate – will there be a lot of paperwork, a personal interview, a series of boxes to check on an online database? Get a feel for how agency staff get to know their IPs on a personal level. In our experience, this is a crucial piece to facilitating the best fitting matches.
Will you be able to view profiles of potential surrogates, or will the agency staff present you with a limited set of options? How will your first meeting be structured? And lastly, what happens if you determine this candidate is not a good fit?
7. How Long Does The Surrogacy Process Take With The Agency?
Surrogacy can be a very long process regardless of the agency you choose. However, there are some key details you should find out about before committing to a particular agency. Individual agencies can vary greatly in terms of their wait times due to their pool of qualified surrogates, internal staffing problems, or other issues. In general, a surrogacy journey takes anywhere from 15-24 months from start to finish.
Consider asking your potential agency the following questions regarding your surrogacy timeframe:
- How long do each of the phases of the journey take, in general?
- How many intended parents are waiting to be matched right now?
- How many surrogates do you have pre-qualified?
- What is the average length of time from initial sign-on to finding a match?
- What steps do you take to help the process move forward smoothly?
- How do you handle unexpected delays?
- What happens if we have a change in circumstance and need to delay our journey for a period of time?
- What are the most common causes for delays that you see?
8. How Do They Ensure Legal Protection For All Parties Involved?
There are many complex legal pieces to the surrogacy puzzle. You need an agency whose staff is well versed in surrogacy law and able to provide you with proper guidance and education on the importance of proper legal representation.
Ask them how they help their clients avoid legal trouble. Is there an in-house attorney? If so, are you still free to choose your own lawyer if you prefer? What qualifications and experience does the in-house attorney have?
Reputable agencies will insist that you and your surrogate each have separate legal representation so that there is no conflict of interest. If an agency says it’s fine to use the same lawyer, that is a huge red flag.
Another red flag would be playing down the possibility of legal trouble. While it is not common to have legal problems, the stakes are extremely high when something does go off the rails. Your agency must advocate for you to have qualified, experienced attorneys to work with on your journey.
If the agency does not have an in-house lawyer, ask them if they refer clients to a particular person or firm. If so, find out why they trust them and seek testimonials from past clients.
9. What Kind Of Post-Surrogacy Support Do They Offer?
Lastly, ask your potential agency about post-surrogacy support. What happens after the journey has concluded and you’ve brought your precious new baby back home? What is their plan for ongoing communication? Will your case manager be available to help you with lingering medical bills, communication with your surrogate, or other post-surrogacy support? Do they provide any sort of post-surrogacy counseling?
Ideally, you will find an agency that is supportive throughout the entire process, including postpartum. Look for an agency that takes the time and effort to get to know you, check in regularly, and listen to your concerns and needs.
Ask The Right Questions To Find The Right Surrogacy Agency
Selecting the right surrogacy agency is a very big decision. It is not one to be made lightly. As you begin your search, keep these nine questions in mind. Take notes, ask for documentation when applicable, and remember to always trust your gut. If something seems too good to be true or simply “off”, it probably is. Good luck as you begin your search!
Still considering which agency to go to for your surrogacy journey? We can help. Learn about our program here.