PODCAST INTRODUCTION
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STANDARD INTRODUCTION
Welcome back to Fertility Café. Today we’re talking about how to find the right surrogate whether it’s a traditional surrogate or a gestational carrier for your journey to parenthood. In episode 2, we talked about the ins and outs of gestational surrogacy. How it works, who might use this method to build a family, and how one can qualify as a surrogate.
This episode we’ll focus on how to find the right person to be your surrogate. This is one of the most important decisions you will make, and there are many factors to consider when finding the right match for your journey. Now, notice how I called it a “journey” – that’s really what this is – a journey to parenthood.
Surrogacy takes a significant amount of time and money – not to mention the emotional investment for everyone involved. So, when it comes to finding your traditional surrogate or gestational carrier, you’re looking for someone you’ll be spending a decent amount of time with. You have to be aligned in your expectations. Because of this, you need someone who is stable, healthy, trustworthy, and open-minded.
Before you even begin your search, there are several questions and preferences you should consider. Some questions are easier than others, as you’ll see. Let’s tackle some of the more sensitive topics first.
TOPICS OF DISCUSSION
I’m going to tackle what I feel is probably the most important topic everyone needs to be on the same page before anything gets started. No matter how or who you choose to be your surrogate or gestational carrier, the most important decision you and she will make will be your positions on termination. You’ll need to consider both termination and selective reduction. These are sensitive topics, but everyone must agree ahead of time. The last thing you want is a disagreement especially when it comes to this life altering decision – and please know that, even if a child is genetically related to you, there is no court in the world that will make a woman terminate a pregnancy if she does not want to.
So, what is your position on termination? Would you want the surrogate to terminate if there is a severe medical anomaly? One in which the child wouldn’t survive after birth or would need round-the-clock care for the rest of their lives? What if the child has developmental disabilities like down syndrome or cystic fibrosis? What happens if the surrogate’s life is at risk?
It’s imperative that everyone is on the exact same page with this, from the beginning, and that it’s all outlined in your Gestational Surrogacy Agreement up front.
Something else to consider is selective reduction. What are your thoughts on selectively reducing one or more of the fetuses to increase the survivability chance of the others? What if you transfer a single embryo and it splits? Are you okay with having multiples when your intention was to only have one? Is the surrogate even willing to carry multiples? Again, these are questions you absolutely must agree on before you get started.
Other considerations are more logistical in nature but still require thought ahead of time.
Where is the surrogate located? The state where the child will be born determines which law applies, so in this case, where you live is irrelevant. In which state will she deliver, and is it a surrogate-friendly state? It’s an unlikely scenario that she will move to your state to deliver. Not to say it can’t happen, but if that’s your wish, you have to be willing to pay for all of her moving and living expenses.
Next up: insurance. Not all insurance policies will cover a surrogacy pregnancy, which can have a significant impact on the cost for you. It’s important to verify her policy ahead of time to see if it has a surrogacy exclusion or not.
If the policy doesn’t have an exclusion, you may be able to use her policy for maternity care. However, it’s not a good idea to use her policy for the pre-conception portion. Unfortunately, a lot of insurance companies won’t pay for fertility care – especially if it’s not for the insured’s own child.
If the surrogate doesn’t have insurance, you can either purchase a policy that has no surrogacy exclusion, and there are companies out there that offer medical insurance specifically for surrogacy pregnancies. She could also be considered a self-pay patient. Self-pay patients can negotiate rates directly with the Obstetrician and the hospital for delivery. I would strongly suggest that, if you go this route, you purchase a backup policy to cover any complications that may arise.
Another consideration is the occupation of your surrogate or GC. Is she a stay-at-home mom or does she work outside the home? This can impact your overall cost and the type of surrogacy journey you have. If she is a SAHM, you’ll need to consider the cost of childcare for medical appointments or if she goes on bed rest. If she works outside the home, how labor-intensive is her job? What’s her salary, and will you need to pay for her lost wages?
What about contact and communication? What are your expectations for the type of relationship you’ll have with her before, during, and after pregnancy? Are you open to a relationship after the child is born? Some surrogates want to be a part of your family. Others appreciate an update once a year, perhaps when you send out holiday cards. There’s no right or wrong answer here: it’s your preference. If you’re not sure how you’ll feel in the future, that’s okay. Just be clear as to what your desires are, and if you want it to be organic, make that known.
For some parents, spiritual beliefs and religious practices are very important. Some request that the surrogate uphold certain practices throughout the pregnancy to ensure the baby’s inclusion in the faith after birth. While religious requirements certainly don’t apply to all pregnancies, you have the option to make them a stipulation of your match.
Let’s briefly look at this from the perspective of Christianity, Judaism, and Islam. In Christianity, some parents desire that their surrogate practice their faith and partake of the Sacrament on a regular basis. Some Christian parents believe surrogacy is a spiritual calling and therefore seek a certain closeness with their surrogate.
In Judaism, beliefs vary. Because surrogacy is a new technology, there is no halachic consensus on it, meaning different sects of Judaism differ in their beliefs surrounding the practice.
While some orthodox rabbis prohibit the practice, citing concerns about adultery, others allow it if certain conditions are adhered to, in order to meet halachic requirements. For example, the surrogate mother must be single and unrelated to either spouse. This is to make sure there’s no question of adultery or incestual relations.
Another major question in the Jewish faith is the religious status of the child. Traditionally, the religious status of the mother determines that of the child. So some rabbis maintain that if the surrogate mother is not Jewish, the child would need to undergo conversion.
Surrogacy is also a bit complicated for those of Islamic faith. Much depends on if you practice under the Sunni or the Shiite branch of Islam. For the majority of the Sunni branch, surrogacy is thought to be inconsistent with Islamic law. Placing sperm into a surrogate from a man who is not her husband is considered adultery.
Under the Shiite branch, many believe that surrogacy is permissible if the surrogate carries another woman’s fertilized egg – as long as it came from a married couple.
Of course, this is not an exhaustive list of religious preferences and isn’t an accurate portrayal of all parents within these religions. I also recognize that there are parents who may have unique religious practices they would like their surrogate to honor during pregnancy. It’s important to be open about these desires upfront, and to find a surrogate who feels the same.
Whatever your religion, you can speak to the appropriate religious leader to gather their input. Personally, I believe that whatever you choose is between you and your God. Ethics and religion are always subject to debate, and ultimately you must be the one who feels right about following your faith as you build your family.
Choosing your gestational surrogate isn’t easy – and it’s one of the most crucial decisions you’ll make during this journey. How do you know you’ve found the right person? How do you know she’ll be healthy and able to carry your child? Where do you even begin to look?
Aside from the important considerations I’ve already mentioned, there are several criteria a woman must meet in order to be a gestational surrogate. And for the purposes of this episode I am going to discuss more gestational surrogacy as some states don’t even allow for traditional surrogacy.
QUALIFICATIONS
The American Society for Reproductive Medicine or ASRM has several criteria for a woman to be considered as a gestational surrogate. That’s not to say someone outside these criteria will never qualify, but clinics will be apprehensive to work with anyone who does not meet these qualifications.
The ASRM recommends that gestational surrogates be between the ages of 21 and 45. She should have delivered at least one full-term child who is in her care, or who she has finished raising. Ideally, she should have had no more than 5 vaginal deliveries or 3 c-sections. She should be healthy, have a healthy BMI, be a non-smoker and not use drugs. Her spouse or partner must be on board with the decision, and her home environment needs to be stable and supportive. It’s also recommended that she be financially independent – most of the time, someone on government assistance will not qualify. That’s to ensure she isn’t signing up for surrogacy solely as a way to make ends meet.
Beyond these medical and logistical considerations, there are several personality and emotional traits you should look for in a surrogate. Is she dependable, reliable, and safe? Does she have a positive outlook toward surrogacy and a like-minded attitude about pregnancy? Is she mature and responsible, able to care for herself and your baby throughout pregnancy? Does she have a clear understanding of expectations and healthy habits, and is she committed to the demands of IVF cycles? Does she have an awareness of what it means emotionally and physically, to give back a baby that is not hers after birth? Being a surrogate requires a large degree of emotional strength – not everyone is up to the task.
Those that are, though, are extremely special women. While it’s true that gestational surrogates may reap some financial rewards for a surrogacy arrangement, they must be motivated by caring and altruistic characteristics. It’s a combination of all these attributes that make for an ideal gestational surrogate. And as you can see, finding that special surrogate can be quite the task.
ADVANTAGES AND DISADVANTAGES
One question intended parents often ask is whether you should work with an experienced surrogate versus a first-time surrogate. Many people wonder if an experienced surrogate would improve the chances of a successful pregnancy? The truth is, there are no clear statistics on whether your odds change when you match with an experienced vs. a first-time surrogate.
Let’s look at the advantages and disadvantages for each type of surrogate. With a first-time surrogate, you have the advantage of both embarking on a new journey together. Collectively, you can create a path you’re comfortable with, without any prior experiences to shape her expectations. Also, compensation tends to be less than that of an experienced surrogate. As for disadvantages, most center on the unknowns: how will she react to the daily reality of medications during the preconception stage? What will her emotional response be once she delivers?
With an experienced surrogate, you know that she has successfully completed the surrogacy process for another family. She has experience with medications, is aware of the emotional and physical challenges, and understands the process. On the other hand, experienced surrogates often request higher compensation. They may also have more stipulations about what they will and won’t be willing to do. They may want more control over the process in general.
Whether you choose a first-time or an experienced surrogate, your physician will have to clear her before proceeding.
FINDING YOUR SURROGATE
Once you have a clear picture of your ideal surrogate, it’s time to begin the search. There are three ways you can go about this: you can find a family member or friend to act as your surrogate; you can launch an independent search via ads or the internet; or, you can work with a professional agency.
How you find your gestational surrogate is really the million-dollar question. Whether you choose a personal friend or family member, or you’re matched with someone you’ve never met before, remember that this is much more than a business transaction. You must trust this woman with the most important aspect of your life – having your baby. Don’t just accept anyone to carry your child for you.
Each search option has its pros and cons, and it can be hard to decide what’s best for your family. Let’s talk about what you should consider and expect from each option to help you weigh this difficult decision.
If you’re hoping for a more personal connection with your surrogate, or if you’re looking to ease the financial burden, you might consider using a family member or friend as a surrogate. Remember that storyline in Friends when Phoebe Buffay agrees to be a surrogate for her brother and his wife? A lot of intended parents start with this option in mind and begin the search within their own personal circle.
Do you have a sister or friend who might be willing to carry the baby? While this can further cement close relationships, it also has the potential to complicate them – as I’m sure you can imagine. Any number of issues, from legal ramifications to lifestyle choices, can be harder to navigate when your surrogate is someone close to you. Keep in mind, also, that your surrogate still needs to meet the criteria we’ve already discussed. If she does not, your clinic won’t accept her as a viable candidate.
FAMILY AND FRIENDS
Let’s talk about some of the pros and cons to working with a friend or family member. First, the pros:
Obviously, there is already an established level of trust between the two of you. This can make the whole experience more personal and add a special element to a close relationship. Communication is already established and comfortable, allowing for free and open dialogue throughout the journey.
On the more practical side, family members or friends typically don’t require financial compensation, so you’ll only be reimbursing them for expenses. If there is compensation requested, it tends to be lower than the average amount. There’s also a bit more flexibility in terms of the age, health, and lifestyle of your surrogate, though your doctor will still have to clear whoever you choose.
What about disadvantages, though? Sometimes the closeness of a relationship can make surrogacy even harder to navigate. For example, there may be things in her medical or psychological history that you don’t know about – and asking can be difficult without feeling awkward. When working with a personal friend or family member, there’s no codified screening process, leaving much of the background work to you.
Boundaries can also get tricky, particularly after the child is born. You’ll need to trust that you can set – and maintain – clear and appropriate boundaries. How often will you get pregnancy updates, for example? If you’re looking for minute-by-minute text updates and she plans to update you after doctor visits, you’re going to have some issues. Same with contact and boundaries after the child is born. How will your children interact? What type of relationship do you expect her to have with the child? Differences in parenting styles could be a factor, so you’ll need to clearly establish authority.
And what about the money? You absolutely must discuss all the financial details – upfront! While you may not be compensating her for her time and efforts, you’ll still need to reimburse her for related expenses. Her medical care, lost wages, maternity clothes, potential childcare for her own kids, and more – you should outline what you’re responsible for to ensure no feelings of resentment. The last thing you want is to negatively impact your relationship.
Here are some questions to ask and ponder when deciding if a family member or friend should be your surrogate:
- Reflect honestly on your relationship with this person. Do you have a history of any sort of drama? How do you handle conflict together?
- What is her lifestyle? Is she healthy? Does she have any health problems?
- Have you successfully weathered stressful situations together?
- Did she have uncomplicated pregnancies with her own children?
- If she works outside of the home, how will this affect her job? If she stays home with her children, how will you handle childcare during appointments and potential bed rest?
Also keep in mind that this surrogacy will have an impact on your wider circle. It affects all parties involved, so you’ll need to consider everyone’s disposition, especially those closest to each of you. How does her spouse or partner feel? What is the relationship like between your two households? What will her relationship with the child be like, and how will this affect her own kids? What are the expectations for how all of your children will interact in the future, and what type of communication will you have with your child about your family building journey?
As with any surrogacy arrangement, receiving qualified counseling from a mental health professional is vital to sorting some of these emotions out ahead of time.
Aside from immediate family members, how will others react? Do you foresee any pushback from other family members, either yours or hers? Have you considered how it might be received by members of her religious community, if she has one? How will you talk with mutual friends about your arrangement?
While ultimately this decision is up to you and her, its impact will be felt by many in your circle.
As for the more logistical side of things, you’ll need to be able to openly and honestly talk details before settling on a path forward.
Again, you MUST discuss compensation in advance. “We’ll figure it out as we go” won’t cut it – that’s a recipe for disaster. You need a clear, established plan for all finances. Look into her medical insurance, and the laws of the state she’ll deliver in. Is it a surrogate-friendly state? Consult with an attorney to hash out all the details.
You also need to discuss her expectations about the physical demands of surrogacy. Yes, she likely remembers the aches and pains of pregnancy, but is she aware that during the preconception stage, she’ll have to take weeks of medications, often injections, on a daily basis? Can you have an open and honest conversation with her about sensitive topics like termination and selective reduction? How will she handle any restrictions that may be placed on her due to the pregnancy, and has she spoken to her doctor about her personal risks?
Bottom line: before you decide to have a family member or friend as your surrogate, you need to be confident that your relationship can weather the stress, emotions, and hard conversations that come along with a surrogacy journey. If so, this can be a truly special and rewarding experience for both of you.
So, how do you pop the question? You have someone in mind, and you’re confident the two of you can navigate surrogacy together. How do you find the right words, and how do you keep your expectations in check?
The first thing to do is begin sharing with your inner circle that you’re trying to find someone who can carry your child for you.
Often, once someone knows you’re seeking help, you don’t have to be the one to approach a family member or friend — she may offer to carry for you. This is amazing news – but proceed with caution. It’s important to go slowly and keep your preferences and desires in mind. Just because someone is willing doesn’t mean they are the right surrogate for you. You’ll still need to do your due diligence in order to have a healthy baby and maintain a solid relationship with.
If someone doesn’t approach you, and you do want to ask, really consider how this will affect her life.
It’s a big ask, and you may initially get some pushback or apprehension. Don’t take that defensively. Surrogacy is a big undertaking, so give her time to process and talk with her significant other, her doctor, and other important people in her life.
Once you have someone who is interested, you can either provide her resources on becoming a surrogate, or ask her to do her own research. She’ll need reliable sources to make an informed decision.
A few words of wisdom from someone who has facilitated many surrogacy matches. Even with a family member or friend:
It’s still extremely important to budget for the unknowns. You never know when something will come up, and you want to be financially prepared for the unexpected. For instance, there may be healthcare-related expenses, complications that may arise, or other factors.
Definitely DO NOT cut corners when it comes to the legal services. Make sure you are working with an attorney versed in reproductive law and that your family member/friend has separate legal counsel. In some states, without an attorney’s involvement, your agreement may be legally void.
Don’t ever guilt or pressure her to feel obligated to do this for you. She must be willing to do this of her own fruition. Make sure you are prepared for her response. If she says no, make sure you show gratitude that she was even willing to consider it. And if she says yes, that is where the excitement begins!
Give her space. Yes, she has agreed to be your surrogate, but remember she has been pregnant before. She knows what she’s doing. It’s ok to give suggestions, but it’s her body. Respect her boundaries just like you would a total stranger.
INDEPENDENT
There are other options if you decide a family member or friend isn’t right for you, or if you are unable to find someone in your personal circle who is willing and able. Many intended parents use an agency or independently find a match. Let’s talk about how these search options work, and what the pros and cons are of each.
First, the independent route. Between the added expense of an agency and some of the unique preferences you might have, you may want to search independently. Intended parents can seek a surrogate by placing ads or by reaching out on social media or in other online communities. Proceed with some caution, though: you’ll need to be well informed of all the legal, financial, and medical issues involved as you embark on this search alone.
Working independently with your surrogate does give you a heightened level of control over who you choose and how the surrogacy relationship works. Because people who choose this route effectively cut out the middleman by not working with an agency, independent surrogacy can be less expensive. Factors like medical visits, legal counsel, and surrogate compensation must still be accounted for, though. No matter how you slice it, surrogacy is going to cost a significant amount of money.
The most daunting drawback to working independently is the drastically higher margin of risk. It’s imperative that you exercise caution when dealing with unknown parties and be extremely cautious of others. In addition, it’s important that you’re also mindful of yourself. Sometimes the eagerness, excitement and determination of your own desires can put up blinders, causing you not to see important “red flags”. Remember, you are seeking someone who can satisfy a very unique role, so you need to be both picky and thorough.
Regardless of your feelings, or how much you really like someone, don’t overlook the tough questions you need to be asking. You want to anticipate and avoid potential problems. Some problems might deeply and negatively impact your surrogacy relationship. At their worst, the problems may result in heartbreak. Do your due diligence and ask all the questions before you make your final choice.
Going it alone can be complicated. Without a professional agency to guide you, you may lack the emotional and logistical support you need. You may have less access to your surrogate’s medical and psychological history, and the full process of screening and interviewing potential surrogates can be exhausting.
Also be aware that compensated surrogacy is illegal in some states, and the laws of the surrogate’s state are what applies here – not yours. Armed with the right information, support, and patience, many intended parents are able to find matches independently, so don’t let this discourage you! Just be informed, aware, and cautious.
There are some definite advantages to an independent surrogacy arrangement. Independent surrogacy can be a good option if money is a major factor and you don’t have a family member or friend to help. By cutting out the middleman, you also have direct access to your surrogate, perhaps making the whole process more personal and hands-on. You can also negotiate compensation directly with your surrogate. Also, if you’re considering traditional surrogacy, in which the surrogate is inseminated with the father’s or donor’s sperm, many agencies no longer offer this. Independent matching may be your only option in this case.
How do you go about finding an independent match, if this is the route you’d like to take?
You can start by asking family or friends if they know of anyone who would be interested in being a gestational surrogate. Some people place ads in newspapers, websites like Craigslist or speciality websites for intended parents and surrogates. You can use various message boards, social media groups, or forums. Others have found success by creating a personal website as a way to share their story on various social media platforms.
A few things to keep in mind as you begin your independent search:
- Deciding who will be your surrogate is a challenge. We’ve already talked about the unique qualities and characteristics that a surrogate needs to have – sometimes it can feel like searching for a needle in a haystack. Stay positive and focused on the goal – finding the best person to carry your baby. Successful surrogacy journeys occur when the intended parents and the surrogate have a strong pre-journey connection.
- Remember, just as you get to choose who your candidate is, she gets to choose who she will carry for as well. Avoid trying to pressure her to decide quickly, and be ready to accept a “no” from her. If she doesn’t choose you, that’s okay. Wish her the best of luck, and move on. You want someone who connects with you as much as you connect with her.
- It’s also important to resist making yourself into something you’re not. The more authentically you communicate the essence of your personality, lifestyle, parenting philosophy and heart, the better chance you have of connecting with a potential surrogate who shares your feelings.
- Be sure to protect your privacy throughout your search. Don’t share personal information such as address, phone numbers, or employer, until you’ve made a decision and fully vetted her. We’ll talk about the steps you should take to vet candidates in a minute.
- You’ll also need to be ready to assemble your team of professionals independently – people like attorneys, mental health professionals, escrow agencies, and more will be needed, and it’s up to you to find your team.
- Lastly, never, never agree to compensate anyone until you have an executed gestational surrogacy agreement, a GSA, drafted and reviewed by an attorney who specializes in reproductive law. This is not the time to find a template agreement online – you need an expert.
So what’s the best way to thoroughly vet a candidate?
First, you should have each potential surrogate complete an application. Take your time reading and reviewing every response she provides. Complete a thorough background check on her as well as her spouse or partner. You might run into a few roadblocks getting this information as a private individual, but there are options available to you. You’ll also need her to complete a psychological screening with a mental health professional. Find someone who has worked with surrogacy arrangements in the past so you can be assured they evaluate your candidate effectively. Your clinic will also want to review her personal and sexual medical history. She’ll need to provide copies of her prenatal and delivery records for each pregnancy, either to you or to your clinic directly.
Does this sound a little daunting to you? I won’t sugarcoat it – while a lot of parents have had successful surrogacy journeys going the independent route, it can certainly be overwhelming for some. That’s why many intended parents choose to work with an agency or other professional who specializes in the industry.
AGENCY
Let’s talk about this third option for finding a gestational surrogate – using an agency.
Agencies are all different, and there isn’t a one size fits all approach to finding the right one. One thing’s for sure, there isn’t any shortage of these agencies. You can find agencies in any surrogacy-friendly state in the US. One thing to note upfront: you can work with an agency in any state, it doesn’t have to be local to you. Ultimately, you should work with an agency that meets all your criteria and is knowledgeable and experienced with the surrogacy process.
Like any service, there are good and bad agencies out there, so it’s imperative to do your homework. You need to thoroughly vet any agency you’re considering, combing through reviews, testimonials, publicly available records, and the credentials of board members or agency leaders.
So what exactly is the role of a professional surrogacy agency? In a nutshell, an agency will take on the work of finding a suitable gestational surrogate, including the review and assessment of her medical and psychological history. The agency works to find a match for intended parents, allowing you to make the final selection. You have the protection of knowing that your surrogate checks out medically and that she and her partner have had thorough background checks prior to passing the application process.
An agency knows what to look for in surrogacy candidates and only qualifies the best applicant.
And speaking of the application process, each surrogate is vetted extensively to ensure that she is physically, mentally and emotionally capable of taking on the important responsibility of surrogacy. Working with an agency can give you the peace of mind in knowing your potential surrogate has passed with flying colors.
When you work with an agency, you get the added benefit of complete legal protection for your surrogacy journey. From drawing up your initial contracts, to specific documents that outline the terms of surrender, and coverage for other unforeseen challenges that may crop up along the way – your legal matters are covered.
Because of the intense screening, customized matching service, and multi-level protection that an agency offers, this option is much more expensive than going it alone. However, sometimes the added expense offers a peace of mind that intended parents find invaluable.
There are other benefits to working with an agency as well. For example, agencies will coordinate medical arrangements with your clinic and will provide general oversight, case management, and coordination of services. They’ll provide support and guidance throughout the process. Because agency professionals are experts in surrogacy laws and medical standards, they help you know what to expect and prepare you for what’s to come. They help you finalize your parental rights, including the birth certificate and adoption if necessary, and they can help you coordinate your trip home with baby if travel is necessary.
A few of the disadvantages? There is certainly an added cost. You’ll be paying a premium for access to industry professionals and concierge-level coordination of services. As you shop around for agencies, be sure to get a clear picture of exactly what their fees include and exclude – and get it in writing. Most agencies have their clients’ best interests in mind, but as with any industry, there are always a few bad apples out there.
Something else to consider: you’ll be working with a middleman, so at times you might feel a bit out of control. Depending on your expectations and personality, this could be a problem. Again, check with the agency about their own policies and standards of practice.
While there is some inherent risk associated with surrogacy and pregnancy in general, choosing to work with an agency may be a better option than going independently. With an agency, you have the security of knowing that you’re working with the best surrogate for your family, and you have a higher likelihood of a smooth, safe journey to parenthood.
CONCLUSION
As you can see, there are many things to consider when finding the right surrogate for you. Although it may be a challenge, find someone who genuinely cares about the task at hand. While compensation is always appreciated and important in these cases, you need a personal commitment and connection above all.
For more information about the surrogacy journey, visit us at SurrogacyRoadmap.com, or at TheFertilityCafe.com for resources, podcast transcripts, and our other episodes.
Thank you so much for joining me today on Fertility Cafe. I’m Eloise Drane, remember “Love has no limits, neither should parenthood.”
