There are a lot of terms to get used to in the world of alternative family building. One particular set of terminology gets confused often: What is the difference between a surrogate vs. a gestational carrier for example?
What Is Surrogacy?
Surrogacy is an arrangement in which a woman agrees to become pregnant for and to carry a baby for someone else. In the fertility world, we use the terms “Intended Parent(s)” or “IP(s)” to refer to the person or people who will be the child’s legal parents. There are two types of surrogates, and it’s very important to understand the differences between a traditional surrogate vs. a gestational carrier.
The most significant difference in working with a traditional surrogate vs. a gestational carrier is the surrogate’s biological connection to the child she will carry. In traditional surrogacy, the surrogate’s own eggs are used, thus making her the biological mother of the child. In gestational surrogacy, the embryo is created using another person’s egg, thus the surrogate is NOT biologically related to the child.
In the early days of assisted reproduction, traditional surrogacy was the only option if someone wanted to pursue parenthood via surrogacy. In the 1970s and early 1980s, traditional surrogacy was usually accomplished by using intrauterine insemination with intended father’s sperm or donor sperm. Intrauterine insemination (IUI) is a medical process in which sperm cells are directly transferred to a surrogate’s uterus. A traditional surrogate is a biological mother, but she enters into the arrangement intending to give up her parental rights to the intended parent(s) upon birth. She never intends to become pregnant to have her own child, and the involved parties sign a legal agreement stating this intent. It is not typical for traditional, or genetic, surrogacy to be achieved by sexual intercourse. For reasons we will discuss later, traditional surrogacy is not common in the United States and is often discouraged in the fertility industry.
Gestational surrogacy, on the other hand, is the most common type of surrogacy in the United States today. A quick note: there are two terms to describe the woman who serves as a surrogate, though they can be used interchangeably. “Gestational carrier” or “GC” is the medical term. “Gestational surrogate” is the lay term. Both are acceptable to use.
Modern reproductive technology now allows a gestational surrogate to become pregnant with a fetus that is genetically unrelated to her. This is accomplished by transferring embryos to her uterus formed via in vitro fertilization (IVF) using donor eggs or the eggs of the intended mother. Learn more about how IVF works with this comprehensive guide: Understanding the Basics of IVF & the Step-by-Step IVF Process. As with traditional surrogacy, a gestational carrier signs a legal agreement with the IP(s) to declare that she has no intention of parental rights.
Because there is no genetic relationship between the gestational surrogate and the child she is carrying (her own egg is not used), it is easier to avoid legal complications. With traditional surrogacy, because there is a genetic relationship (the traditional surrogate is the biological mother), the surrogate could successfully demand parental rights after the child is born. This has happened in the past, resulting in complicated and sensational legal battles between the intended parents and the traditional surrogate. The most famous court case is the Baby M case from 1986 which resulted in several states banning surrogacy in all forms.
In general, here are the differences between a traditional surrogate vs. gestational carrier:
Traditional Surrogate
- Is the biological mother of the child
- Her own egg is used along with donor sperm or the intended father’s sperm
- Pregnancy is achieved via intrauterine insemination (IUI), a medical procedure that inserts sperm cells directly into her uterus
- Has no intention of having any parental rights; typically signs a legal contract to relinquish rights upon birth
- Can encounter legal and emotional complications
- Far less common today in the United States
Gestational Surrogate
- Is not the biological mother
- A donor egg or the intended mother’s egg is combined with donor sperm or the intended father’s sperm to form an embryo
- Pregnancy is achieved via in vitro fertilization (IVF), a medical procedure that combines egg and sperm in a lab to create an embryo which is then inserted into the uterus
- Has no intention of having any parental rights; typically signs a legal contract to relinquish rights before birth
- Less likely to experience legal or emotional complications
- Commonly accepted in most of the United States
What Is a Gestational Carrier?
According to the American Society for Reproductive Medicine, or the ASRM, gestational carrier is defined as “a woman who carries and delivers a child for another couple or person (intended parent[s]). When using a GC, the eggs used to make the embryos do not come from the carrier.”
Gestational surrogacy is the most popular form of surrogacy since the carrier is not genetically related to the child. In vitro fertilization, or IVF, is the technological method used to create an embryo using the intended mother’s – or donor’s – egg and the intended father’s – or donor’s – sperm, which is then transferred to the surrogate. Because of the modern technology and medical procedures involved, gestational surrogacy is more expensive than traditional.
There are several reasons why an Intended Parent would choose to work with a gestational surrogate over a traditional surrogate.
Some Gestational Surrogate Advantages include the following:
- As stated previously, although the gestational surrogate carries the child she does not have a genetic linkage that might further complicate issues of parentage and ethicality.
- IPs have the option to have a child genetically related to themselves or the option to select the egg donor that best fits their needs.
- It could be potentially less of an emotional issue for the gestational surrogate.
- In many states, it’s easier to apply law for parental establishment when the parents are genetically related.
- And it’s easier to find gestational surrogates.
Some Gestational Surrogate Disadvantages include the following:
- Gestational surrogacy arrangements are more expensive.
- The Intended Parent will have to either go through IVF to retrieve her own eggs, or they will have to choose an egg donor.
Choosing a Gestational Carrier
A large majority of surrogacies in the United States involve gestational carriers rather than traditional surrogates. The choice between the two types of surrogacy is important, but there are other things to consider as well:
- Compensated or Altruistic? Will you be looking for a compensated arrangement, where your surrogate receives a significant base compensation in exchange for her time, effort, and commitment to carrying your child? Or will you look for an altruistic journey, one where you only reimburse her for expenses incurred.
- Known vs. Unknown. Do you have someone in your personal circle you’d like to ask to be your surrogate? Or will you be conducting a search online or via an agency?
- Agency-Led vs. Independent. Will you work with a surrogacy agency like Family Inceptions to help facilitate your journey? Or will you save on agency fees by going the independent route?
Once you’ve made some key decisions about the type of surrogacy arrangement you’ll pursue, you can begin searching for a woman who will serve as your surrogate.
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?
First and foremost, your gestational carrier will need to meet certain health and lifestyle criteria. You can find the full list of qualifications to be a surrogate on our website. A few important criteria for our surrogates include:
- Between the ages of 23-39
- BMI between 19-30
- Non-smoker
- No significant health history
- Have had one healthy pregnancy (at least)
- Financially stable
- No recent history of mental illness or antidepressant use
- Lives in a surrogacy friendly state
Each agency and fertility clinic sets their own particular criteria, but in general you are looking for someone who is healthy, stable, and is likely to have a successful, complication-free pregnancy.
Beyond these medical and logistical considerations, there are several personality and emotional traits you should look for in a surrogate. Here are some questions to consider:
- 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?
- Do you like and trust each other?
So how do you actually find this special person to be your gestational carrier? You have a few different options.
- You can work with an agency to find your match. Our matching process at Family Inceptions is incredibly successful. We have a 96% success rate on our first try!
- You can ask a friend or family member to carry for you. Keep in mind that this person will still need to meet all of the criteria required by your clinic.
- You can conduct an independent search using social media, local media, word of mouth, or internet message boards.
If you are searching for a gestational carrier independently, be sure to go through a thorough vetting process. Unfortunately there are people who will take advantage of your desire to become a parent, so make sure to run background checks and complete every step of the screening process.
At Family Inceptions, all of our surrogates are pre-screened, including a full psychological evaluation and a home visit. Schedule your free 60-minute consultation to talk about working together on your surrogacy journey.
Choosing Surrogacy
There are many reasons why someone may choose to become a parent via surrogacy. In general, it is used by people who don’t have a uterus or by someone with medical complications that make pregnancy impossible or risky.
Heterosexual couples may choose surrogacy if they are experiencing infertility, if there is a history of inheritable genetic conditions, or if a medical condition such as cancer prevents pregnancy. Similarly, a single woman may choose to work with a surrogate if she herself is unable to become pregnant.
Surrogacy is an increasingly popular option for gay men who wish to have a biological child. By working with a surrogate, one or both of the intended father’s can use his sperm to create the embryos. Surrogacy is also an option for single men who want to become parents without a female partner.
The vast majority of surrogacy arrangements in the United States are gestational surrogacies; however, traditional surrogacy is legally permissible in many states. It can be an option for some IPs, however it has many layers of complications to consider.
If traditional surrogacy is your only viable path to parenthood, please proceed with an abundance of caution. You should invest in additional counseling, airtight legal protection, and crystal clear expectations. Know that many fertility clinics and other fertility professionals will not assist with traditional surrogacy.
You also must know that in the case of traditional surrogacy, the surrogate IS the mother. If she has even the slightest hesitation, if she decides that she wants to keep the child, the court will NOT force her to give up the child, no matter what your contract says. She is the biological mother of that baby, and as such, she has inherent parental rights, right up to the moment that she signs a legal agreement terminating her rights before a court of law.
Making The Best Choice
Ultimately, the choice of whether to pursue parenthood via traditional vs. gestational surrogacy is a personal decision based on your unique situation. Whatever you decide, you should do so after carefully considering all of your options and consulting with professionals for guidance.
Law Regulation
Before you move ahead with any surrogacy arrangement, you need to have a complete understanding of the laws about surrogacy. Currently, there is no federal law in the US that governs surrogacy. It’s left to the discretion of each individual state. It’s important to understand that the state your child will be born in, most often the state you surrogate lives in, will be the state law applied. The home state of the intended parents doesn’t matter unless you live in the same state as your GC.
You will need to work with an attorney who is familiar with surrogacy laws in the state of birth — often, your agency will provide you with or refer you to a qualified attorney.
Some states have specific laws on the books regarding surrogacy, but most do not. That means that it’s up to the court system to rule on whether a surrogacy contract is enforceable. We have compiled an up-to-date guide to US Surrogacy Law for your reference. Keep in mind, you need to know about the law in the state where the baby will be delivered.
As of this publication, the following states have laws or court precedent that are favorable to surrogacy: California, Connecticut, District of Columbia, Delaware, Maine, New Hampshire, New Jersey, Nevada, Rhode Island, Vermont, Washington State, and New York.
Several states permit surrogacy; however there may be some restriction based on the intended parents’ marital status or sexual orientation. Some states also vary in which types of surrogacy arrangements they allow, such as traditional vs. gestational, and whether it’s permissible to compensate a surrogate beyond basic expenses.
There are currently three states where surrogacy is illegal: Louisiana, Nebraska, and Michigan. We do not recommend working with a surrogate who lives in any of these three states at this time.
Cost
Traditional surrogacy is typically a more affordable option than gestational surrogacy. There is a potential savings of $20,000 to $40,000 which can make a significant difference for some intended parents. Much of the savings is because you aren’t paying for IVF to create your embryos. IUI is a much less expensive procedure. As we have mentioned, traditional surrogacy carries much more risk, both legally and emotionally, so keep that in mind as you make your decision.
The average cost of gestational surrogacy in the United States is $110,000-200,000. Check out a breakdown of the costs on our website: Average Cost of Surrogacy. It is an expensive process no matter which way you proceed, but there are ways to make your dream a reality.
More on how to finance your surrogacy journey:
12 Ways You Can Save Money on Surrogacy
A CPA’s Advice on Taxes, Escrow, and Funding
Becoming A Gestational Carrier
Pursuing a surrogacy journey is as emotionally involved as it is physically involved for the gestational surrogate, but it is so rewarding for the women who undertake this important task.
If you are interested in becoming a gestational carrier, start to get familiar with the application process and general requirements. While an initial application to become a surrogate can take an hour or so of your time, the entire screening process can be quite long.
The screening process is a bit different at every agency but often it involves collecting records from multiple doctor’s offices, getting a letter of approval from the applicant’s OB and submission of lots of paperwork. There is also evaluation by a licensed mental health professional, and often a home check. If everything goes well, you’ll move to the matching phase!
When matching with intended parents, keep in mind that this is your journey too. You get a say in what you want it to be like. If you want to carry for an LGBTQ couple to honor your cousin, tell your agency. If you want to carry for a woman who has beat cancer to help support cancer survivors, tell your agency… you do not get to control everything in your journey, but a good agency will do their very best to honor the vision you have for this adventure.
After matching, you’ll move to the medical phase to be evaluated by the fertility clinic. If everything looks good, you’ll complete the legal contract, known as the Gestational Surrogacy Agreement, and move ahead to take fertility medications and complete the embryo transfer.
This may all seem like a cut-and-dried process, but the reality is that a surrogacy journey can take a long time. Surrogates need to be prepared and committed to the surrogacy process. It is involved and can require you and your family to essentially put life on hold for 12-24 months.
This could mean restricted travel, limiting job changes and relocations, as well as following strict surrogacy guidelines. Spouses/partners are also required to be involved in the background checks, legal contracts, psychiatric evaluation, medical screening, home visit and parentage orders of the surrogacy journey. Your spouse or partner has to be in agreement with the surrogacy journey in order for the surrogate to proceed with a pregnancy.
Still on the fence? We get it! The decision to become a surrogate is not one to take lightly. Take this quiz to find your Surrogate Score: Are You Ready to Be a Surrogate?
Understanding Surrogacy Better
Surrogacy is a complex and emotional process that has allowed thousands of people to become parents when they otherwise may have been unable to. Gay men, cancer survivors, women with reproductive health issues, HIV positive people, older individuals, single men…all types of people for whom parenthood once seemed impossible.
Whether you are choosing traditional vs. gestational surrogacy to have a child, or you’re weighing the decision to become a surrogate yourself, Family Inceptions is here to help.
Learn more about how we can support you on your surrogacy journey at FamilyInceptions.com.
