What are some of the qualifications to become a surrogate? How do you know if you meet those qualifications? How do you match with Intended Parents?
Deciding to becoming a gestational carrier is not something to be taken lightly. There are strict parameters in place to make sure that surrogacy is safe and ethical for any woman who chooses to become surrogate. In the United States, laws governing commercial surrogacy are designed to minimize risk for both the intended parents and especially for surrogates. Thanks to a robust legal framework designed to protect all who engage in surrogacy, the United States is a top destination for ethical surrogacy worldwide and the model for other countries considering the legalization of surrogacy.
What is a gestational surrogate?
A gestational surrogate, also known as a gestational carrier, is a woman who carries a pregnancy on behalf of Intended Parents. Unlike a traditional surrogate, a gestational surrogate is not genetically related to the child she carries. In a gestational surrogacy arrangement, an embryo is created using the Intended Parents’ or donor(s)’ genetic material through an in vitro fertilization (IVF) process. The embryo is then transferred to the gestational surrogate’s uterus, where she carries the pregnancy.
The key distinction between a gestational surrogate and a traditional surrogate lies in the genetic relationship to the child. In traditional surrogacy, also known as genetic surrogacy, the surrogate’s own egg is used, making her the genetic mother of the child. This is typically achieved through artificial insemination or intrauterine insemination (IUI) with the Intended Father’s sperm or donor sperm. As a result, a traditional surrogate is both the genetic and gestational mother of the child. In contrast, a gestational surrogate has no genetic connection to the child and is purely providing the physical environment for the embryo to develop and grow. This distinction allows gestational surrogacy to provide a pathway for individuals or couples who may not be able to conceive or carry a pregnancy due to medical reasons, same-sex couples, or those who prefer not to have a genetic connection with the surrogate. There are also many states where gestational surrogacy is legal while traditional surrogacy is heavily restricted or prohibited. This is largely because when the surrogate is the genetic mother of the child(ren), it creates legal complications that are not present in gestational surrogacy. For this reason, the vast majority of surrogacy practiced in places where commercial surrogacy is legal and regulated is gestational in nature.
8-steps Guide to Gestational Surrogacy for Surrogates
Step 1: Evaluate why you want to become a surrogate
Surrogates motivated by a huge paycheck alone generally do not make good surrogates. While most surrogates do not choose to become surrogates for free (so-called “altruistic surrogacy”), most aren’t purely motivated by the compensation either. Most women become surrogates with a sincere desire to help childless couples and individuals. They loved being pregnant with their own children and find joy and a sense of pride and accomplishment in being pregnant in the service of others. Many surrogates feel that surrogacy is a life calling, something they were born to do to make a positive impact on the world.
Step 2: Evaluate your medical and psychological history
Ultimately only the Intended Parents’ Reproductive Endocrinologist can perform medical clearances on prospective surrogates. However, given the time and money involved in surrogacy, most Intended Parents will want to know your medical history proper to matching and involving their clinic.
Things to consider: How were your previous pregnancies? Did you have any significant complications such as infections, preterm labor/birth, miscarriage, placental abruption/previa, preeclampsia, gestational diabetes, severe, persistent nausea and vomiting, anemia, or unplanned C-sections? What was the birth weight of children born from your previous pregnancies?
Prior C-sections are generally allowed in surrogacy, though the maximum number is ultimately decided by the clinic/Reproductive Endocrinologist. Most clinics will not allow more than 3 C-sections. Age is also a factor with surrogates falling between the ages of 21-44 years old with exceptions on the higher end for direct relatives of Intended Parents.
BMI restrictions vary with some clinics going as high as <33, while others preferring to stay <30.
Mental health is an important consideration. If you are on medication for anxiety or mental health disorders, it is imperative that you do not go off of medication or against the advice of your doctor to become a surrogate.
Gestational carriers generally have to undergo a psychological evaluation. Prospective surrogates are evaluated on their motivations for wanting to become a surrogate, screened for aggression, narcissistic disorders, and other negative personality traits, alcohol and drug issues, and general anxiety or mental health disorders. Prospective surrogates are personally interviewed by a trained psychologist typically one that specializes in assisted reproduction. Thanks to modern technology, surrogates are usually interviewed over video chat/Facetime/Zoom or similar technologies.
One of the many things a psychologist will ascertain is what type of support system a prospective surrogate has and how they feel about carrying a child that isn’t theirs. They will want to know what happens when there are disagreements between themselves and Intended Parents and the likelihood a surrogate does not fully understand what she is getting into in agreeing to a surrogacy arrangement. These questions are meant to make sure surrogates are emotionally and mentally able to carry out a successful journey and to protect both sides from a bad match.
Step 3: Evaluate whether now is a good time for surrogacy
Questions all potential gestational surrogates should ask themselves:
Are you done with having your own kids? This is an extremely important consideration as any pregnancy carries the risk of complications which may lead to future infertility.
Is your relationship with your spouse/domestic partner and biological children in a place where added stress could be absorbed? If the surrogacy journey created unforeseen circumstances where work or day-to-day living became interrupted e.g. doctors visits, medical complications, or pre-term labor, will you have help from a supportive family? Do you have reliable and safe housing?
Are you AND your partner/members of your household smoke and drug free?
Are you financially secure? In order to become a surrogate, you cannot be on any type of government assistance, including SNAP, welfare, and Medicaid. If you are temporarily utilizing those programs for you or your family, you must wait until you’re in a more financially secure place to pursue surrogacy.
Step 4: Matching!
Matching with a friend and family member you already know and trust is great when it’s available to you, though it’s recommended you still go through all the same steps as though you were matched with strangers. Skipping out a surrogacy contract for example just because you know the person is extremely ill advised.
Matching with agencies carries unique benefits and risks. We at Surrogacyplace.com are advocates of surrogates being able to match independently with Intended Parents directly. Here are some of the top reasons you may want to:
You have prior experience with surrogacy and know what you want.Agencies have their own agendas and often will prioritize cash-rich Intended Parents at the expense of your own preferences and match points. You will be shown 1-2 profiles which may not be Intended Parents you’d prefer to match with and you will be pressured to make it work.
Higher compensation.Intended parents save an extraordinary amount of money not using an agency. When they do, they can often afford to pay you a higher fee. You deserve your full desired fee, instead of most of the money going towards a third-party matching service.
Not having to compromise on your major match points.Do not be limited by who an agency happens to have in their database. Explore a wider range of potential matches. Many agencies will not disclose how many surrogates or Intended Parents they represent. It could be a very small pool.
Have a direct and potentially closer relationship to your intended parents.With no requirement to funnel all emails and texts through agency coordinators, you’ll be able to communicate directly with your Intended Parents or through your attorney for any difficult conversations. Develop a closeness throughout the process without a middle man.
Don’t be afraid to have multiple conversations with prospective Intended Parents. Get to know them over several phone or video calls. If you’re feeling great about a potential match, don’t be afraid to ask them to travel to meet you to make sure. Only you know what feels right. Trust your instincts and do your own due diligence. Ask every possible question that’s on your mind. If you have concerns, share them openly. Make sure you communicate your needs and make sure you have potential Intended Parents willing to honor them.
Step 5: Medical Screening and Contract Stage
Once matched, Intended Parents will arrange for a surrogate to receive a medical evaluation at their clinic. This usually involves travel and other arrangements, including childcare for any minor children that live with the surrogate. Surrogates will have their medical records evaluated by a Reproductive Endocrinologist and will undergo a general physical. A surrogate will usually undergo a mock cycle which is a trial run to see how a surrogate will respond to medications used in IVF. By doing a mock cycle, a doctor can measure the endometrium lining and adjust as needed.
Sometimes medical and legal happen concurrently, though a surrogacy agreement may or may not be fully executed until a surrogate is medically and psychological cleared to start her surrogacy journey.
All surrogates choose their own legal representation and their attorney fees must be covered by Intended Parents. Surrogates never pay out-of-pocket expenses for legal advice and must never be pressured to forgo the counsel of a qualified assisted reproduction attorney.
Surrogacy Place has a directory of qualified attorneys.
Choose your lawyer carefully; make sure they have a history of representing surrogates and that they understand your unique needs and requirements.
Step 6: Embryo Transfer!
During the weeks leading up to embryo transfer, you’ll start your medications and you’ll attend medical appointments to monitor your progress. Then, the day will finally arrive – embryo transfer day! Your doctor will give you specific instructions on what to do after transfer, including restrictions on activities (sometimes bed rest is recommended) and protocols to follow. If all goes well, 10 days after transfer you’ll have an official positive beta test. After that, at around 6 weeks, you’ll receive an ultrasound for heartbeat confirmation. This is a huge milestone and the earliest indications that you are officially progressing with a surrogacy pregnancy!
Step 7: Pregnancy
This is the moment you get to share the journey with your Intended Parents with photos and ultrasounds and conversations about how it’s going. There will be moments of pure joy as you witness the impact you’re having on your Intended Parents. It is a truly special time and the part of the journey everyone has worked so hard to get to. There will be medical appointments and evaluations and moments to enjoy the pregnancy. Take time to appreciate the innovations in medicine and reproductive science that make gestational surrogacy possible!
Step 8: Delivery
Childbirth can be unpredictable, though the medical and legal professionals have been there every step of the way to help minimize risks. Assuming the delivery goes as anticipated, this is when your Intended Parents get to meet their child(ren)! It’s an indescribable feeling to watch Intended Parents hold their child(ren) and show you their gratitude for your part in making their family possible.
You will say goodbye to your surro baby and potentially to the Intended Parents unless all parties have agreed to an active relationship post birth. Regardless of whether you choose to stay in touch, you will always carry with you the feeling of what you did for another family.
Surrogacy is a priceless and rewarding gift. The women who choose to be surrogates have a profound need to give back and will carry with them the pride of being able to help others in a deeply meaningful, selfless way. The community of surrogates/gestational carriers are angels and warriors; it’s an extraordinary undertaking not everyone is qualified to do. Those that are able provide an incredible miracle for others.
Want more info on whether you qualify? Try taking our short quiz.