The Gist

The Core Concept – What is Gestational Surrogacy?

It’s crucial to distinguish the modern standard of care from historical methods.

• Gestational Surrogacy (The Standard): In this process, the surrogate (also called a Gestational Carrier or GC) has no genetic link to the baby. An embryo is created in the laboratory through In Vitro Fertilization (IVF) using the intended parents’ own sperm and eggs, or donor gametes. This embryo is then transferred into the surrogate’s uterus. She carries the pregnancy and delivers the baby, but she is not the biological mother.
• Traditional Surrogacy (Largely Outdated): This involves artificially inseminating the surrogate with sperm from the intended father, making her the biological mother of the child. Due to significant legal and emotional complexities, this method is rarely practiced today and is illegal in many states. This guide focuses exclusively on gestational surrogacy.

Why Surrogacy? Common Indications:
Surrogacy is a medical solution for intended parents who are unable to carry a pregnancy to term. Common scenarios include:

• Medical Absence of a Uterus: (e.g., MRKH syndrome, previous hysterectomy).
• Uterine Factors: Recurrent implantation failure (RIF), significant uterine anomalies, or intrauterine adhesions (Asherman’s Syndrome).
• Medical Contraindications to Pregnancy: Severe heart disease, advanced renal disease, or a history of severe pre-eclampsia.
• Same-Sex Male Couples and Single Men wishing to have a biological child.

The Key Players – A Coordinated Team Effort

A successful surrogacy journey relies on a dedicated team of professionals and individuals.

1. The Intended Parents (IPs): The individuals or couple who will become the legal and nurturing parents of the child. They provide the genetic material (or select donors) and are central to all decision-making.
2. The Gestational Carrier (GC) / Surrogate: A healthy, thoroughly screened woman who volunteers to carry the pregnancy. Ideal candidates have had prior, uncomplicated pregnancies, have a stable lifestyle, and are motivated by a desire to help others.
3. The Fertility Clinic & Reproductive Endocrinologist (REI): The medical team responsible for the IVF process: stimulating the egg provider, creating embryos in the lab, and performing the embryo transfer into the surrogate.
4. The Surrogacy Agency (e.g., Surrogacy4All): The project manager of the journey. A reputable agency handles matching, screening, legal coordination, financial management (escrow), and provides ongoing support and mediation.
5. The Reproductive Lawyer: Absolutely essential. Separate legal counsel for the IPs and the GC draft and negotiate the surrogacy agreement, which establishes parental rights, financial obligations, and protocols for various scenarios, ensuring a legally sound process.

The Medical Process – A Step-by-Step Breakdown

The medical journey is a meticulously timed sequence of events.

1. IVF and Embryo Creation:
   • The intended mother or an egg donor undergoes an IVF cycle: ovarian stimulation, egg retrieval, and fertilization with sperm from the intended father or a sperm donor.
   • The resulting embryos are cultured in the lab for several days, and one or more high-quality embryos are cryopreserved (frozen) for future use.
2. Synchronizing Cycles:
   • The Gestational Carrier and the person who provided the eggs (if she is not the intended mother for the cycle) take medications to synchronize their menstrual cycles. This ensures the surrogate’s uterus is perfectly receptive at the time of transfer.
3. Preparing the Uterine Lining:
   • The GC follows a precise regimen of estrogen and progesterone (via patches, pills, or injections) to build a healthy, receptive endometrial lining in her uterus.
4. The Embryo Transfer:
   • A single frozen embryo is thawed and gently transferred into the GC’s uterus. This is a quick, painless procedure that does not require anesthesia.
   • Following the transfer, the GC continues progesterone support to facilitate implantation and early pregnancy.
5. Pregnancy and Delivery:
   • Approximately 10-12 days after transfer, a blood test confirms if pregnancy has been achieved.
   • Once a heartbeat is confirmed, care is typically transferred to the GC’s local Obstetrician for standard prenatal care.
   • The delivery occurs at a hospital chosen during the legal process, with the Intended Parents present to welcome their child.

The Legal & Financial Framework – Protecting Everyone Involved

This is the backbone that ensures a secure and predictable journey.

• The Surrogacy Agreement: Before any medical procedures begin, this legally binding contract is negotiated and signed. It covers:
  • Compensation & Expenses: The GC’s base compensation, monthly allowance, and all reimbursable expenses (medical, legal, travel, maternity clothing, etc.).
  • Risks & Responsibilities: Outlines the expectations for both parties throughout the pregnancy.
  • Scenario Planning: Establishes agreed-upon protocols for complex medical situations (e.g., selective reduction, pregnancy termination for medical reasons).
• Parental Establishment: The process of securing the Intended Parents’ legal parentage. This is typically achieved through a Pre-Birth Order (PBO), filed by your attorney during the pregnancy. The PBO ensures the Intended Parents’ names are placed directly on the birth certificate, bypassing the need for adoption post-birth. The specific laws governing PBOs vary by state.

The Surrogate Screening Process – Ensuring a Healthy Foundation

Rigorous screening is non-negotiable for the safety of the surrogate and the future child.

• Medical Screening: Conducted by the fertility clinic. Includes a full physical exam, uterine evaluation (HSG or saline sonogram), and infectious disease panel.
• Psychological Screening: A licensed mental health professional assesses the GC (and often her partner) for mental and emotional stability, realistic expectations, and preparedness for the journey.
• Background Check: A comprehensive review of criminal and financial history is standard.