WHAT IS A GESTATIONAL SURROGATE? A Gestational Surrogate is a woman who carries a pregnancy for a family who unfortunately cannot otherwise carry a pregnancy. A Gestational Surrogate is NOT the same as a “traditional surrogate”; in Traditional Surrogacy the woman who has donated her egg then subsequently carries the child. In the case of Gestational Surrogacy, the woman carrying the pregnancy has not used her own egg to become pregnant and is, therefore, not biologically or genetically related to the child she is carrying; she is simply providing a warm, nurturing environment (her uterus) for another family’s child to grow in for the gestational period of 40 weeks. The eggs and sperm are derived from the intended parents (or at times an egg donor and/or sperm donor; through the process of In Vitro Fertilization (IVF) they are then fertilized in the lab and the embryo, or embryos, are placed into the uterus of the Gestational Surrogate.
WHO IS IN NEED OF A GESTATIONAL SURROGATE? A couple whose female partner is unable to carry a pregnancy herself will be in need of a Gestational Surrogate. The intended mother’s inability to carry may have resulted from a condition that required her to have her uterus surgically removed, such as in the case of cervical or uterine cancer, fibroids, severe endometriosis, or any other conditions requiring a hysterectomy. In other cases, she may still have her uterus intact but it may be nonfunctional and unable to support a pregnancy; this may have occurred as the result of scarring caused by prior surgeries or infections, to name a few of the possible causes. Or the intended mother may have a health condition which makes carrying a pregnancy on her own too risky. As long as her ovaries are still intact and functional, there is a good possibility that her eggs may be harvested, fertilized in the lab with the male partner’s sperm to create embryos and the embryos can then be placed into the uterus of the Gestational Surrogate. Same sex male couples will also need the help of a Gestational Surrogate (along with an egg donor) in order to achieve their dream of having a family.
WHY WOULD A COUPLE CHOOSE A SURROGATE OVER ADOPTION?
Most couples dream of having a child who is biologically/genetically their child. Gestational Surrogacy is often the only way for a couple to have a child who has a genetic connection to one or both of the intended parents. Gestational Surrogacy also allows the intended parents to become emotionally invested in the pregnancy without the risk that the birth mother will change her mind once the baby is born. In the case of adoption, the numbers are often against the intended parents; there may be as many as seventy couples vying to adopt a single newborn. Adoption, in general, can be a very emotionally risky process. Gestational Surrogacy offers intended parents increased peace of mind as well as increased legal standing.
WHAT WOULD MAKE ME A GOOD CANDIDATE TO BECOME A GESTATIONAL SURROGATE? You may be a good candidate for Jewish intended parents if you are between the ages of 21 and 42 years, of Jewish lineage from your mother, enjoy being pregnant, have a strong desire to help another family, are in good physical health (with a body mass index -height/weight ratio- of no greater than 30, and have a history of healthy, full-term, uncomplicated pregnancies and deliveries. You are a non-smoker (and certainly drug free) and maintain a healthy lifestyle. Being kind, mature, reliable and having great communication skills are also essential, as well as having the support of your friends and family. You are willing to abstain from alcohol during pregnancy and to limit your caffeine intake. You optimally have health insurance coverage and are also financially stable, have reliable transportation and have a safe home environment.
I HAD MY TUBES TIED, CAN I STILL BE A SURROGATE? Absolutely; a pregnancy in a Gestational Surrogate is accomplished through in vitro fertilization (IVF). In IVF the embryos are placed directly into the Gestational Surrogates uterus via a painless trans-vaginal transfer so that it is not necessary to use her fallopian tubes.
IS THERE ANYTHING REQUIRED OF MY HUSBAND/PARTNER? Your husband or partner must feel comfortable and be totally supportive of your decision to help another family in this way. He will participate in medical screening (HIV, Hepatitis B and C, CMV, and any other sexually transmitted diseases or disorders). If you are married your husband will become a party to the contract and will also be involved in a meeting with the psychologist and the intended parents.
DO I CHOOSE WHO I HELP? Yes, there all kinds of families who are in need of a Gestational Surrogate. Married couples, single parents, same sex couples, domestic and foreign couples and singles, and people of all ages and backgrounds. We also have parents who would like to add to their families and others who are having a first child.
WILL I MEET THE INTENDED PARENTS? Yes, unless for some reason you and the intended parents reach an agreement to the contrary. The meeting is intended to help you, your partner (if applicable) and the intended parents all feel totally comfortable before agreeing to work together. If at the end of the meeting the arrangement does not feel comfortable to everyone involved then there is no obligation to continue.
WILL I BE COMPENSATED FOR BECOMING A GESTATIONAL SURROGATE? Yes, you will be absolutely receive compensation for helping a family in this extraordinary way. The average compensation for a Gestational Surrogate is about $35,000+ for a single fetus, with an additional $3000 to $5000 for a multiple birth. Experienced Gestational Surrogates usually receive higher amounts of compensation. Additional forms of compensation offered may include maternity clothes, child care and housekeeping (under specific circumstances), health insurance if needed, lost wages, travel expenses and more. However, ultimately the amount that you will receive is negotiable and will be the result of a discussion between you and your intended parents.
WHO PAYS FOR ALL THE MEDICAL BILLS? Your insurance company (or the one we find for you) will pay most of the bills related to your pregnancy and delivery. The intended parents will pay for any uncovered medical costs, all IVF medical procedures, expenses, co-pays and deductibles related to your pregnancy.
WILL I NEED TO TRAVEL Yes, in most cases you will need to be available to travel for the embryo transfer, which is typically a 3-5 day trip. During the phase leading up to the transfer, though, you will be monitored at an IVF center closer to home. Also, in most cases, the overseeing IVF center will require you to travel for an initial screening appointment, which is typically an overnight trip. In the event that travel is not possible for you then please let us know; there are families who will be receptive to the idea of traveling to you for the cycle (assuming that there is a reputable center nearby). All travel costs will, of course, be fully paid by the intended parents.
DO GESTATIONAL SURROGATES HAVE TO GIVE THEMSELVES INJECTIONS? We have good news and bad news. The bad news: it's generally true. If you are thinking “but...I hate needles,” don't worry; if you told us that you loved needles we’d really need to worry about you. Once you get over the initial shock, and you will, the injections will become just a normal part of your daily routine. The good news: those little shots are going to give you the best possible chance to bring a baby into the world for its parents and they are only needed for the first 9-12 weeks of your pregnancy. Everyone who has been through the series of injections felt intimidated at first. After just two days, you will be so proud of yourself and amazed by how simple and relatively painless the process is. You will also have a lot of help. You will attend a “shot class” at the IVF center, (not nearly as fun as it sounds) where a nurse will help you through the initial injections, and we will always be available to assist you in any way possible. And, finally, when you "graduate" from the center at nine to twelve weeks of pregnancy, you will be able to celebrate the end of the injections, as well.
WILL THE MEDICATIONS HAVE AN EMOTIONAL EFFECT ON ME?
You may experience symptoms as you would during your monthly cycle, such as mood swings. When pregnant, your hormones will be changing and therefore you may experience changes in mood, as you may during a "normal" pregnancy
DO I HAVE TO BE WILLING TO CARRY MULTIPLE BABIES?
You do not have to be willing to carry multiples. In fact, many fertility centers now discourage intended parents from trying to achieve a twin pregnancy both due to the health and well being of their surrogate as well as the babies she is carrying. There are though intended parents who may want to try to have twins ie in a 2 dad situation. Additionally even if a single embryo is transferred there remains the possibility that it will split and become a twin pregnancy. So a Gestational Surrogate has to have a healthy understanding of the psychological ramifications of potentially needing to undergo a fetal reduction in the event that she becomes pregnant with multiples that were unplanned.
WHAT TESTING/SCREENING WILL I NEED TO UNDERGO TO BECOME A SURROGATE? You will have testing for HIV-1, HIV-2, Hepatitis B, Hepatitis C, Syphilis, Herpes Simplex Virus, Toxoplasmosis, CMV as well as other possible sexually transmitted diseases. This is essential in order to minimize the risk of transmitting any disease to the fetus. According to the guidelines of the American Society of Reproductive Medicine, you will also have a psychological evaluation, a physical exam (blood work and uterine evaluations), a Pap smear and drug and nicotine testing. Your partner, if applicable, will also need to undergo infectious disease testing and psychological screening. Also, in order to be sure that you will respond well during the “real” cycle (and that you will develop a uterine lining which is thick enough to support a developing embryo) you may be asked to undergo a “mock cycle” first. A mock cycle is simply a practice cycle. The mock cycle involves injections, patches OR oral estrogen taken over a stretch of days or weeks, followed by a uterine evaluation in order to confirm that your uterine lining has developed well enough to support a pregnancy. If the lining is not exactly right during your mock cycle then adjustments will be made to your medications for the real cycle. After the mock cycle, the prescreening blood work and the psychological screening are complete the real cycle can begin.
WHAT TYPE OF TESTING DO THE INTENDED PARENTS DO?
The intended parents will also undergo screening, medically and psychologically. Under the regulations of the Food and Drug Administration (FDA), the intended parents must also be tested for communicable diseases, since their embryos will be placed into the uterus of their Gestational Surrogate.
HOW WILL MY CYCLE PROCEED ONCE MY TESTING IS COMPLETED?
While the intended parent or egg donor is undergoing an IVF cycle (which will culminate in eggs being retrieved and then fertilized into embryos in the lab) you will be given Estrogen and Progesterone in order to prepare your uterine lining for implantation with the resulting embryos. The individual preference of the physician in charge of your cycle will determine the exact type of Estrogen and Progesterone which will be used to prepare your uterine lining (Progesterone and Estrogen will be administered either through intramuscular injection, oral medication, vaginal suppositories and/or patches). During the phase of preparing your uterus for the embryo transfer you will be monitored every few days with trans-vaginal ultrasound and blood work. This will insure that your lining is developing adequately so that, when the embryos are ready to be transferred, your uterus will be ready too.
WILL I NEED TO BE ON BED REST AFTER THE TRANSFER?Guidelines vary from one IVF center to another, however often they do require some type of modified bed rest for 24-36 hours.
HOW LONG WILL I BE ASKED TO ABSTAIN FROM SEXUAL INTERCOURSE WHEN I BECOME A GESTATIONAL SURROGATE?
Typically, ten days before a transfer and ten days after a transfer would take place. However, the IVF center will give you specific instructions according to their protocol.
IF I DON'T GET PREGNANT THE FIRST TIME, DOES THAT MEAN I WAS NOT A GOOD CANDIDATE TO BE A GESTATIONAL SURROGATE? If I don’t get pregnant the first time, does that mean I was not a good candidate to be a Gestational Surrogate? Women who are considered to be naturally fertile make great potential Gestational Surrogates; however, this does not guarantee success because there are so many factors involved in this type of cycle; egg and embryo quality, the number of embryos transferred, etc. If the intended parents are aggressive in their birth plan, they can have excellent chances of getting pregnant the very first time. However, if the intended parents are conservative in their approach (i.e. if they choose to transfer only one embryo) the odds that their Gestational Surrogate will get pregnant during her cycle may be reduced. In this case, a second and possible third cycle may be necessary.
WILL MY PREGNANCY BE ANY DIFFERENT PHYSICALLY FROM MY OTHER PREGNANCIES BECAUSE I AM NOT RELATED TO THE BABY/IES?
No. The pregnancy should not be experienced physically any differently then what is considered a "normal" pregnancy. You may experience morning sickness, headaches, swollen feet and hands as you would a "normal" pregnancy. If you become pregnant with multiples and have not had them in the past, then you may experience some differences. Your agency, clinic, social worker and OB will be there to answer any questions and support you in this process.
WHAT KIND OF CONTACT SHOULD I EXPECT DURING MY GESTATIONAL SURROGACY?Whatever makes you and the intended parents feel most comfortable is what you should expect; this should be discussed when you are in the process of getting to know the intended parents. Contact should be as frequent as you and the intended parents feel comfortable with. Before your cycle and during the pregnancy contact may include phone calls, emails, and likely an occasional visit, particularly for OB appointments and ultrasounds. After you deliver, you and the family may have decided to remain in contact with emails, phone calls, pictures and letters or maybe an occasional visit; we ask everyone involved to do what makes them the most comfortable.
WHEN GIVING BIRTH TO THE INTENDED PARENT'S CHILD, WILL I BE ALLOWED TO HAVE AN EPIDURAL?Of course it is their baby, but it is your body. You are allowed any hospital approved pain relief you wish to request during childbirth. We have never had an intended parent who wanted to have a drug-free birth against their Gestational Surrogates wishes. This is an issue which is obviously best addressed well before your cycle but, it is important to remember that even if both parties plan to have a drug-free birth, everyone needs to be flexible the day of the birth-things can change quickly. An intended parent who requests a drug-free birth will only be matched with a like-minded Gestational Surrogate.
WHAT HAPPENS IF ONE OR BOTH OF THE INTENDED PARENTS DIE BEFORE THE BABY IS BORN? If one intended parent dies, the other will take sole custody of the baby and fulfill the contract as if both were still living. If both intended parents die before the birth of the child, the Gestational Surrogate will relinquish the child at birth to the person named in the wills of the intended parents to serve as guardian of the child. Intended parents must make guardianship arrangements before achieving a pregnancy. Intended parents are required to carry life insurance naming the unborn child or a trust for the exclusive benefit of the unborn child as the beneficiary. If intended parents have contributed sperm and/or eggs, samples of DNA are to be preserved in the event of the death of one or both of them prior to the birth of the baby. The death of the intended parents prior to the birth of the child will not result in you being obligated or permitted to raise the child.
HOW DO THE PARENTS GET THEIR NAMES ON THE BIRTH CERTIFICATE? The law varies from state to state so it will depend on where you live as well as where your intended parents are from. The attorney will take this into account when matching you with your intended parents to be sure all legal work can be accomplished. Sometimes this is done by a pre-birth order, sometimes by virtue of a single, step or second parent adoption.
I AM SERIOUSLY CONSIDERING BECOMING A GESTATIONAL SURROGATE, BUT A FEW OF THE PEOPLE WHO ARE CLOSE TO ME ARE NOT CONVINCED THAT IT IS A GOOD IDEA; HAVE OTHER GESTATIONAL SURROGATES ENCOUNTERED THIS SAME TYPE OF RESISTANCE? To many people, the concept of offering this gift to another family is completely foreign. Many Gestational Surrogates encounter resistance from a friend, parent, or grandparent when initially considering becoming a Gestational Surrogate. We generally find that these concerns are best addressed by educating those of your friends and family who have concerns. Being knowledgeable, having a passion for being a Gestational Surrogate, and the ability to speak intelligently on the topic of Gestational Surrogacy, are usually your best defense--should any resistance arise. Ultimately, what is most important is that you make a decision that is right for yourself (and for your partner, if applicable).
DOES A GESTATIONAL SURROGATE FEEL THE SAME BOND FOR THE BABY AS SHE FELT FOR HER OWN CHILD? Being a Gestational Surrogate is a very different experience from carrying your own child. Your feelings are determined largely by your expectations. When you are carrying your own child, you are preparing to welcome your baby into your family and into your home. You prepare the nursery, purchase baby clothes, pick out a name, and anticipate bringing your baby home and raising him/her. When you are a Gestational Surrogate, your expectations are that at the birth the intended parents will take their child home, and that your part of the process will be complete. As a Gestational Surrogate, you are aware that you are not the mother, but rather the angel who has selflessly offered to help a family less fortunate than yourself finally be blessed with their own child.