The Surrogacy Process Overview

Surrogacy includes 5 main parties:

  • Intended Parents (IP) – Intended parents can include all kinds of couples and single people.
  • Egg Donor – Egg Donor is a woman that donates her eggs to enable another woman to conceive as part of an assisted reproduction treatment (ART).
  • Carrier (Gestational Surrogate) – The Gestational Surrogate is a woman who carries and delivers a child for another couple or person.
  • IVF Clinic – Fertility clinics are medical clinics that assist couples, and sometimes individuals, who want to become parents but for medical reasons have been unable to achieve this goal via the natural course.
  • Surrogacy Agency – The Surrogacy Agency provides part or all the surrogacy services, including the surrogate matching process, support counseling, and case management.

The Surrogacy Process

Step 1: Selecting Surrogacy Professionals

Once Intended Parents have decided that they want to pursue a surrogacy journey, they must determine their goals, expectations, and the professionals they are willing to work with. They will retain an attorney who works within the realm of 3rd party reproduction. They may also seek out the assistance of a surrogacy agency to help match them with a qualified gestational surrogate.

Step 2: Selecting an Egg Donor or Sperm Donor (If Needed)

Intended Parents can either bring their own egg donor/sperm donor or select one from a clinic’s or egg donor agency’s database. In either case, the candidate must pass a thorough medical screening. Their medical records will be reviewed by a reproductive endocrinologist before being accepted into the donor program.

An egg donor and sperm donor clinic screening may include the following:

  • Fertility Screening: A donor’s ovaries will be examined for the ability to produce eggs through a physical/pelvic exam, and blood tests. To determine ovarian function and reserve, the egg donor may also need to have a vaginal sonogram on the second or third day of menstruation.
  • Medical Screening: This involves testing for blood type, infectious diseases, drug use, and general health. The sexual partner of an egg donor may also be asked to undergo screening for sexually transmitted infections.
  • Genetic Screening: Family history will be evaluated to raise awareness of possible hereditary diseases or genetic disorders. Testing consists of blood tests for genetic diseases, such as cystic fibrosis, Tay-Sachs disease, sickle cell anemia, thalassemia, and more.
  • Psychological Screening: The donor will be asked to speak with a psychologist to make sure she fully understands the benefits and risks of egg donation and has proper motivations for becoming a donor.

Step 3: Selecting a Gestational Surrogate (Carrier)

Similar to the previous step, Intended Parents can either choose a family member or a friend as their surrogate or go through an agency. The surrogate candidate and the Intended Parents will undergo medical, mental health, financial and criminal background screening.

The gestational surrogate agency and clinic screenings include the following:

  • Interview: The process begins with a face-to-face interview between the gestational surrogate and the agency. They will go over the screening process, expectations and requirements. They will also share their reasons for wanting to be a surrogate.
  • Background Check: An agency will conduct a criminal, civil, and financial background check and a DMV check on the gestational surrogate as well as their partner or spouse and anyone over the age of 18 living in her household.
  • Medical Record Review: The gestational surrogate will be asked about her medical and pregnancy history. Her medical records will be procured independently by the agency. Forms detailing her previous pregnancy(ies) and confirming her current clean bill of health from her medical providers will also be required.
  • Psychological Screening: It is imperative that every surrogate fully understand the emotional ramifications of gestational surrogacy and it is also a requirement of IVF centers that each surrogate receives a psychological evaluation and letter of clearance for the cycle. An MMPI or PAI personality assessment will be administered to the surrogate, and a personal interview with the psychologist will be required for the surrogate and her spouse/partner. The psychologist will discuss how surrogacy impacts life and family and positive ways to communicate with the intended parents. The goal of this screening is to have surrogates give consideration to the entire surrogacy from beginning through birth.

A profile is created for both the Intended Parents and the gestational surrogate, by the agency. When the time comes to make a match, the agency will match the Intended Parents with a gestational surrogate who’s surrogacy plans, expectations, and personal beliefs are similar to theirs. This is a mutual matching process. Both parties must agree to the match in order to move forward with the surrogacy arrangement.

Medical Screening of Surrogate

The medical screening of the surrogate is always completed by the IVF clinic chosen by the intended parents. Some of the testing may take place in the surrogate’s local area, but in most cases, the full screening will take place at the IVF center where the embryo transfer will take place. All surrogates must attend a medical screening appointment to determine that they are physically capable of undergoing the surrogacy process. As a part of the medical screening, surrogates can again expect to give their pregnancy and health history, do blood and urine testing, and have an ultrasound.

  • History: The IVF physician will take the surrogate candidate’s medical and pregnancy history and will review the surrogate’s profile and previous birth records.
  • Process: The IVF physician will discuss the IVF process with the surrogate, all testing the surrogate will complete, all medications anticipated will be used during the cycle, the embryo transfer procedure and care that will be provided by the IVF center for the first 8-10 weeks following embryo transfer. Injection teaching may be a part of the initial visit.
  • Blood and Urine Testing: Surrogates will be tested for sexually transmitted or other transmissible diseases which will include: HIV, HTLV-1 & 2, Hepatitis B & C, Chlamydia, Gonorrhea, Syphilis, and any other tests as required by FDA guidelines. The sexual partner of the surrogate MUST be screened for sexually transmitted diseases as well.
  • Ultrasound and Hysteroscopy: An ultrasound and vaginal cultures will also be required at the first IVF visit. A hysteroscopy may be done during the first visit as well, which is used to view the uterine environment to make sure there are no scars or adhesions that could interfere with the implantation process.
  • Birth Control: If the surrogate is not already taking oral contraceptives she may receive a prescription for birth control at this time. This is used to help regulate the surrogate’s cycle and will allow the physician to coordinate her cycle with that of the egg donor or intended mother. The surrogate may be asked to start birth control prior to having the legal contract signed with the intended parents, but she will not be allowed to start any injectable medications until legal clearance has been issued. The starting of birth control pills is not considered a medication start event.

Step 4: Signing Contracts

All parties involved in this step of the process will have their own attorney representing their own interests. Before beginning the embryo transfer process, it is required that each party agrees to the terms of the contract and signs it.

  • Separate Representation: Separate representation means the surrogate and the intended parents are represented by two different law firms that specialize in reproductive law. With separate representation, the intended parent’s attorney is called the drafting attorney; and the surrogate’s attorney is called the reviewing attorney. The drafting attorney will first consult with intended parents and once they approve the initial contract the drafting attorney will send a contract to the reviewing attorney. The reviewing attorney is responsible for getting a copy of the contract to the surrogate and scheduling a time to go over all the terms of the agreement with the surrogate. Any changes to the contract will be relayed to the drafting attorney for final approval by intended parents.

Attorneys must have a license in the US state where the surrogate and the egg donor live.

To this end, each party will review the terms of the contract carefully beforehand:

  • Surrogate: Compensation, possible risks, rights and obligations, what to do in case of unexpected events, abortion rights, etc.
  • Intended parents: Making your legal rights clear, including how to manage potential risks and the process for establishing parentage.

Once the terms of the final contract are agreed upon all parties will be required to sign the contract in front of a notary. The cost of the surrogate’s legal representation shall be paid for by the intended parents. Medications cannot begin until all parties have signed the contract. A letter will be sent by the drafting attorney to the IVF physician to notify them that legal clearance has been issued and that she can begin medications.

Step 5: Undergoing The Medical Process

At this stage, two steps are crucial—fertilization and embryo transfer.

  1. Fertilization – The eggs and sperm of the intended parents are used to create the embryo.
  2. Embryo Transfer – The embryo is transferred to the uterus of the surrogate.

Before the fertilization, the intended mother or the egg donor in case she cannot use her own eggs has to take medications in order to stimulate the ovaries for the production of multiple eggs. Once mature, they will be collected through follicle puncture (Eggs Retrieval).

Before the Embryo Transfer, the gestational surrogate has to take medications in order to prepare the endometrium for it to be receptive at the moment of the embryo transfer.

The surrogate will take a pregnancy test about 15 days after the transfer and prenatal care begins once the fetal heartbeat has been confirmed by ultrasound.

Step 6: Pregnancy, Birth & Parental Rights

When pregnancy is achieved, it is the agency’s job to support both the Intended Parents and the surrogate and to help them prepare for the birth of the child. At 18-20 weeks of pregnancy, the parental establishment documents are put together and finalized. The drafting attorney will present everything to the court from the county in which the birth will take place and the court will approve a judgment declaring the intended parents as the legal parents from the moment the child is born. Intended parents are always responsible for the care of the child immediately upon birth and they are always responsible for making any and all medical decisions for the child. Prior to the birth of the child, the documentation for parental rights will be submitted to the hospital in which the surrogate will give birth.

After the birth of the child, it is common among surrogates and intended parents to remain connected over the years and maintain a close relationship during the child’s life.