What Is A Surrogate Mother? Process, Types, Cost, More - Healthline

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Parenthood

Growing Your Family Through Gestational Surrogacy

Medically reviewed by Carolyn Kay, M.D. — Written by Ashley Marcin on October 29, 2019

Purpose
Gestational vs. traditional
Finding a surrogate
Criteria for surrogates
Process
Cost
Legal issues
Other considerations
Being a surrogate
Takeaway

What do Kim Kardashian, Sarah Jessica Parker, Neil Patrick Harris, and Jimmy Fallon have in common? They’re all famous — that’s true. But they’ve also all used gestational surrogates to grow their families.

As these celebrities know, there are many ways to have children these days. And as technology advances, so do the options. More and more people are turning to surrogacy.

While you may associate this practice with movie stars and the rich, here’s what you can expect — from the general process to the overall costs — if you think this route may be a good match for your family.

Why choose surrogacy?

First comes love, then comes marriage, then comes baby in a baby carriage. The old song sure leaves a lot out, doesn’t it?

Well, surrogacy can help fill in some of those details for the 12 to 15 percent of couples experiencing infertility issues — as well as for others who want to have biological children and are in other situations.

There are many reasons people choose surrogacy:

Health issues prevent a woman from getting pregnant or carrying a pregnancy to term.
Infertility issues prevent couples from either getting or staying pregnant, like recurrent miscarriages.
Same-sex couples wish to have children. This may be two men, but women also find this option attractive because the egg and resulting embryo from one partner can be transferred and carried by the other partner.
Single people want to have biological children.

Related: Everything you need to know about infertility

Types of surrogacy

The term “surrogacy” is generally used to describe a couple different scenarios.

A gestational carrier carries a pregnancy for an individual or couple using an egg that is not the carrier’s. The egg may come from either the intended mother or a donor. Likewise, sperm may come from the intended father or a donor. Pregnancy is achieved through in vitro fertilization (IVF).
A traditional surrogate both donates her own egg and carries a pregnancy for an individual or couple. The pregnancy is usually achieved through intrauterine insemination (IUI) with sperm from the intended father. Donor sperm may also be used.

According to the Southern Surrogacy agency, gestational carriers are now more common than traditional surrogates. Why is this? Since a traditional surrogate donates her own egg, she is technically also the biological mother of the child.

While this can definitely work out just fine, it can create complex legal and emotional issues. In fact, several states actually have laws against traditional surrogacy for these reasons.

How to find a surrogate

Some people find a friend or family member who’s willing to serve as a surrogate. Others turn to surrogacy agencies — in the United States or abroad — to find a good match. Agencies first screen candidates to ensure they meet the criteria associated with the process. Then they cross-match your own wants/needs to find the best situation for your family.

Don’t know where to start? Nonprofit group Society for Ethics in Egg Donation and Surrogacy (SEEDS) was created to review and maintain ethical issues surrounding egg donation and surrogacy. The group maintains a member directory that may help you find agencies in your area.

Criteria for becoming a surrogate

The qualifications for being a gestational surrogate vary by agency, but they involve things like:

Age. Candidates must be between the ages of 21 and 45 years old. Again, the specific range varies by location.
Reproductive background. They also have to have carried at least one pregnancy — without complications — to term but have fewer than five vaginal deliveries and two cesarean sections.
Lifestyle. Surrogates must live in a supportive home environment, as confirmed by a home study. Drug and alcohol abuse are other considerations.
Tests. Additionally, potential surrogates must have a mental health screening, a complete physical — including screening for sexually transmitted infections (STIs).

Intended parents have certain requirements to meet as well. These involve:

providing complete health histories
having physical exams to ensure they can successfully go through in vitro fertilization retrieval cycles
screening for infectious disease
testing for certain genetic diseases that could be passed to a child

Mental health counseling is also recommended to cover things like expectations from surrogacy, addiction, abuse, and other psychological issues.

Related: The 30-day guide to IVF success

How it happens, step-by-step

Once you’ve found a surrogate, achieving pregnancy differs depending on what type of surrogate you use.

With gestational carriers, the process looks something like this:

Choose a surrogate, usually through an agency.
Create a legal contract and have it reviewed.
Go through the egg retrieval process (if using intended mother’s eggs) or obtain donor eggs. Create embryos using intended father’s sperm or donor sperm.
Transfer embryos to the gestational carrier (surrogate) and then — if it sticks — follow the pregnancy. If it doesn’t work out, the intended parents and surrogate may pursue another IVF cycle.
The child is born, at which time the intended parents obtain full legal custody as outlined in the legal contract.

Traditional surrogates, on the other hand, are also donating their eggs, so IVF is usually not involved in the process.

Choose a surrogate.
Create a legal contract and have it reviewed.
Go through the IUI process using the intended father’s sperm or donor sperm.
Follow the pregnancy or — if the first cycle doesn’t work out — try again.
The child is born. The surrogate may need to legally terminate parental rights to the child, and the intended parents may need to complete a stepparent adoption in addition to any legal contract set up in earlier stages of the process.

Of course, this process may be slightly different depending on the state in which you live.

How much is this going to cost?

The costs associated with surrogacy depending on the type and where you live. In general, the costs for a gestational carrier may fall somewhere between $90,000 and $130,000 when you take into account the compensation, health care costs, legal fees and other situations that may arise.

The West Coast Surrogacy Agency, based throughout California, lists its costs in detail on its website and explains that these fees can change without notice.

Overall compensation

Base pay is $50,000 for new surrogates and $60,000 for experienced surrogates. There may be additional fees as well. For example:

$5,000 if the pregnancy results in twins
$10,000 for triplets
$3,000 for a cesarean delivery

You may also incur costs (that vary) for things like:

monthly allowances
lost wages
health insurance

Costs may also include special circumstances, such as canceled IVF cycles, dilation and curettage, ectopic pregnancy, fetal reduction, and other unexpected situations.

Screenings

Expectant parents will also pay around $1,000 for mental health screenings for themselves, the surrogate, and the surrogate’s partner. Criminal background checks for both parties cost between $100 and $400. Medical screenings will depend on recommendations by the IVF clinic.

Legal costs

There are actually quite a few legal fees involved, from drafting and reviewing a surrogacy contract ($2,500 and $1,000, respectively) to establishing parentage ($4,000 to $7,000) to trust account management ($1,250). The general total here is somewhere between $8,750 to $11,750.

Other costs

This varies by clinic and agency. As an example, West Coast Surrogacy recommends psychological counseling to its intended parents and surrogates at 90 minutes a month and after different milestones, like embryo transfers. In total, these sessions may cost $2,500 — however, this support may or may not be recommended by other agencies.

Other possible costs include the surrogate’s health insurance ($25,000), life insurance ($500), and hotel stays/travel fees associated with IVF cycles ($1,500). Parents may also arrange for private health insurance verification ($275).

Again, there are other miscellaneous situations, like IVF medications and monitoring or lost wages due to pregnancy complications, that may vary in cost.

What about traditional surrogates?

Your costs may be lower with traditional surrogacy because there’s no IVF involved. The cost of IUI is less and tends to have fewer associated medical procedures.

Does health insurance cover any costs?

Likely not, but it’s complicated. According to the ConceiveAbilities agency, around 30 percent of health insurance plans include verbiage that specifically states it will not cover costs for a woman for surrogacy. Around 5 percent do provide coverage, but the other 65 percent are a bit shady on the matter.

In short: There are many appointments, procedures, and then the birth itself to think about. You don’t want an unexpected and costly health insurance bill.

Most agencies will help you review the surrogate’s health insurance plan to determine coverage. They may also recommend that you purchase outside insurance for the surrogate using comprehensive surrogacy insurance programs through agencies like New Life or ART Risk Solutions.

Legal issues to consider

There aren’t any federal laws surrounding surrogacy. Instead, the laws that apply depend on the state in which you live. Legal issues may arise when one parent is biologically related to a child and the other isn’t — even if the surrogate is not biologically related.

Traditional surrogacy — when the surrogate is also the biological mother — can be particularly complicated. Among other issues, you may need to secure what’s called a pre-birth order to be listed as a parent on the birth certificate when the baby is born. Some states may not allow this, even if they don’t have laws against traditional surrogacy. This means the non-biological parent(s) may need to go through adoption proceedings.

No matter the scenario, the American College of Obstetricians and Gynecologists recommends that the surrogate and the intended parents arrange for independent legal representation with lawyers who have experience with surrogacy.

Related: Lawsuit filed by surrogate mother raises new legal, moral issues

Unanticipated issues with surrogacy

When planning surrogacy, everything may seem quite straightforward. However, it’s important to note that as with most things in life, there are opportunities for issues to arise and make things tricky.

Some considerations:

IVF or IUI isn’t a guarantee of pregnancy. Sometimes these procedures don’t work on the first or even subsequent tries. You may need several cycles to achieve pregnancy.
We don’t mean to be a Debbie Downer here. But another consideration is that even if pregnancy occurs, miscarriages are possible.
Just as with the traditional pregnancy-to-parenthood path, there is always a chance for health issues with the baby or complications with the surrogate or actual birth.
Pregnancy with IVF and IUI may result in multiples — twins or triplets.
While home studies and psychological evaluations are part of the screening process, they can’t guarantee that surrogates won’t engage in behaviors you may consider risky. (On the other hand, most surrogates carry babies out of a desire to bring the joy of parenthood to people who might not experience it otherwise.)

A note to those considering being a surrogate

There are various ways that being a surrogate may make sense in your lifestyle. You may find the money appealing or feel fulfilled giving a couple something they may not be able to achieve without your help.

Still, it’s a big decision. The Family Inceptions Agency outlines a few things to consider before applying to be a surrogate.

You’ll need to meet all the minimum requirements — including those regarding age, health status, reproductive history, and psychological status — that may vary by agency.
You’ll need to be OK with giving up control during the pregnancy. While it’s your body, what happens during the pregnancy isn’t entirely up to you. This involves things like testing that you may not choose for yourself but that the intended parents may wish to undergo.
You’ll also need to think about the process itself. Getting pregnant via IVF takes a number procedures and medications. Consider how you’ll feel about taking injectable and oral drugs and hormones.
You’ll want to consider if your own family is complete. Do you want more children? Understand that with each pregnancy and with advancing age, more risks for complications can arise that might impact your fertility.
You’ll need to get input from the rest of your family as well. How does your partner feel about surrogacy? What about your children?

There aren’t necessarily right or wrong answers to questions you need to ask yourself — these are just things to consider. Surrogacy can be a wonderful process and gift.

Related: Infertility after donating eggs

The takeaway

While surrogacy may not always be simple or straightforward, more and more people are choosing this route.

In 1999 there were just 727 gestational carrier cycles reported in the United States. In 2013, this number jumped to 3,432, and it continues to climb each year.

It’s an involved process but certainly one worth investigating. If surrogacy seems like it might be a fit for your family, consider contacting an agency near you to go over the timeline, costs, and any other considerations that may be specific to your journey. There are many ways to become a parent — and this is one of them.

Parenthood
Infertility

How we reviewed this article:

SourcesHistoryHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

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Family building through gestational surrogacy. (2016).https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Ethics/Family-Building-Through-Gestational-Surrogacy?IsMobileSet=false
Gestational carrier (surrogate). (n.d.). https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/gestational-carrier-surrogate/
Gestational carrier versus surrogacy. (n.d.).https://www.reproductivefacts.org/resources/infographic-gallery/images/gestational-carrier-vs.-surrogate/
How common is infertility? (2018).https://www.nichd.nih.gov/health/topics/infertility/conditioninfo/common
Overview of the surrogacy process. (n.d.). shttps://www.hrc.org/resources/overview-of-the-surrogacy-process
Patel NH, et al. (2018). Insight into different aspects of surrogacy practices.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6262674/
Perkins KM, et al. (2016). Trends and outcomes of gestational surrogacy in the United States. https://www.ncbi.nlm.nih.gov/pubmed/27087401
Surrogacy myths and facts. (n.d.).https://resolve.org/what-are-my-options/surrogacy/myths-and-facts/
Third party reproduction. (n.d.).https://www.asrm.org/topics/topics-index/third-party-reproduction/

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Medically reviewed by Carolyn Kay, M.D. — Written by Ashley Marcin on October 29, 2019

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