Surrogacy is a hot topic right now thanks to a certain reality TV family (if you're just back from another planet, Kim Kardashian West and Kanye West welcomed their third child, daughter Chicago West, via surrogate on Jan. 15, 2018, and are already rumored to be thinking of adding to their brood). But surrogacy has been a viable option since the 1970s for those who are unable to or choose not to carry their own biological children.
Since 2005, surrogacy (gestational carrier) transfers have nearly doubled, says reproductive endocrinologist Dr. Daniel Kaser, who oversees the third-party reproduction program at Reproductive Medicine Associates of New Jersey. There are two types of surrogacy — and there's a big difference between them. In traditional surrogacy, the surrogate donates the egg and is genetically connected to the child. In gestational surrogacy, the surrogate receives a fertilized embryo and has no genetic connection to the child. That embryo may have been fertilized by the intended father and mother or by a separate egg donor. (Kardashian West and West used a gestational surrogate in case you were wondering.)
Surrogacy can be a highly emotional process, and the laws are complex at best. In fact, many U.S. states don't have clear surrogacy laws at all. To shed some light on the process for those considering it (and the rest of us too) we spoke to experts in the field. Here are the facts about surrogacy — which bear little resemblance to the movies.
1. The screening process is intense...
Whether you're looking for a surrogate or thinking about being a surrogate yourself, the screening process is very thorough. The treating fertility doctor carries out a personal interview and all necessary tests to make sure the surrogate is physically healthy. According to IVFMD fertility specialist Dr. Maria Bustillo, these include an assessment of intent to follow through with the process; standard tests for transmissible diseases such as hepatitis and HIV; and tests to rule out diabetes, hypertension and elevated cholesterol. A trained psychologist or social worker with experience working with surrogates will perform psychologist screening to ensure they're mentally healthy. But the spotlight doesn't just shine on the surrogate; all parties have to feel comfortable with the arrangement, meaning the surrogate gets profiles of the intended parents and can choose whether she wants to work with them or not.
2. There's a lot of red tape
A legal contract between the intended parents and the surrogate is an absolute must, says Kaser, and this should be drawn up and executed by an experienced reproductive lawyer — and should include what type of contact the parties want to have with each other throughout and after the pregnancy. Of course, this comes with significant costs, particularly if you are an intended parent using an agency to recruit a surrogate.
On top of legal fees, you have to:
- Pay for all medical procedures to generate and transfer the embryos(s) into the surrogate
- Pay all obstetrical costs of care, labor and delivery
- Cover related expenses for the surrogate (for travel to medical appointments, etc.)
- Pay a fee to the surrogate.
Costs and fees paid to the surrogate can vary greatly depending on location, but as a general guide, you can expect to pay around $100,000, says Bustillo.
3. There's no (official) age cap on surrogacy
That said, most surrogates are under 40 years old because pregnancy can be more complicated as women age (even if they are healthy), says Bustillo. While there's no standard upper age limit for surrogates, most fertility clinics do impose their own age cap, which could be anything up to 55.
Other — possibly more important — considerations include whether a surrogate has her own children and has experienced an uncomplicated birth, whether she lives in a stable and healthy environment with supportive family and friends, whether she is receiving any form of governmental assistance and whether she has a criminal record.
4. "Surrogacy guilt" is a thing
If you're considering surrogacy after failing to get pregnant yourself, you may feel strong feelings of guilt. This is perfectly normal, says Eirene Heidelberger, nationally renowned parenting expert and founder of GIT Mom (Get It Together, Mom!), who has experienced infertility herself. "It’s your body’s fault, not your fault!" she says. "Once I made the decision to accept that my body and not me as a woman was letting me down, I started to feel less humiliated and more empowered. My husband and I understood that we were not out of options on how to grow our family. Every couple concludes in their own time when to stop trying to conceive and to begin looking to surrogacy. You did not give up on building a family when you came to that conclusion; rather, you moved on to another option. That’s something to feel proud of, not guilty!" Heidelberger recommends leaning on your support system of family, friends, people with shared experiences and a therapist to help you move from feelings of guilt and grief to excitement and joy.
5. It's natural to worry about bonding
If you're worried you won't bond with your baby because you haven't given birth to them, you're not alone. And you can get over those concerns. Heidelberger's advice to the families she's coached is always to address fears from the very start and communicate them to your partner and support system. "Adopt the mantra, 'everything is going to be OK,' because everything is going to be OK," she says. "You’re having a baby, and in addition to welcoming a child into your family, you’ll be able to share your story of survival, love and compassion. Your story of hope may help another woman endure the same experience."
On the flip side, it isn't a given that a surrogate will feel attached to the baby just because she delivered it. Most surrogates go into the process with both eyes open, having prepared themselves for the emotional risks and accepting that the baby is simply "on loan" until it is born without the emotional connection of carrying their own child.
Tests, paperwork, legalities and costs aside, when surrogacy works out, it's an amazing thing — for all parties involved. It may not be an easy process, but that makes it all the more rewarding when the baby arrives.