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By Alexandria Gomez featuring commentary from RMANJ Dr. Marie D. Werner


Keeping Up With The Kardashian’s, and more recently, it’s been thrust back into the national conversation via Hulu’s The Handmaid’s Tale, an adaptation of Margaret Atwoods’s 1985 novel of the same name.

The show is set in a not-so-distant American future in which reproduction rates take a nosedive and fertile women are subsequently forced into conceiving children for elite couples. Of course, this totalitarian premise is far from a realistic portrayal of the surrogacy process. It does, however, beg the question: What does the real-life version of this look like?

More women than ever before are having children through medical intervention, according to the Society for Assisted Reproductive Technology. And however far-fetched Atwood’s infertile future may seem, there’s a lot to be learned about what goes down when it comes to surrogacy. Whether you’re thinking about having a child through a surrogate, becoming a surrogate yourself, or are generally curious about how the process works, here’s what you need to know:


1..There are two kinds of surrogates

It’s important to realize there are different definitions of the term surrogate. In traditional surrogacy, a woman is artificially inseminated with the father’s sperm (or a donor sperm). She carries the baby to term and gives it to the couple, but is the biological mother of the child, as it was her egg that was fertilized, says Marie D. Werner, M.D., of Reproductive Medicine Associates of New Jersey.

Then there’s gestational surrogacy. Through IVF, the mother’s eggs are collected and fertilized by the father’s sperm. A fertilized embryo is then placed in the gestational surrogate’s uterus and she carries the baby to birth. In this case, the surrogate is not the biological mother, as it was not her egg that was fertilized, says Werner. This method has become preferred as it gives both parents genetic ties to the baby and is less complicated legally (more on the legal stuff below).


2. It’s done for medical reasons, not vanity

Contrary to what Hollywood tabloids may have you believe, a surrogacy is never—or, at least, rarely—executed out of convenience or to spare the mother’s body. Surrogacy is only recommended for medical reasons, says Werner. The most common indications include absence of the uterus, a significant uterine anomaly, absolute medical contraindication to pregnancy, or biological inability to carry a child.


3. A surrogate can be a friend or complete stranger

There are plenty of options when it comes to who will carry the baby—for some, it’s a family affair and others see it as strictly business. A surrogate may be a close family friend or relative, but often times the most successful arrangements are with a carefully screened non-related individual, says Werner. There are agencies that specialize in finding gestational carriers for intended parents. If you go through the process with an agency, the typical timeline can be anywhere from 16 to 23 months from when you start your search to when you have a baby.


4. Surrogates have typically had a baby before

One of the top requirements for women applying to be surrogates, gestational or traditional, is that they’ve had a baby before. In addition to this, the surrogate must be at least 21 years old, says Werner. This is similar to what we see in Atwood’s novel and the show, where the fictional society only uses women who’ve previously had children as surrogates.


5. There will be contracts involved

As one might imagine, having one woman carry another’s baby can be a complicated process if the proper regulations aren’t in place. The legal process can by tricky and it varies from state to state, says Werner. The variables are quite different, though, as some states, including New York, Lousiana, and Washington, don’t recognize compensated surrogates at all, making it more difficult to transfer the baby into the parents’ care.

For example, in New York, the woman who gives birth is defined as the “birth mother.” According to this law, a gestational carrier in New York has preferred parental status with respect to a child she carries but is not genetically related to, even above the parental status of the genetic intended parents. It’s important to check your clinic’s and state’s regulations for both implantation and delivery to make sure your rights are protected, says Werner. A reproductive lawyer is always recommended to protect the rights of all involved parties.


6. It will cost you

A lot of time and analysis goes into making sure the surrogate and parent(s) are a match. “There is a detailed screening process for the intended parents and the gestational carrier to ensure compatibility for all involved parties,” says Werner. “This may include a psychosocial assessment and infectious disease screening”

All of that comes at a cost. How much is dependent on several factors. For example, if you choose to use an egg donor, that adds an extra $15,000 to $20,000 to the price tag. It differs by situation, but if you include the cost of medical care, an agency fee, surrogate insurance, egg donation, psychological support, and the surrogate benefits, you’re looking at a bill that’s well into the six-figure range.