Gestational surrogacy is an increasingly common option for individuals and couples who are infertile or unable to have a child on their own.

This article provides an overview of gestational surrogacy, how it works, and the benefits and risks associated with this method of family building.

What is gestational surrogacy?

Gestational surrogacy is when one person (gestational surrogate or gestational carrier) carries a pregnancy for another couple or individual (intended parent). An embryo is created using the intended parents’ gametes (sperm and eggs) or donated gametes through medically assisted reproductive technologies (ART), such as in vitro fertilization (IVF). The embryo is then transferred to the surrogate’s uterus. The person who carries the pregnancy has no genetic relation to the baby.

Benefits of Gestational Surrogacy

Gestational surrogacy can provide benefits for both the gestational carrier and the intended parents.

Benefits for the carrier

  • Financial compensation: Gestational carriers are typically compensated for their time, expenses, and medical care. The amount of compensation can vary depending on the specific surrogacy arrangements between the carrier and the intended parents.
  • Emotional fulfillment: Being a gestational carrier can be an incredibly rewarding experience. Helping an individual or couple achieve their dream of becoming a parent can provide a sense of purpose and joy. The carrier may also feel connected to the intended parents and the child they’re carrying.
  • A supportive community: Surrogacy agencies and support groups can provide carriers with a supportive community of other women going through the same experience. This can be helpful for the carrier to feel connected to others and to share their experiences. The carrier may also find comfort in knowing she’s not alone in her journey.

Benefits for the intended parents

  • Genetic connection:  The intended parents can choose to use their own eggs and sperm to create the embryo, or they may choose to use donor eggs or sperm. This can help the intended parents feel a stronger connection to their child.
  • A healthy pregnancy: The American Society for Reproductive Medicine (ASRM) has a list of criteria that gestational carriers must meet before becoming surrogates. The ASRM website states that an “ideal” carrier is between 21 and 45 years old, has previously had a successful term pregnancy, and has undergone comprehensive medical and psychological evaluations. The carrier should have no more than five previous vaginal deliveries and no more than two previous C-section deliveries. These guidelines help ensure that the carrier can carry out a healthy pregnancy and reduce the risk of complications for both the fetus and the carrier. Ideal criteria for carriers can vary by physician and fertility clinic.
  • A legal guarantee: Intended parents can enter into a legal contract with the gestational carrier to ensure they have legal rights to the child after birth. This can help protect the intended parents’ parental rights and ensure they can raise their child without intervention from the gestational carrier.

Potential Risks of Gestational Surrogacy

Gestational surrogacy is a complex and emotional process, and potential risks are involved for both the gestational carrier and the intended parents, including:

Medical risks

  • Miscarriage: Approximately 10-20% of pregnancies end in miscarriage. This is the most common risk of pregnancy, and it can happen at any time during gestation. However, most miscarriages occur before 20 weeks.
  • Ectopic pregnancy: Ectopic pregnancy is a serious condition in which a fertilized egg implants outside the uterus. It occurs in about 2% of pregnancies. The most common site for an ectopic pregnancy is in one of the fallopian tubes, but it can also occur in the ovaries, cervix, scar from a prior cesarean section, or abdomen.
  • Preterm labor: Preterm birth (when labor begins before 37 weeks of pregnancy) is a serious condition that can lead to health problems for babies. However, with advances in medical care, many premature babies live healthy lives. In the United States, about 1 in 10 babies are born prematurely yearly.
  • Other pregnancy complications: These can include gestational diabetes, high blood pressure, preeclampsia (a serious blood pressure condition), and abnormalities of the placenta like placenta accreta (a condition where the placenta implants into the muscle layer of the uterus and can cause severe bleeding that often results in the need for hysterectomy)

Psychological risks

  • Attachment to the child: Even though gestational surrogacy involves carrying a child that’s not biologically theirs, the gestational carrier may develop an emotional attachment to the child she’s carrying. This can be difficult for the carrier to cope with after the child is born.
  • Anxiety and uncertainty: The surrogacy process can be long and stressful, and the gestational carrier may experience anxiety and uncertainty about the outcome. Some studies suggest that gestational surrogates may have higher levels of depression during pregnancy and post-birth.

Financial risks

  • Cost of surrogacy: Gestational surrogacy can be costly, and the intended parents are typically responsible for all of the costs. These costs can include medical expenses, legal fees, and compensation for the surrogate.
  • Loss of income: The gestational carrier may need to take time off from work during the surrogacy process, which could lead to a loss of income.
  • Other expenses: There may be other unexpected expenses associated with gestational surrogacy, such as travel costs for the intended parents to visit the gestational carrier during her pregnancy or childcare costs if the carrier already has children.

Gestational Surrogacy Cost

The cost of gestational surrogacy varies depending on a number of factors, including:

  • Legal fees: Legal fees can range from $7,000 to $15,000. These fees cover the cost of drafting and filing surrogacy contracts and the cost of legal representation for the intended parents and the gestational carrier.
  • Medical expenses: Medical expenses can range from $20,000 to $50,000. These expenses include the cost of:
    • Fertility treatments: This can include the cost of IVF, intracytoplasmic sperm injection (ICSI), and other procedures used to help intended parents conceive.
    • Ultrasounds: Doctors use ultrasounds to monitor the pregnancy and check the fetus’s health.
    • Childbirth: The cost of childbirth can vary depending on the location and the type of delivery (vaginal or cesarean).
    • Egg donor: Individuals and couples using an egg donor may need to pay additional fees. This is because the egg donor will need to undergo fertility treatments and ultrasounds, and she may also need to take medication. The additional fees for using an egg donor can range from $10,000 to $50,000.
    • Other medical care: Other medical care that may be needed during surrogacy can include prenatal care, blood tests, and medication.
  • Agency fees: Agency fees can range from $10,000 to $30,000. These fees cover the cost of screening, matching intended parents with gestational carriers, and providing administrative support and other services during the surrogacy process.
  • Compensation for the Gestational Carrier: Compensation for the gestational carrier can range from $30,000 to $70,000. This amount is typically paid in installments throughout the surrogacy process.

The total cost of gestational surrogacy can range from $50,000 to $150,000. However, it’s important to note that this is just an estimate, and the actual cost may vary depending on the individual circumstances of the intended parents and gestational carrier.

It’s also important to note that IVF treatment doesn’t always work on the first try. In some cases, intended parents may need to repeat the process multiple times, which can increase the overall cost of surrogacy. The need for multiple IVF cycles using a gestational carrier can be drastically decreased due to the careful selection of healthy gestational carriers with prior healthy pregnancies and deliveries.

Who should consider gestational surrogacy?

There are many reasons why someone may consider working with a gestational carrier, including:

  • Absent uterus: This can be due to congenital absence or prior hysterectomy.
  • Severe uterine factor infertility: This can include uterine fibroids, adenomyosis, intrauterine adhesions, persistent thin lining, or pelvic radiation.
  • Recurrent pregnancy loss (RPL): Recurrent pregnancy loss (RPL) is when a woman has two or more miscarriages. An estimated 5% of pregnant individuals experience RPL.
  • Repeated implantation failure (RIF): Repeated implantation failure (RIF) is when a woman has had three or more failed IVF cycles.
  • Medical conditions such as cardiac, psychological, pulmonary, or renal disease: These conditions may make it difficult or impossible for a woman to carry a pregnancy to term.
  • Same-sex couples: If a same-sex couple, single man, or transgender individual wants to have a child, they may need to consider gestational surrogacy.

Gestational surrogacy is a complex and potentially expensive process that requires careful consideration. It’s not right for everyone. Intended parents should make sure that they’re both emotionally and financially prepared for surrogacy, as it can be a long and complicated process.

Gestational vs. Traditional Surrogate: What is the difference?

There are two main types of surrogacy: gestational and traditional.

Gestational surrogacy is when a woman not genetically related to the fetus carries the pregnancy. The embryos are created using the intended parents’ genetic material through IVF or other type of ART. The intended parents may also use an egg donor or sperm donor, depending on their specific situation. Gestational surrogacy is the most common type of surrogacy.

Traditional surrogacy is when the surrogate is also the child’s biological mother. The surrogate’s egg is fertilized with the intended father’s sperm, and she carries the pregnancy to term. Traditional surrogacy is less common than gestational surrogacy. This type of surrogacy is illegal in many states.

The Process of Using a Gestational Surrogate

The gestational surrogacy process typically begins with the intended parent(s) finding a gestational surrogate.

Below, we outline some key steps in using a gestational surrogate.

Finding a Gestational Carrier

There are a few different ways to find a gestational carrier:

  • Through a surrogacy agency: Surrogacy agencies typically have a pool of potential gestational carriers who have been screened and vetted. This can be a convenient way to find a surrogate, but it’s more expensive than other methods.
  • Through word-of-mouth: Intended parents may hear about potential gestational carriers through friends, family, or social media. This can be a more cost-effective way to find a gestational carrier, but it can also be more time-consuming and less reliable.
  • Through online surrogacy forums: There are several online forums where intended parents can connect with potential gestational carriers.
  • Through personal connections: Some people may ask a family member or friend to be their gestational surrogate. While this is a personal and often very meaningful option, navigating it may require additional emotional considerations and dynamics.

Medical Screenings for Gestational Surrogacy

The intended parents and the gestational carrier must undergo a medical evaluation, including screening for psychological conditions to ensure their mental health and well-being throughout the gestational surrogacy process.

The ASRM recommends that gestational carriers undergo a comprehensive medical exam, including:

  • A physical exam: This will assess the gestational carrier’s overall health and fitness to carry a pregnancy.
  • Blood tests: These will check for sexually transmitted infections (STIs), HIV, hepatitis B and C, and other medical conditions that could affect the pregnancy.
  • A psychological evaluation: This will assess the gestational carrier’s emotional stability, ability to handle the process, and potential emotional challenges.

The ASRM also recommends that gestational carriers get the following vaccinations:

  • Rubella
  • Varicella
  • Tdap (tetanus, diphtheria, and pertussis)
  • Influenza
  • Hepatitis B

The ASRM recommends that intended parents undergo a medical evaluation, including screening for STIs, HIV, hepatitis B and C, and other medical conditions that could affect the pregnancy.

The Legal Process of Surrogacy

Gestational surrogacy requires a complex legal process that involves multiple parties, including the intended parents, the gestational carrier, and the fertility clinic.

Before any medical procedures can begin, all parties must sign a surrogacy agreement outlining the arrangement’s terms.

This agreement should include:

  • The names and contact information of all parties involved in the surrogacy arrangement, including the intended parents, the gestational carrier, and the fertility clinic.
  • The intended parents’ legal rights and responsibilities as the child’s parents.
  • The gestational carrier’s legal rights and responsibilities, including her right to compensation and her right to terminate the pregnancy if necessary.
  • The specific medical procedures that will be performed, including the use of IVF and the transfer of embryos to the gestational carrier’s uterus.
  • The financial arrangements, including the amount of compensation that the gestational carrier will receive and who will be responsible for paying for medical expenses.
  • The process for resolving disputes, such as what happens if the gestational carrier experiences a pregnancy complication or if she decides to keep the child.
  • The jurisdiction in which the surrogacy will take place, as surrogacy laws vary from state to state.

It’s important to have an attorney review the surrogacy agreement before it’s signed to ensure it is legally binding, follows state laws, and protects all parties’ rights.

The agreement may also include:

  • The gestational carrier’s medical history and health screening results.
  • The intended parents’ medical history and health screening results.
  • The intended parents’ plans for raising the child, including their religious and cultural beliefs.
  • The gestational carrier’s contact information for the intended parents and the fertility clinic.
  • The gestational carrier’s right to privacy and confidentiality.
  • The intended parents’ right to terminate the surrogacy arrangement at any time.
  • The gestational carrier’s right to terminate the surrogacy arrangement if she experiences a change in her circumstances, such as becoming pregnant with her own child.
  • The process for determining the child’s legal name and citizenship.
  • The process for resolving disputes, such as what happens if the child is born with a disability.

A Note From RMA Network

The process of locating, connecting with, and achieving a pregnancy with a gestational carrier can be stressful and lengthy, but it can also be a rewarding experience.

At RMA, we take a collaborative approach, with our physicians, nurses, mental health professionals, and financial counselors working together to support patients at every stage of their surrogacy journey with the highest level of care and expertise.

If you’re considering surrogacy, we encourage you to contact us to learn more about how we can help.