Why You May Need a Surrogate
There are many reasons why patients may work with a gestational carrier (surrogate), including:
- Absent uterus (congenital absence or prior hysterectomy)
- Severe uterine factor infertility (fibroids, adenomyosis, intrauterine adhesions, persistent thin lining despite hormonal treatment, pelvic radiation)
- Recurrent pregnancy loss
- Repeated implantation failure
- Medical conditions that preclude safely carrying a pregnancy (cardiac, pulmonary or renal disease)
- Same-sex male couples, single men and transgender individuals
The Gestational Surrogacy Process
RMA’s care team can offer guidance to patients interested in surrogacy by helping them select a carrier that fits their needs and preferences. Some may choose to work with a friend or relative to carry the pregnancy, while others may prefer to match through an agency with a woman who has applied to become a surrogate.
Legal Issues with Surrogacy
There are many important legal issues to consider when using a gestational carrier. Since parental rights and obligations can vary from state to state and country to country, RMA recommends patients consult with an experienced attorney that specializes in third-party reproduction. At RMA we only work with carriers from surrogacy-friendly states to assure that legal parentage is established without question. Our staff can assist you in finding the legal professionals and resources necessary to help you make these important decisions for your family.
What to Expect
The process of locating, connecting with and achieving a pregnancy with a gestational carrier can be a stressful and lengthy experience, but hopefully a rewarding one as well. Our approach is collaborative with RMA physicians, nurses, mental health and financial counselors working together to support the patient at every stage of the process with the highest level of care and expertise.
Becoming a Surrogate
The below information is intended for women who would like to become a surrogate and help build a family.
A physician must first determine that surrogacy is the best choice for the patient/intended parents. Being a gestational carrier is an important responsibility that includes many physical, medical, emotional and legal issues for participants to consider. RMA works closely with all carriers, beginning with an intensive physical and psychological screening process at our fertility clinic.
Before becoming a surrogate, gestational carriers must meet the following criteria:
- Take part in a preliminary phone interview with a physician and mental health professional.
- Furnish copies of medical records and history.
- Complete preliminary paperwork.
- Provide any additional requested materials.
- After the above criteria are met, the carrier will meet with the recipient couple, nurse, physician and mental health coordinator at a “screening appointment.”
Following the initial appointment:
- The carrier will be briefed on medications that will be used during the implantation procedure.
- A coordinator reviews the contract between the carrier and the couple.
- Carriers and partners must complete a Personality Assessment Inventory (PAI) and participate in a series of interviews and tests.
Screening the Carrier
Prior to becoming available to match, all gestational carrier candidates (both known and recruited) undergo a thorough review of their medical and obstetric records, along with a clinical interview by the RMA physician and mental health teams. This process is designed to ensure only healthy carriers are matched, both for the well-being of the child and the carrier herself.
Carriers also undergo a uterine cavity evaluation with either a saline sonogram or hysteroscopy to verify that the uterine environment is optimal for carrying a child, free of polyps, fibroids and scar tissue. At RMA, we only work with carriers from surrogacy-friendly states and countries. Typically, this involves the carrier traveling to one of our offices for an appointment to complete the screening process and a second visit for the embryo transfer.
Screening the Intended Parents
Intended parents undergo routine infectious disease screening in compliance with requirements by the U.S. Food & Drug Administration. Genetic testing, along with a genetic counseling appointment, are required. Embryos can be created at any time through In Vitro Fertilization (IVF), even prior to matching with a carrier.
Without exception, a complete copy of the executed legal contract between the gestational carrier and the intended parents must be provided to the RMA nurse coordinator before the start of the prep cycle and prior to the initiation of treatment involving any medications.
- Prior to the start of a treatment cycle, intended parents must agree to the payment requirements for these services and receive a financial clearance from RMA. Any questions surrounding insurance coverage or other finance issues should be directed to the RMA Finance Department.
- RMA is not responsible for any costs associated with medications and outside monitoring services for a carrier. These costs are paid directly by the intended parents.
- Any fees related to the use of RMA mental health professionals and counseling services are billed separately by RMA and are not included in the cost of treatment. Please contact the Collaborative Wellness Team for a fee schedule for these service.
Once the uterine lining is ready for implantation, the carrier returns to RMA. On the morning of the scheduled transfer, the carrier will undergo one final monitoring ultrasound and blood test to ensure that the endometrial lining is optimal before thawing the embryo. After this final check, the embryo will be thawed for transfer. The frozen embryo transfer is a brief procedure done under ultrasound guidance without anesthesia.
The intended parents are welcome to be in the room for the transfer, but their presence is optional. Typically the day after transfer, the carrier returns to her own state of residence. Normal daily activity following the transfer is encouraged.
Nine days after the transfer, the first pregnancy test is performed at the off-site monitoring location. If pregnancy results, the first ultrasound is done seven to ten days later.
If the gestational carrier is located near an RMA clinic, our team will manage all monitoring during the treatment process. If the carrier is located outside of driving distance to an RMA location, she is responsible for choosing a monitoring facility and providing RMA with all contact information. Once a monitoring center is selected, the carrier must schedule all monitoring appointments directly with that center, following guidelines provided by the RMA nurse coordinator.
Monitoring facilities must:
- Be open at least five days a week
- Be able to perform transvaginal ultrasound
- Obtain same-day results for blood tests to measure estrogen and progesterone levels
Once the carrier reaches approximately eight weeks of pregnancy, her care is then transitioned to a local obstetrician for the duration of pregnancy and delivery.
All fees for outside monitoring services used by carriers are paid directly by the intended parents to the treatment center, not through RMA.