Surrogacy has really taken off recently. In the most popular surrogacy group on Facebook, there are over 13,000 members eagerly asking questions, commenting and either completing or beginning their surrogacy journey as an intended parent or as a surrogate, gestational or traditional. It seems more and more I see my timeline popping up with friends going through surrogacy, that I really never expected to.
I have people reach out to me daily asking about my surrogacy experience and honestly, answering is becoming exhausting, time consuming and draining, so I will put it here for the world to see and it will find the people it’s meant to find and if you’re looking for answers and perspectives, here they are. Please read in full before reaching out to me with questions. It’s long but it’s necessary if you feel you are wanting to make an informed decision on whether surrogacy is right for you. If you are contemplating egg donation, please see our egg donation article for my perspective on that here.
Preparing for Surrogacy
You must know that the process going into surrogacy is a hurry up and wait game. Whether you go through an agency or independent, you can expect to be waiting at minimum 6 months before even starting to get pregnant; some women wait much longer – even years. So do not go into this expecting to get pregnant or get a paycheck quickly, by any means.
Before you even get into the nitty gritty, check if your state even allows surrogacy. The ability to be a surrogate depends on the state YOU live in, not the parents. For example, in New York, surrogacy is not permissible or legal. There are ways to get around it, but it’s a gamble for you and the parents legally. For a state by state guide, learn more here.
Types of Surrogacy
There are different types of surrogacy, so you must decide which route you will take.
Traditional surrogacy involves using your own egg, so you would be biologically related to any baby you carry. This may involve home insemination, in clinic insemination, IUI or the full IVF process, extracting your eggs, creating an embryo or multiple embryos, and transferring the embryo(s) into your uterus.
A gestational carrier is just that – a carrier. You are simply hosting the embryo(s) and they are not directly biologically related to you, though, if you are carrying for a cousin, sister, daughter or any other relative, they will be distantly related to you, of course. This involves the second half of IVF and we will go in depth with that explanation in a bit.
The Legal Side
Once you’ve decided whether you want to be a gestational carrier or a traditional surrogate, you will pursue an agency. Typically agencies do not aide traditional surrogates as they are legally more complex and involved. There are TONS of agencies to choose from; vet them wisely. Ask questions about how they support you through the process, what process steps they handle prior to you getting matched with parents, if they can match you with parents that fit your values and birth plan, how compensation is handled, and if you are 10-99d for the compensation you receive (if so you must save at least 15% of your compensation for the following tax year, or you will be investigated by the IRS).
Some values that are important to consider in surrogacy are:
- Compensation: What is the compensation amount to make it worth it for you to dedicate your body for a minimum of 10 months, sometimes over a year if transfers fail, you have to do mock cycles, you have an early loss, etc? What about lost wages if you have to miss work for appointments, or quit your job all together? What will be your transfer fee? What about if you have to have a hysterectomy from birth complications?
- Embryo Transfer: This is one that really stirs the surrogacy community up, but let me make it clear that transferring multiple embryos to increase likelihood of pregnancy is no longer evidence based. It sounds like it makes sense at first, but it is not backed by science. It just increases your risk of multiples, and there are some theories that transferring a lower grade embryo with a higher grade embryo makes a pregnancy LESS likely to occur or sustain. Multiples occurred through IVF increase the interventions pushed in pregnancy and birth and enhances your risks for pre-term labor, placental complications, pain, rupture and more. If your Reproductive Endocrinologist recommends transferring two or more, run away. You should always transfer ONE for yours and baby’s safety. Transferring two or more, to “save money”, is NOT worth it.Also, how many separate transfers are you willing to do before you have the option to drop the contract? The standard is three, but it’s absolutely your choice. It can be very taxing on your body and may require out of state travel and lots of time away from your own family.
- Termination: Under what circumstances are you willing to terminate? None? Any? Parents choice? Specific birth defects? Multiples? You absolutely must know what your stance is on this and put it in the contract.
- Parental Involvement and Contact: How involved do you want the parents to be? Would you like someone local that can attend every appointment? Or do you prefer someone to give you space through the pregnancy and update them via text or call after each appointment? Can you tolerate communicating via translator if your parental match is foreign? Are you comfortable with them being present through the entire birth, or are you more private?
- Birth plan: Do you want someone that is okay with a natural birth? Home birth? Birth center? Hospital? Who will your provider be? Are you okay with being induced if requested? Would you agree to a scheduled cesarean? What are your limitations on intervention? At what stage of labor do you plan to go to the hospital? Who will be present in the room if you need a cesarean and only one person can go with you? What happens if the parents don’t make it to the birth? Who will cut the cord? Who do the baby/babies go to immediately? Would you like a doula present? A birth photographer? If so, who covers those costs? Will you share a room after birth? Who gets the placenta(s)?
- Providing Breast Milk: Are you willing and able to provide breastmilk?What will be your charge per oz? Will you do it for free? How long are you willing to provide for?
There are certainly other factors to consider as well that your lawyer will discuss with you in building contracts, but those are the main, important factors.
The Evaluation Stage
Now, let’s move on to the evaluation stage! In this stage you will be required to attend several appointments, gas and time coming from your own pocket. This involves a medical evaluation of your reproductive organs and general health at a Reproductive clinic, an approval from your OBGYN for clearance of pregnancy, a psychological evaluation for you and your partner, a background check, and a blood draw to screen for diseases, drugs, hormones and nutrient levels.
You will need to get a hysteroscopy during the medical evaluation, in which they insert a catheter into your uterus and fill a balloon with saline to examine you for cysts, endometrial tissue abnormalities, and uterine shape to check for optimal conception and pregnancy chances. It’s not really painful but definitely feels odd and you may experience period like cramps and bloating after. You will need a recent healthy, normal Pap smear and pelvic examination from your OBGYN for pregnancy clearance. If you are not immune to specific “preventable diseases” some reproductive clinics may require you to be immunized before proceeding. If you have any drugs in your system, you will be denied point blank, for obvious reasons.
During the psychological evaluation you will need to take a test that’s about 300 questions long, it tests for psychotic and sociopathic tendencies and how risky of a person you are. It’s all multiple choice and true or false, and based on your own opinions, so don’t worry, you don’t need to study. Then you will meet with the psychologist where she or he will chat with you about your surrogacy motives, family psychological well-being, how safe your home is, how your birth and previous pregnancy experience was, how you feel about different surrogacy scenarios and what you would do in those situations, and they will gauge your partner’s well-being and how supportive they are of the surrogacy. Your partner must be completely on board. If you don’t have a partner, you must have great support, such as your parents, reliable childcare or someone else that can be there when you call, as needed.
You also must be at least 21 years old, not be on any type of government financial assistance (food stamps, WIC, or any variety of that), have had at least one healthy, complication-free and term pregnancy and be raising said child. People who have had gestational diabetes, pre-eclampsia, antenatal depression, pre-term delivery, hyperemesis gravidarum, placenta accreta, or any other complication may not qualify.
Once you have gotten through all that, now it is time to start contracts. Contracts can take several months for some matches, and as little as a couple weeks for others. Have your lawyer go over EVERY SINGLE DETAIL and ASK QUESTIONS. ADVOCATE for yourself, or you may regret it. Remember all those values we mentioned before and include them ALL. It doesn’t matter if you are “being complicated,” the lawyers are making thousands off this contract and it’s so worth it to protect yourself. Take your time, don’t feel rushed by this part. You will need to have your contract notarized and if you are married, your spouse will need to sign as well, in most states.
Now, we move forward into the process of getting pregnant! Are you exhausted yet?? LOL
You may have a mock cycle to see how your body responds to medications, or may be put on birth control to syncopate your cycle with the Intended Mother’s if doing a fresh transfer. The medication protocol is different per every clinic, and sometimes different per each individual, so it’s truly hard to gauge what your specific cycle will look like. It is EXTREMELY rare that a clinic allows a natural cycle so do not hang on those hopes going into it.
The medications you may be put on include:
Birth Control (this may be the mini pill or something stronger)
Lupron (this is an ovulation suppressor and is self-injected into your abdomen)
Estrogen (this may be oral or self-injected)
Progesterone (there are many forms, PIO, or progesterone in oil is the most common and effective, and is injected into your upper buttocks or your thigh, you may be on this for 2 months or more once transfer occurs. There is also oral progesterone and vaginal suppositories and those may be used in combination with progesterone in oil or solitary.)
PLEASE research the side effects of these medications before proceeding, they can have life long effects and include but are not limited to, dizziness, fainting, vaginal bleeding, painful and sore knots at injection site, allergic reaction, nausea, vomiting, migraines, sore breasts, infertility and cancer of the breasts, cervix and ovaries. Progesterone supplementation can lead to placental complications and those complications are common in the surrogacy world.
I also strongly encourage you to look into birth trauma and primal memories of infants, but that’s a subject for a different day. Surrogacy is not victimless and not solely a positive gift, no matter the relationship between the surrogate and parents. Moving forward…
My Surrogacy Story
This is my personal story and perspective of my surrogacy, after sharing that informational bit. Take it and do with it as you will!
I had always envisioned myself one day carrying a child for someone that couldn’t, I was not actively pursuing, it wasn’t something I was necessarily looking to do right away at the time, but I was open to it and researching it and did talk to a couple women that were connected to me by a friend that had her babies via surrogate. Between these first conversations I realized what was important to me.
I met a woman that was the sweetest soul, her story touched my heart. I spoke with her about my intentions and knowledge for the pregnancy and birth, and she communicated that there was trust and free reign, that she agreed with how I felt about interventions, that it was my body to make informed and safe choices with, that she believed in the natural lifestyle, she was raised naturally and her business seemed to jive with exactly what she was saying. I thought we connected very well, that I had found my soul sister. We talked for months and months, and I even drastically lowered my compensation to almost nothing because I truly thought this was a lifelong bond and connection, as it should be, and as it was portrayed from her that it would be. The monthly compensation wouldn’t even pay my rent by itself, if that gives you any idea of how low it was. But I was okay with it because I felt that she truly respected and appreciated me, and that’s all I wanted, to bless a loving pair of souls with a beautiful little baby, it was never about money for me. I bring up the low compensation because when you’re a surrogate, at least in my experience, apparently it’s justifiable that the parents treat you however they want because they pay you so well. I beg to differ.
I went through every check of the process with flying colors. I responded to the medications with ease, was injecting myself daily but pushing through.
We transferred two embryos and both of them implanted, that evening I felt the actual implantation and remember pointing out the exact spots of the implantation to the mother, it was pretty cool to be so in tune to my body at that time. We got a positive pregnancy test just 3 days later. I flew home the day after.
Then, just 6dpt…
About 5 weeks go by and my pregnancy tests have just been getting darker and darker and my HCG is through the roof. A little nausea and sickness has started to show itself, but I didn’t think much of it. I went to my first ultrasound of the pregnancy and I remember the tech asking me how many embryos I had transferred as she turned the screen to me to show me two distinct sacs with little beans growing in them.
As the days passed after this appointment and my HCG kept spiking, my little bit of nausea turned into violent all day sickness, barely keeping water down, fainting spells, and basically bed ridden. Turns out, the medications used for surrogacy and IVF can stimulate H Pylori overgrowth and cause Hyperemesis Gravidarum.
And then things got worse again… Had my first and only ER trip at 14 weeks because I started to faint again, and felt like I was dying this time. My body was so depleted. My BP was very low and my heart rate was 150 resting, obviously my body was in dehydration survival mode. My husband quickly whisked me to the hospital and they were able to replenish my fluids and check on the babies but they also found placenta previa. Handling my sickness was a challenge between the parents and I because they weren’t comfortable with CBD oil, or prescription meds. I was at a loss.
There were also payment complications with bills. Somehow my moms FSA account got charged from that hospital bill, payment plans in my name were discussed, but in the end it all got paid, after a very stressful few days for everyone. So be aware this can happen! This is why it’s important to have an escrow account.
Finally, around 17 weeks, I came out of the horrible sickness I was experiencing. Around 20 weeks the placenta previa cleared on its own.
At 24 weeks the parents came down again, this time for a little bit longer, and I was forced into a high risk MFM appointment, for absolutely no reason, where they did almost a two hour long ultrasound that was very painful. If anything, those high risk appointments are WHY women lose babies because of how stressful they are. The doctor there put it in the mother’s head that an induction must be done at 38 weeks for twins or else they could die. Couldn’t give any statistical or scientific back up for this, she said it just is what it is. On our two hour car ride trip back to my house, I explained how inaccurate that is and even found studies that negated what the doctor said.
For the remainder of my pregnancy, this would be an issue that continuously came up – the doctors wanting to schedule an induction. At this point, I felt I was the only one truly advocating for the health of the babies, and that no one understood how dangerous this was and started to shut down emotionally. After all, lung development continues well up to 40 weeks and beyond, why would we want to risk them having poor breathing and spending time in the NICU?
For the rest of the pregnancy it was almost nothing but a hassle, and dealing with people watching me in surrogate groups on social media. Anything I would post in private surrogate only groups were immediately sent to the parents, so I didn’t even have a safe place to express my feelings anymore. Things were taken out of context and made the parents feel concerned with my emotional well-being and state of mind. Even someone I thought was a good friend sent screenshots of text messages of me venting, which caused a major wedge in the surrogate-intended parent relationship that never needed to be there.
As “induction day” drew nearer, tensions were high, speaking terms were non-existent, and I was gathering the necessary tools and speaking with legal people in preparation for a court battle, if need be. I cancelled the induction appt.
At the same time, the OBs office was also giving me a hard time, refusing to even see me if I wasn’t going to be induced, which is completely unethical and from what I read up on, actually illegal. I forced my way into the office and demanded an on the spot appointment because I wasn’t about to be accused of breaching contract just because I didn’t have my weekly appointment. I allowed the weekly NST, as usual, and the chart immediately picked up back to back contractions, and a hard time picking up baby A (the boys) heart rate. The OB asked me to just do an hour of monitoring in the hospital to be safe.
Monitoring at the hospital still showed contractions back to back, though I wasn’t feeling a thing so I assumed it was at best early labor, I could see them and they were nice and strong and steady. But I wanted to go home.
About mid point of monitoring, I got up and had to go to the restroom pretty badly. I felt a lot of pressure. My water gushed out with a pop and was a heavy flow, there was no mistaking, but I was still doing great. They came back in to hook me up and I let them know my water had broken and she asked to check me to see where I was at and I agreed to one check, I was 7cm. Well, guess go time is soon then, I thought. The OB came in quickly and announced that I needed an epidural, and with a calm and collected face (still having no contractions), I told her absolutely not and signed a non consent for pain medication form. My beautiful doula friend came to support me at this point. I asked them to call the mother and when she got there, things got really obnoxious with them trying to force the epidural.
Basically telling me I either get it or I’m having a c section right now. I asked the doctor to place it without running it, so if there was an emergency, it was quick easy access. I thought this was a good compromise that I could live with.
While they were preparing the anesthesiologist, I entered transition and was in my zone. On the floor, on all fours, full on growling though contractions in a true animalistic state. It was the most powerful feeling that I will never forget. Toe curling, full body coursing, back to back intense pressure. Like a hug from a large person that’s just way too tight, but is warm and familiar.
Now let me tell you, trying to sit still through transition with nurses holding you down while they place a needle in your spine is outrageous and gross. A needle that I didn’t even want. A needle that served me no purpose. I was at the finish line, let Birth happen for goodness sake.
And, wouldn’t you know it, they ran the damn medication anyways without permission. My body instantly reacted very badly. At first I started to go numb, then I felt my body go weak, tingly, my vision went blurry, now black and in and out of consciousness. I was shaking profusely. All I could think in my head was don’t pass out or they will cut you, don’t die for this, you have your own baby at home. My BP tanked to 70/30.
Tons of nurses rushed in to try to stabilize me. All of this for a medication that I was refusing. I should have kicked them in the face. I should have been stronger. In this test, I surely failed. The strength that I am for other women, I couldn’t even be for myself. I was ashamed.
They pulled the epidural and I regained myself and started to regain feeling and immediately went straight to the best part, when the babies came from womb to earth. I didn’t have all my feeling back for when the boy came, I was still a bit limp in my legs so I gave a little effort of push for him. With the girl I had my body back and FER completely took over when she was ready! She took her sweet time, coming 45 minutes after the baby boy, descending and my body taking a nice little break in between them, but she flew on out when she was ready with minimal efforts on my part!
The parents and I shared a room the first night and the babies were discharged before I was. I was able to make it home just in time for my baby boy’s third birthday party on the 7th! My son’s birthday is July 3rd and the twins is July 5th.
Because of misunderstandings, the parents and I didn’t talk from about 3 weeks postpartum to about 4-5 months postpartum, in which we fought about bills and all the complicated crap that happened in the surrogacy. It all surrounded expectations that weren’t met and hurt feelings.
If you ask me if I would ever do surrogacy again, the answer is no. I wouldn’t even go back and re-do the surrogacy I had. I would have never chosen to pursue it, knowing what I know, now. I think it is one of the least natural and most emotionally complex things you can do. I would only ever do it for my siblings, if needed. It aged me immensely, caused an array of health issues that who knows when I will fully recover from and has a lasting emotional impact. Not because of the bonding with the babies, I didn’t feel sadness when they were given to their parents, but the sadness that the surrogacy was everything I didn’t want. The birth wasn’t even breezy, though short, it too, was stressful. There are some that have beautiful, heart warming stories about their surrogacy and go on to have many journeys, and I wish I did too, but alas, there are two sides to surrogacy, and I’m here to share that it isn’t all rainbows and butterflies.
It has been a year since I had the twins, and my, oh my, how things have changed. I have not spoken to the mother in several months, even prior to my son’s cancer diagnosis in April. Needless to say I am so disappointed that she did not even care enough to reach out when my son was diagnosed, when mine or his birthday came around, or even at all on the twins’ birthday. It is such a shame to give someone so much love and happiness into their world without any gratitude. But I am generally at peace with it, I cannot make other people be good people out of pure desire, they have to choose to do so on their own.
Thanks for reading. Feel free to reach out with anything I did not answer here..