Look at Kim Kardashian and Kanye West, Keith Urban and Nicole Kidman, Ellen Pompeo and Chris Ivery, Elton John and David Furnish—high-profile celebrities who, at one point or another, all turned to surrogacy as a way to expand their families. “This is an incredible thing to do with your life, to give the gift of carrying someone’s child,” Grey’s Anatomy star Pompeo said of her personal experience with surrogacy. “I am forever grateful and feel very blessed and grateful to her—she who will remain anonymous. I was there with her when they inseminated her, and we held hands. I looked into the microscope and I saw the embryo.” Although celebs have brought surrogacy into the limelight in recent years, it’s actually been around for a long time. Surrogacy has been a lifeline of sorts for individuals looking to have a child without a partner or for same-sex couples. Before we dive deep into surrogacy, here are a few important terms to know:
An intended parent is a person who intends to be legally bound as a parent of a child resulting from assisted reproduction or a gestational carrier agreement.A gestational carrier is a woman who has agreed to carry a pregnancy for an intended parent that is not created using her own egg.A genetic surrogate is a woman that contributes her egg to create a pregnancy and carries that pregnancy for an intended parent.
Historically, the two types of surrogacy have been called traditional and gestational; however, in recent years the language has changed to be person-first: Gestational carrier, surrogate, and genetic surrogacy. Parade consultedDr. Sanaz Ghazal, Co-Founder and Medical Director of RISE Fertility, who also vetted and approved the information in this article. “A gestational carrier (also sometimes referred to as a ‘gestational surrogate’) is a woman who carries a pregnancy for another person (an intended parent). The gestational carrier does not provide the egg so she is not genetically related to the child,” Dr. Ghazal tells Parade. “A surrogate is a woman who both donates her egg and carries a pregnancy for another person. This was termed ’traditional’ surrogacy, but more recently it is referred to as ‘genetic’ surrogacy.” Dr. Ghazal adds, “In these cases, a woman is inseminated with a man’s sperm and even though she is biologically related to the child, she has no intent to parent the resulting child.” For answers to the most frequently asked questions about surrogacy—including what it is and how much it typically costs—keep reading.
What is surrogacy?
First off, what exactly is surrogacy? As Dr. Ghazal answers above, surrogacy is a non-traditional way to have children in which a woman carries a pregnancy for another individual or couple. A couple or individual may elect for surrogacy due to medical issues that prevent a woman from getting pregnant or giving birth or complications that prevent adoption or make it difficult. Some same-sex couples may pursue surrogacy as well. The two types of surrogacy are genetic and gestational. “[Genetic] surrogacy is when the surrogate’s own genetic material—her own eggs—are used to create the embryos that will be used in the pregnancy,” Parham Zar, founder of Egg Donor & Surrogacy Institute (EDSI), tells Parade. “Gestational surrogacy is when the surrogate has no genetic link to the baby that she carries—either the intended mother or an egg donor was the source of the egg.” Zar adds, “Almost all surrogacy cases are now gestational surrogacy.” You may also come across other terminology for the two types of surrogacy—full, which refers to gestational surrogacy, and partial surrogacy, which refers to genetic. Still, according to Dr. Ghazal, “gestational” and “genetic” are becoming the standard descriptors. In addition to wondering what surrogacy actually is, you may also question why some people choose to use it as a family planning method. “There are several indications for the use of a gestational carrier. A GC may be used if the intended parent has a medical condition that prevents her from carrying a pregnancy or that would present a significant risk to her or the baby,” Dr. Ghazal explains. “Some women have anatomic abnormalities of their uterus, which make it difficult for her to conceive. Members of the LGBTQ+ community may also use gestational carriers to help them build their family.”
How does a surrogate mother get pregnant?
Typically in surrogacy, the surrogate mother gets pregnant via in-vitro fertilization. If it is a genetic surrogacy, then the surrogate mother’s own eggs will be used, if it is gestational surrogacy, the intended mother will serve as the egg donor. “The surrogate mother gets pregnant through a process called in-vitro fertilization, where embryos are created in a lab using an egg and sperm source,” Zar explains. “Then the embryo is inseminated into the surrogate.”
How much does surrogacy cost?
As is the standard with most non-traditional ways of having children—IVF included—surrogacy can cost a fair amount of money. “Using a gestational carrier can be expensive,” Dr. Ghazal explains. “There are several fertility treatment-related costs such as medical screening, blood work, medications, agency fees, legal contracts that need to be drafted, mental health screening in addition to the cost of the treatment itself. Intended parents are also responsible for compensation for the GC, covering obstetric care, health insurance, and other possible related costs, which are usually outlined in a contract between the IP and GC before cycle start.” As you can imagine, all that adds up. “There are many factors to consider when looking at costs of surrogacy,” Zar says. “However, a magic number to consider is about $100,000.” However, the cost of surrogacy typically varies based on whether the surrogate has her own insurance and whether or not a surrogacy-pregnancy policy is needed. According to Dr. Ghazal, some carriers are also paid, depending on the terms of the contract. “A gestational carrier may be paid or unpaid. Typically, paid gestational carrier contracts are arranged through a third party agency,” Dr. Ghazal explains. “Some intended parents choose to use friends or relatives as a gestational carrier, in which case they are sometimes unpaid.”
Where is paid surrogacy illegal?
Despite the hefty price point of surrogacy, paid surrogacy is technically illegal in many areas. “There are many legal considerations involving surrogacy,” Zar explains. “One thing to note is that surrogacy is unfortunately not legal everywhere. In some countries, surrogates can be reimbursed for their medical expenses and time and in others, it is only allowed on an unpaid, altruistic basis, which can make it very hard for intended parents to find a surrogate.” According to Surrogate.com, surrogacy is legal in the following U.S. states: California, Connecticut, Delaware, District of Columbia, Maine, New Hampshire, Nevada, Oregon, Rhode Island, and Washington. Alternatively, states like Michigan and New York specifically prohibit paid surrogacy arrangements and therefore, in the states, surrogacy may be subject to fines or other criminal penalties. “The law around surrogacy and the use of a gestational carrier vary from state to state,” Dr. Ghazal says. “Some states, like California, have favorable laws and policies around third-party reproduction, so some intended parents choose to travel to those areas in order to build their families.” Of course, there are ways around this. In fact, some people even consider traveling in order to make their surrogacy dreams come true and in many cases, contracts are drawn up to mitigate confusion and to protect all parties. “It is very important to work with an agency, such as EDSI, which can guide you through all the aspects of your surrogacy, including the complex legal considerations in your state,” Zar adds.
Will the baby look like the surrogate mother?
Because surrogacy isn’t always entirely understood, many people wonder if the baby will look like the surrogate mother. The short answer is: It depends on the type of surrogacy. “In the case of gestational surrogacy—where the egg of the surrogate mother was not used—there is no genetic link between the surrogate and the baby, so the baby will not have the surrogate [mother ’s] genes and looks.” In the context of genetic surrogacy, however, the embryo would be made from the surrogate mother’s genetic material and therefore would inherit the surrogate mother’s genes and looks. Surrogacy is also often used in many same-sex marriages as it provides an opportunity to have children to couples who may not be able to naturally. “Members of the LGBTQ+ community may also need to explore the surrogacy option to help them build their family,” Dr. Ghazal says. “A male couple or intended parent can use an egg donor to combine with sperm to create an embryo, which can then be transferred into a gestational carrier. If a genetic surrogate is being used, a male intended parent can also consider an intrauterine insemination with a genetic surrogate who would contribute the egg as well as carry the pregnancy.” Dr. Ghazal continues, “Lesbian couples may need to use a surrogate if one or both partners are unable to carry a pregnancy. Lesbian couples may also consider reciprocal IVF, which is different from surrogacy. In reciprocal IVF, one partner contributes the egg, which is combined with sperm to create an embryo, and an embryo is then transferred into the uterus of the other partner who carries the pregnancy.” Celebrity same-sex couples who have used surrogacy include Elton John and David Furnish, David Burtka and Neil Patrick Harris, Perez Hilton, Ricky Martin, and more.
Is it insensitive to ask about someone’s surrogacy experience?
Maybe. Understand that every person’s surrogacy journey—for all parties involved—is incredibly personal and sensitive. “Conversations with someone who has had a child via surrogacy can be a little sensitive,” Dr. Ghazal says. “These journeys are often complicated, long, and emotional, so, it’s usually best not to ask probing questions, but instead give them the space and opportunity to share what they feel comfortable sharing. Some people are very open about their experience, but some prefer to remain more private and that’s OK. Out of respect for the parent, avoid conversations about surrogacy in front of the child and take the parent’s lead when navigating these discussions.” First and foremost, remember that there is no right or wrong way to build a family and to always take the parent’s lead when discussing such sensitive subjects. Dr. Ghazal adds, “There are so many ways to build a family and they are all beautiful. Third-party reproduction is gaining in popularity with more and more people choosing to go this route to have a baby. But this process can get complicated very quickly, there are many options to consider, and it’s easy to get overwhelmed. I always recommend working with an experienced board-certified Fertility Specialist to help you navigate this journey and to help you understand your options in light of your goals. Empower yourself with evidence-based and personalized information to help you make the best decisions about how to grow your family. At RISE Fertility, we partner with our patients and guide them through every step of the process to help them achieve their goals.” Next up, everything you ever wondered about pregnancy and labor, answered.
Sources
Dr. Sanaz Ghazal, Co-Founder and Medical Director of RISE FertilityParham Zar, founder of Egg Donor & Surrogacy Institute (EDSI)
