Bringing a child into the world via a surrogate was once rare, but now surrogacy is becoming increasingly common—and not just among celebrities. In fact, the Centers for Disease Control and Prevention (CDC) reports that number of embryo transfer cycles that used a gestational carrier increased from 2,841 in 2011 to 9,195 in 2019. That’s a three-fold increase! Despite the growing prevalence of surrogacy, stigma remains. Research shows that 33% of people who have completed their surrogacy journey feel that the social stigma attached to surrogacy is “significant.” Part of the reason? Misinformation. To help with that, keep reading to learn what surrogacy is, how it works, and what using a surrogate really costs.

What is surrogacy?

Surrogacy is when a person carries and gives birth to a baby for another individual or couple.

Most surrogate pregnancies are conceived via in vitro fertilization (IVF). IVF is when an egg and sperm are extracted from individuals and then used to create an embryo in a lab setting. Once the embryo is made, it’s transferred into the surrogate’s uterus. In some cases, the egg and sperm are from the intended parents and other times the egg and/or sperm are from a donor.

What is a gestational surrogate?

A gestational surrogate carries a baby but has no genetic connection to the child. In other words, the pair are in no way related. Instead, a gestational surrogate carries an embryo from the intended parents—or, less often, from a donated oocyte (a cell in an ovary) or sperm. Because of the complexities and risks surrounding surrogacy, the American College of Obstetricians and Gynecologist (ACOG) does recommend gestational surrogacy be reserved for situations where carrying a pregnancy is “biologically impossible or medically contraindicated for the intended parent(s).”

What is a traditional surrogate?

Traditional surrogacy is when the surrogate’s own egg is fertilized by an intended parent’s—or  donor’s—sperm by way of IVF. That means with traditional surrogacy, there is a genetic link between the surrogate and the child—and the surrogate must legally surrender their parental rights. Many surrogacy agencies no longer offer traditional surrogacy arrangements because it’s “more legally and ethically complex” than gestational surrogacy. In fact, traditional surrogacy is illegal in many states.

What’s an altruistic surrogate?

Altruistic surrogacy (also called compassionate surrogacy) refers to an arrangement in which a surrogate carries a baby for intended parents without payment. This arrangement is generally reserved for a close friend or family member acting as your surrogate. While you don’t need an agency for this type of surrogacy arrangement, you should definitely consult with a qualified reproductive lawyer before you embark on your compassionate surrogacy journey, so that all parties fully understand the laws in your state.

Is surrogacy legal?

Yes. Gestational surrogacy is legal in the United States, but surrogacy is not federally regulated. That means surrogacy laws vary widely from state to state. For example, surrogacy is essentially illegal in Michigan where surrogacy contracts, agreements, or arrangements are legally void and unenforceable. Meanwhile in California it’s legal and regulated by the state’s surrogacy laws. To find out what the surrogacy laws are in your state, check out the American Society of Reproductive Medicine’s (ASRM)  guide to state surrogacy laws.

Because of the confusing and varying laws across the country, the ASRM recommends that both the surrogate and the intended parents both have independent representation by lawyers who are well-versed in surrogacy contracts within the state or states where everyone resides—and intend to deliver.

Why do people choose gestational surrogacy?

Gestational surrogacy allows individuals and couples to have biological children in situations where it normally would not be possible. So it stands to reason that surrogacy is most often used when a medical issue or abnormality makes it so a prospective parent physically cannot carry a baby. In addition, 75% of those who turn to surrogacy tried to conceive for more than three years beforehand. Folks may turn to gestational surrogacy if the intended parent…

• Is infertile due to a hysterectomy or other issues related to the uterus

• Is biologically incapable of conceiving or carrying a child, for example, a single person or cis-men in same-sex relationships

• Cannot be pregnant or give birth due to a serious medical or psychological condition that puts them or their unborn baby at risk

• Has had multiple unexplained in vitro fertilization failures despite the transfer of good-quality embryos.

How do I find a surrogate?

Finding a gestational carrier is generally not a go-it-alone type of situation! Instead, most folks who are interested in surrogacy meet with a surrogacy agency. The agency helps to locate a gestational carrier who’s a good match, they establish legal agreements between the parties, and essentially act as the middlemen between the gestational carrier and the hopeful parents. (A recent survey from one surrogate agency found that 87% of intended parents successfully found a surrogate match in less than six months.) If you’ve been working with a fertility clinic, it’s a good idea to ask for a list of reputable and recommended surrogacy agencies, especially since there’s no federal oversight or set standards that surrogacy agencies must adhere to.

At the very least, make sure your surrogacy agency follows the ethical guidelines developed by the ASRM, which recommends…

• Legal counseling: This helps to ensure that the gestational carrier understands the laws surrounding the surrogacy agreement.

• Ideal age: ASRM recommends surrogates fall between 21 and 45 years old, but preferably younger than 35.

• Weight: The Yale Fertility Center—and other centers and agencies—require gestational carriers to have a body mass index (BMI) less than 30, but preferably less than 27.

• Pregnancy history: An ideal surrogate will have had at least one, but no more than five, complication-free, full-term pregnancies—and no more than three prior c-sections.

• Support system: Having a stable family environment with adequate support is important for a successful surrogacy arrangement.

• Infectious diseases screening: Questionnaires, physical examination, and laboratory testing should be utilized to screen for HIV, hepatitis, gonorrhea, chlamydia, syphilis, cytomegalovirus, and more.

• Preconception testing: This testing should include blood type and Rh factor testing, cervical cancer screening, a urine drug screen, and more.

• Vaccinations: It’s suggested that gestational surrogates should get all ACOG and CDC recommended vaccinations, including measles, mumps, rubella (MMR), Tdap, and the COVID-19 vaccine.

• Psychosocial testing and counseling: A psychosocial assessment that evaluates an individual’s mental and emotional health should be conducted by a qualified mental health pro who’s experienced in gestational surrogate evaluations. This should happen before legal counseling and signing any legal contracts.

How does a surrogate get pregnant?

A gestational surrogate undergoes some of what’s involved in standard IVF treatment—but there are key differences. For example, since the surrogate’s own eggs don’t need to be collected, there’s no need for the surrogate to receive ovulation-stimulating injections. Instead, the egg donor gets the hormone shots and undergoes the egg retrieval process. The surrogate, on the other hand, takes fertility meds to prep the uterus for an embryo. Once the embryo is ready, it’s implanted into the surrogate’s uterus.

What’s the success rate of gestational surrogacy?

When compared with other fertility treatments, the success rate of gestational surrogacy pregnancies and births is relatively high. A 2020 report found that when donor eggs originated from someone under 35 years old, the live birth success rate was roughly 58%, where the live birth success rate for IVF is approximately 47% for those in the same age group.

That said, surrogacy is not without risks and potential pitfalls. For example, 53% of surveyed intended parents have experienced what’s called a “broken match” during their surrogacy journey. That means the intended surrogate did not work out for a variety of reasons, including the failing medical clearance, which is the primary reason for a broken match. 

What does surrogacy cost?

Surrogacy is not cheap! Research shows that the average soup-to-nuts cost of surrogacy is roughly $162,000. The broad breakdown is generally something like this:

• IVF: $20,000

• Agency Fees: $20,000

• Health Insurance: $15,000 to $30,000 (Since most insurance plans don’t cover surrogate pregnancies, hopeful families will likely need to pay the premiums and deductibles for their surrogate’s insurance plan.)

• Surrogate Fee and Expenses: $30,000 to $50,000

• Legal and Counseling Fees: $20,000

• Other costs: Invasive procedures, multiple pregnancy, c-section, and other contingencies increase the total

Compensation to your surrogate should be agreed upon before your move forward with IVF—and it should be clearly documented in the legal contract you’ve created.

 

Infertility, Adoption, Fostering, and More:

• After Tragedy, Laura Hutfless Knew Adoption Was Her Path
• This Foster Mom Leaned on SNOO
• Making Sense of Secondary Infertility
• Heartwarming Adoption Announcement Ideas
• Super-Sweet IVF Pregnancy Announcements

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REFERENCES

• Centers for Disease Control and Prevention (CDC): Assisted Reproductive Technology (ART), 2020 National ART Summary
• Surrogate First: Intended Parent Survey 2023
• Cleveland Clinic: Gestational Surrogacy
• American College of Obstetricians and Gynecologist (ACOG): Family Building Through Gestational Surrogacy
• American Society for Reproductive Medicine (ASRM): Gestational Carrier (Surrogate)
• Gestational Surrogacy: Current View. The Linacre Quarterly. April 2019
• ASRM: Recommendations For Practices Using Gestational Carriers: A Committee Opinion (2022)
• Yale Fertility Center: Surrogacy
• ACOG: Maternal Immunization
• CDC: Pregnancy and Vaccination
• Women & Infants Fertility Center: Eight Things You Should Know About Gestational Surrogacy
• Society for Assisted Reproductive Technology: National Summary Report, Patient’s Own Eggs, Live Births Per Live Patient
• UT Health San Antonio: What are my chances of success with IVF?
• Incidence of surrogacy in the USA and Israel and implications on women’s health: a quantitative comparison. Journal of Assisted Reproduction and Genetics. December 2019

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Disclaimer: The information on our site is NOT medical advice for any specific person or condition. It is only meant as general information. If you have any medical questions and concerns about your child or yourself, please contact your health provider.