Surrogacy provides an amazing opportunity for queer men to have a biological connection to their child. In a gestational surrogacy arrangement, which is the most common version practiced, a woman — known as a surrogate, gestational carrier, or surrogate mother — will be compensated for carrying a baby to term for the intended dad or dads.
Surrogacy will also involve an advanced fertility treatment known as in vitro fertilization (IVF), during which a fertility center will create embryos, using sperm from an intended father and an egg donor, which in turn will be transferred to the surrogate's uterus.
Surrogacy and IVF are complicated processes — but you don't have to go through it alone! We've created this comprehensive guide to help break down gay surrogacy and IVF, step by step. Still have questions? Schedule a free consultation with one or more of our partners to fatherhood below.
The surrogacy and IVF process is a complicated one, and comes with its own specific language that could use its own Rosetta Stone course. We’ve created this guide to break down surrogacy and IVF step by step.
First, you will need to work with a fertility clinic and IVF laboratory — where a doctor, a reproductive endocrinologist, will conduct medical screenings, create embryos and help your surrogate achieve pregnancy. Reproductive endocrinologists specialize in using advanced fertility technology to help you have your child. You should be sure to work with a reproductive physician and fertility clinic that has extensive experience with surrogacy — and particularly with gay, bi and trans intended fathers.
You will also need to work with an experienced assisted reproductive attorney, who will negotiate legal contracts with your surrogate and egg donor. Some surrogacy agencies have lawyers in-house and can help you navigate the legal aspects of the journey in addition to coordinating the overall journey. If your surrogacy agency does not have lawyers in-house, you will need to hire your own outside counsel. Your lawyer will help you navigate two critical issues:
Surrogacy is legal in most states — but each state has a different set of laws that govern surrogacy and egg donation. You will need to make sure you have a lawyer that understands the nuances in each state.
Your lawyer will also need to understand the steps needed to establish your parental rights and to sever those of your surrogate’s. This is best done through obtaining a “pre-birth order” from a judge, which will establish you as the legal parent before the birth of your child. However, not all states permit pre-birth orders. In this instance, your lawyer will help you obtain a “post-birth order,” which will confer your legal parental status after the birth of your baby.
Next, you will need to work with an experienced mental health professional. The American Society for Reproductive Medicine (ASRM), which offers guidelines for the ethical practice of surrogacy, recommends you, your surrogate and your donor — and each of your partners, where relevant — undergo screening by a trained mental health professional early on in the process.
You will also need the support of fertility insurance experts, who will help make sure both your surrogate and egg donor are properly covered. Your surrogacy agency should help facilitate that process. Even if the surrogate has her own health insurance that is approved to cover her maternity care during a pregnancy, parents should expect to compensate her for using that insurance, as well as paying her premiums and deductibles during the journey. You will also need a special form of insurance for your egg donor, as insurance companies do not cover the egg donation process.
If you’re feeling overwhelmed by all of these professionals, the last team member — your surrogacy journey case worker, is meant to help guide you through this all. In most instances, your surrogacy agency will assign a caseworker who will help support and guide you throughout your entire journey.
You will be working incredibly closely with your team of experts, it’s important that you feel comfortable with your professionals. Make sure to speak with several before making a decision. And see our founding member page for a listing of agencies and IVF Centers with a long track record of working with gay, bi and trans men.
Most people choose to work with a surrogacy agency to complete their journey. (Though you can also do an independent surrogacy journey on your own). What does a surrogacy agency do? Well, they are responsible for a wide range of responsibilities to help you through your journey, including recruiting and screening your surrogate and managing most aspects of your journey, start to finish. Surrogacy agencies will help you obtain proper insurance to cover your surrogate and egg donor.
Most people choose to work with a surrogacy agency to complete their journey. (Though you can also do an independent surrogacy journey on your own). What does a surrogacy agency do? Well, they are responsible for a wide range of responsibilities to help you through your journey, including recruiting and screening your surrogate and managing most aspects of your journey, start to finish. Surrogacy agencies will help you obtain proper insurance to cover your surrogate and egg donor.
The American Society for Reproductive Medicine (ASRM), which sets guidelines for the ethical practice of surrogacy in the United States, advises that surrogates be between the ages of 21-45 years old — most tend to fall somewhere in the age range of 25 to 35. All surrogates must have completed at least one previous full-term pregnancy without major complications, and can have had no more than three cesarean deliveries. Guidelines also stipulate that surrogates must independently have sufficient emotional and financial support throughout the process. These guidelines, however, typically are just the very beginning of the screening process.
Surrogates undergo comprehensive psychological testing prior to being approved. This evaluation will seek to identify her motivations for wanting to become a surrogate, whether or not she has adequate support, both financially and emotionally, in her network, and additional measures such as her particular style of communication. Surrogates are also given a mental health test to help identify any potential personality or mental disorders that may complicate her ability to serve as a surrogate. Her partner or husband will be screened along many of these lines as well. Physical health screening: Applicants will also undergo extensive medical screening to ensure she is a proper candidate to serve as a surrogate. Typically, this will include a thorough review of her medical history, pre-pregnancy planning, a physical exam, a pap smear, STI testing, drug testing, and a uterine cavity evaluation. Surrogates will also be screened for blood antibodies to maximize the chances for a healthy pregnancy. Finally, the levels of certain hormones, like thyroid hormone are also checked.
Your surrogacy agency will be responsible for matching you with your surrogate. Part of that matching process will take into account what type of relationship you have with your surrogate before, during and after the surrogacy journey. You can also choose to work with a family member or friend in what’s known as an altruistic surrogacy arrangement. Your surrogacy agency will also be responsible for matching you with a surrogate based on many factors — including:
Your lawyer will help with the legality of matches, and determine if the match between you and your surrogate is legally sound.
Your agency will also want to ensure there is a proper fit with regards to timing and scheduling between you, as the intended parent, and your potential surrogate match.
In some ways, the most important part of the matching process is whether the intended parents and surrogates are a good personality fit. Agencies will try to generate matches so that both share the same expectations, hopes, and dreams for their upcoming journey.
Johnny & Sebastian - Dads Through Surrogacy
“We felt an overwhelming sense of joy and happiness”
If your agency doesn't have a legal department in house, they should facilitate the process of helping you find a highly qualified assisted reproductive attorney who is knowledgeable about the laws regarding surrogacy in your states. Your lawyer will also help you develop a detailed surrogacy contract with your surrogate that will help determine things like who will be at the appointments, under what circumstances a pregnancy may be terminated, and the type and frequency of contact throughout the pregnancy.
Your agency should provide you and your surrogate with the aid of mental health professionals whenever needed throughout the process. A surrogacy journey is excited, but it’s not without stress — things like a failed embryo transfer, a miscarriage, the need of a second surrogate, or any other number of unforeseen complications can and do occur. In these instances, your surrogacy agency should be there to help connect you to professionals who can help.
Your surrogacy agency will connect you with an escrow management company, that will be responsible for handling compensation and expenses for your surrogate and donor. Some agencies have their own escrow team in-house who will manage your funds on your behalf. During this process, your surrogate is going to have medical bills for prenatal care and delivery — any time those are sent in, they’ll be paid directly from escrow to the companies that provided services for your surrogate. Quality of agencies vary widely, so it’s important to do your research, and speak with several, before making a decision.
You will also need to work with a fertility clinic to complete IVF as part of your surrogacy journey. What does a fertility clinic do? They screen you, your egg donor, and your surrogate, conduct the embryo transfer, and monitor early pregnancy.
One of the first steps your fertility clinic will take is to conduct a semen analysis for you — and your partner if you both plan to create embryos — to ensure the samples are in the best condition possible. Your fertility clinic will also conduct testing for you and your partner if applicable for genetic issues to reduce the risk of your child having a recessive genetic disease such as cystic fibrosis by screening both you and your egg donor to make sure there is not a match that increases the risk of disease to 1 out of 4. Your fertility clinic will work with you to improve your sperm quality where needed, including suggesting certain lifestyle changes, such as quitting smoking, alcohol consumption, the usage of certain medications, and steps to help you maintain a healthy weight. Though roughly 98% of men will have viable sperm following these changes, the remaining 2% may need to seek the aid of a urologist for further analysis. Your fertility clinic will help connect you to a reproductive urologist if necessary.
Before you begin IVF, you will also need to find an egg donor. There are several different places you can find one to work with:
An “internal egg donor” will be one associated with a donation program run by the fertility clinic you’ve contracted with for your journey — not all fertility clinics maintain such programs, but many do. Generally, internal donors are local to your clinic, which can help cut down on travel costs for your donor during her egg donation process. But you may also have fewer options to choose from.
This type of donor comes from an egg donation agency. These agencies tend to have a much wider variety of egg donors to choose from, as they often recruit from across the country — increasing the possibility that you will find a donor with the exact characteristics important to you. However, this may increase your travel costs depending on where she is located.
Another option for sourcing a donor is through an egg bank. These are places that have cycled egg donors previously and have frozen their eggs. You will often be able to purchase six to eight eggs from an egg bank to help you in your embryo creation process.
Next, will come the egg donor screening process, per Federal Drug Administration (FDA) regulations and guidelines from the American Society for Reproductive Medicine (ASRM). Each potential donor will first need to complete a 14-20 page questionnaire about their medical history, personal lifestyle choices, and other factors that may impact their ability to be a successful donor. Donors will then undergo multiple health screening to test for infectious diseases, recessive genetic diseases, drugs and alcohol and more. She will also undergo mental health testing and screening to examine her mental health, motivations for donating, and to ensure she understands the implications of her donations. Most egg donors will also be between the ages of 21 and 30, and with stimulation can produce a large quantity of eggs — anywhere between 15 to 40. This rigorous screening process ensures only the best candidates proceed to becoming egg donors.
Among the most important parts of screening a donor will involve checking her ovarian reserve — which refers to the number of healthy eggs a donor is able to produce each cycle. This will involve a blood test called anti-mullerian hormone (AMH) and an ultrasound assessment of her basal antral follicle count and these two pieces of information predict how many eggs a donor will produce during a treatment cycle. Selection of your egg donor is one of the most important parts of the process, because her egg quality has a large impact on embryo quality, which will impact your success rate.
To help improve your chances of partnering with an egg donor that will produce a high quality and quantity of eggs, you may consider working with a “proven” or “experienced” donor who has successfully donated in the past, but this will increase your costs slightly.
When it comes time to create an embryo, it’s important to note that only a single sperm is used to fertilize a single egg — which can pose a problem for a couple made up of two men. The solution to this problem will not be to mix the sperm together — the IVF lab will not do this. And increasingly, to protect the health of your surrogate and the pregnancy, fertility clinics are recommending only one embryo be transferred at a time to avoid the risks of a twins pregnancy. So you and your partner will want to decide whose sperm to use at the outset of the IVF process. One common solution to this problem is to have half the eggs fertilized with one partner’s sperm and half with the other. Couples can freeze and store the embryos of the second father for use in a future sibling journey.
Next, it’s time to create embryos. Once both the eggs and sperm are screened and secured, your fertility clinic will fertilize the eggs from your donor with your sperm source, and then observe them as they grow into a healthy embryo — a 150 to 300 cell called a blastocyst. Most of the time, these embryos will be cryopreserved for use once your gestational carrier is properly screened and prepared. Many dads have five to 10 embryos cryopreserved from one egg donation process. Eventually, an embryo of your choosing will be thawed and placed into the uterus of the gestational carrier.
Before your first embryo transfer, you can opt to have your clinic conduct preimplantation genetic testing (PGT) to help determine which of the embryos you have created have a higher chance to result in a successful pregnancy. The PGT process will help your clinic identify embryos with any chromosomal abnormalities that can lead to conditions such as Down’s Syndrome. In some unique situations PGT can be used to screen out embryos with single gene disorders and even genes that may predispose your child to breast cancer. Testing can also help reveal which embryos contain abnormalities that may increase the likelihood of miscarriage or difficulty conceiving. This process can also be conducted if you hope to transfer an embryo of a particular sex.
Once ready for the embryo transfer, your fertility clinic will carefully use hormones to prepare your gestational carrier to receive the embryo. Your doctor will pay particularly close attention to the thickness of the uterine endometrial cavity lining. When ready, your embryo will be thawed and transferred into your surrogate’s uterus. A successful pregnancy can be detected 11 to 12 days after the embryo transfer.
When a sperm source, egg donor, and surrogate have all be thoroughly evaluated and deemed healthy — as is often the case for gay men using IVF and surrogacy to start their families — the success is very high. For gay men in these cases, the success rate for IVF is 75% to 85%. The vast majority of gay men using surrogacy will see a successful pregnancy within three transfers if the first two fail.
The quality of fertility clinics also vary widely, so it’s important to do your research and interview several before making a decision. Here are some tips for choosing your fertility clinic.
There’s no way around it — surrogacy is expensive. Most experts agree that surrogacy costs, on average, around $135,000 — but it can easily stretch upwards of $200,000 depending on your unique situation and requirements. Given this variability, it’s important the professionals you’re working with are very transparent about the costs involved in the process.
There’s no way around it — surrogacy is expensive. Most experts agree that surrogacy costs, on average, around $135,000 — but it can easily stretch upwards of $200,000 depending on your unique situation and requirements. Given this variability, it’s important the professionals you’re working with are very transparent about the costs involved in the process.
There are four main areas that impact surrogacy costs:
The agency fees refer to the professional costs associated with the coordination of your journey, legal work, social work screening, and the surrogate matching process. This includes all the associated services of the journey itself. Reputable agencies will ensure these costs are transparent and accessible — including a timeline of when certain expenses are expected to be paid.
The main fees incurred at your fertility clinic will be those associated with screening your egg donor, surrogate, and you — as well as those incurred during the embryo creation and transfer processes. There is a lot of variability in costs that can occur, however, depending on your unique set of circumstances.If you are partnered, and you both hope to contribute sperm, that will increase your costs since you will both need to undergo the screening and embryo creation process. With two sperm sources to consider, you may want to consider working with an experienced donor to help increase the odds that you will end up with a high number of quality eggs. Also, If you transfer more than one embryo, you will increase the likelihood of a twin pregnancy — which will also increase your costs.
to $80,000: These costs include the compensation to gestational carriers and egg donors, any needed travel costs, and any contingency fees that might arise — like bedrest or a c-section. Additional costs come from legal expenses, which are charged separately from the agency fee, and range from $8,000-$10,000 if all goes well. The location of your surrogate, donor and clinic will also impact your overall costs. Your surrogate and egg donor will go to your clinic at least twice — once for the medical screening, and again after the legal process is complete prior to transfer. Surrogates will typically need to stay in the same city as your clinic at least overnight, and maybe up to two to three days. Egg donors are typically required to stay nearby for five to 10 days, depending on how quickly their bodies mature eggs for retrieval. If your surrogate and donor don’t live nearby your clinic, you will need to cover their travel costs and hotel stays.
You will also need to make sure both your surrogate and egg donor have insurance. Sometimes, a surrogate’s own insurance policy will cover her pregnancy, but increasingly they won’t. You will also need to pay for insurance for egg donors, who aren’t allowed to use their own insurance for any part of the egg donation process. International parents may have additional insurance costs to consider, because their baby will often not be covered under their own home insurance plan. That means they will have to buy insurance for their baby or babies.
Yes, surrogacy is expensive — but here are some suggestions for helping to put this path to parenthood within your reach:
You don’t have to pay for your entire journey upfront, which allows you to approach and pay for your surrogacy process piece by piece. For instance, you can consider first identifying an egg donor and creating embryos with the aid of a fertility clinic, and cryopreserve them for future use — when you are financially ready to undertake the rest of the process.
There are a couple of financing options in the field that provide parents loans between $20,000 and $65,000 that you can pay over the course of 3 to 6 years.
Increasingly, employers are covering certain elements of a surrogacy journey for their employees. This may pertain to costs associated with IVF, agency fees, or even some of the insurance as a way to provide family planning assistance to LGBTQ people.
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