Gay Surrogacy Guide 🌈 - Gays With Kids

Overview of Surrogacy & IVF

Whether you’re ready to get started on your gay surrogacy journey — or just browsing for information — you’ve come to the right place!

We’ve partnered with some of the most well-regarded and experienced surrogacy professionals & IVF doctors in the world to create this Overview of Surrogacy and IVF Video Series below that will guide you through each step of a surrogacy journey for gay men. Watch these videos for a step-by-step overview of the surrogacy and IVF processes, and then explore the rest of this page for more detailed info.

Chapter 1: Intro to Surrogacy & IVF

Featuring: Sam Hyde, Circle Surrogacy & Egg Donation; Kristen Hanson, Simple Surrogacy; Victoria T. Ferrara, Worldwide Surrogacy Specialists

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Chapter 2: Build Your Surrogacy Team

Featuring: Sam Hyde, Circle Surrogacy & Egg Donation; Kristen Hanson, Simple Surrogacy; Victoria T. Ferrara, Worldwide Surrogacy Specialists

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Chapter 3: Choose Your Surrogacy Agency

Featuring: Sam Hyde, Circle Surrogacy & Egg Donation; Stephanie Scott Of Simple Surrogacy; Kristen Hanson, Simple Surrogacy; Victoria T. Ferrara, Worldwide Surrogacy Specialists

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Chapter 4: Choose Your Fertility Clinic

Featuring: Dr. Mark Leondires, Reproductive Medicine Associates Of Connecticut; Dr. Guy Ringler, California Fertility Partners; Dr. Jerald S. Goldstein, Fertility Specialists Of Texas; and Dr. Daniel Skora, Fertility Specialists Of Texas

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Chapter 5: Overview of the IVF Process

Featuring: Dr. Mark Leondires, Reproductive Medicine Associates of Connecticut; Dr. Guy Ringler, California Fertility Partners; Dr. Jerald S. Goldstein, Fertility Specialists of Texas; and Dr. Daniel Skora, Fertility Specialists of Texas

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Chapter 6: Choosing & Screening Egg Donors

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Chapter 7: Intended Parent Screening

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Chapter 8: Surrogate Matching & Screening

Featuring: Sam Hyde, Circle Surrogacy & Egg Donation; Kristen Hanson, Simple Surrogacy; Victoria T. Ferrara, Worldwide Surrogacy Specialists; and Dr. Mark Leondires, Reproductive Medicine Associates of Connecticut

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Chapter 9: Surrogacy Costs & How to Afford Them

Featuring: Sam Hyde, Circle Surrogacy & Egg Donation; Kristen Hanson, Simple Surrogacy; and Victoria T. Ferrara, Worldwide Surrogacy Specialists

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Your Surrogacy Team

They say it takes a village to raise a child — but where surrogacy is concerned, this is true just to conceive one.

Your surrogacy and IVF team, made up of a variety of professionals, will help get you started and guide you throughout every step of your journey. Below an overview of the professionals who will make up your surrogacy team.

Your Surrogacy & IVF Professionals

Fertility Clinics

You will also need to work with a fertility clinic and IVF laboratory — where a doctor, an experienced 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 dads. Book a free consult with one or more of our GWK-approved fertility clinics here.

Surrogacy Agencies

You will need to work with a surrogacy agency, ideally one with a long track record of success helping gay men become fathers. While it is possible to do a surrogacy journey on your own (which is called an "independent" surrogacy journey) a surrogacy agency will be there to guide you through every step of the experience — and be there when and if complications arise. (And as our GWK Partners to Parenthood will tell you, something always does!) Your surrogacy agency will assign you a case worker who is meant to help guide you through this all. Book a free consult with one of our GWK-approved surrogacy agencies here.

Egg Donor Agencies

You will also need to find an egg donor — and there are several different places you can do so. Some surrogacy agencies and fertility clinics have their own in-house egg donor directories. Fertility clinics generally work with a smaller group of donors they have already screened, and are less expensive for that reason, while agencies may have a wider selection, with slightly higher costs. You can also find an egg donor from an egg bank. In this case, an egg donor would have already donated her eggs, which have been frozen and stored. Lastly, you can work with a "known" egg donor — these are friends or family members willing to donate their eggs to you, often for free, and may play some role in your child's life.

Legal Counsel

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: navigating surrogacy laws and establishing your legal parenting rights.

Mental Health

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.

Insurance

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.

Choose Your Professionals Carefully!

You will be working incredibly closely with your team of experts, so it’s important that you feel comfortable with your professionals. Make sure to speak with several before making a decision. And visit our Partners to Fatherhood page for a listing of GWK-approved surrogacy agencies and IVF clinics with long track records of success and a commitment to working with gay, bi and trans men.

Surrogacy Agencies

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? 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.

Reputable agencies should provide you with a main point of contact throughout your journey. Lastly, though it may not be the most exciting part of your journey, it's among the most important — your surrogacy agency will help ensure you've obtained all the appropriate insurance plans you'll need throughout your journey.

Surrogate Screening

ASRM Guidelines:

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.

Mental health screening:

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 — they will also help coach you through the matching process. 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. Though uncommon, it's important to be prepared — sometimes you may need to rematch with a new surrogate if something does not pan out with your first match.

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:

What to consider before matching with a surrogate

Legal fit:

Your lawyer will help with the legality of matches, and determine if the match between you and your surrogate is legally sound.

Timing fit:

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.

Personality fit:

In some ways, the most important part of the matching process is whether the intended parents and surrogate 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.

“We felt an overwhelming sense of joy and happiness”

Johnny & Sebastian - Dads Through Surrogacy

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.

How to Choose a Surrogacy Agency and IVF Clinic

Your agency should provide you and your surrogate with the aid of mental health professionals whenever needed throughout the process. A gay surrogacy journey is exciting, but it’s not without stress — things like a failed embryo transfer, a miscarriage, the need for 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 also connect you with an escrow management company, which 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. The quality of agencies varies widely, so it’s important to do your research, and speak with several before making a decision.

Fertility Clinics & IVF

You will also need to work with a fertility clinic to complete IVF as part of your gay 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.

How does the IVF process work for gay men?

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, they can make sure there is not a match that increases the risk of disease to 1 out of 4. Your fertility clinic will help you interpret the results of your semen analysis and 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 giving 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 — who must meet certain requirements in order to donate eggs. There are several different places you can find one to work with:

Where can I find an egg donor?

Internal egg donor:

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.

Egg donor agency:

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. Your fertility clinic will work closely with your egg donor agency.

Egg bank:

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.

After you match with your egg donor, there will be several more steps your fertility clinic will walk you through prior to your IVF cycle. First will come the egg donor screening; a process that is broken into several stages. All fertility clinics must screen donors according to 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.

Why do women become egg donors and surrogates?

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 ovarian stimulation can produce a large quantity of eggs during the egg retrieval process — 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. These two pieces of information will 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 egg 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 your sperm together — the clinic will not do this.) 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. Don't worry, your fertility clinic will walk you through some options if you both want to become biological dads. It's very common for both dads to provide sperm samples at this time.

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 ball called a blastocyst. Most of the time, these embryos will be "frozen" or 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. Your clinic will help you interpret your PGT results. 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.

Your fertility clinic will also work closely with your gestational carrier and your surrogacy agency to help you achieve a positive pregnancy. Once ready for the embryo transfer, your fertility clinic will carefully use hormones to prepare your surrogate 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. Your fertility clinic will provide care for your surrogate for the first 8-10 weeks of her pregnancy before she begins seeing her own OBGYN.

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 rate 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 gestational surrogacy will see a successful pregnancy within three transfers if the first two fail.

The quality of fertility clinics also varies widely — so it’s important to do your research and interview several before making a decision. You'll want to work with a physician and clinic with a long track record of success and a demonstrated commitment to helping gay, bi and trans men become dads. Be sure to come prepared to your first consult with questions to ask your fertility clinic before signing with them.

Surrogacy & IVF Costs

There’s no way around it — gay surrogacy costs a lot. Most experts agree that surrogacy will cost gay men, on average, around $135,000 — but it can easily stretch upwards of $200,000 depending on your unique situation and requirements.

Given the variability in surrogacy and IVF costs, 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:

Main Costs of a Surrogacy Journey for Gay Men

Agency fees: $35,000 - $55,000:

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.

IVF clinic: $25,000 - $50,000:

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.

Gestational carrier and egg donor: $60,000 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 or 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.

Insurance: $15,000 to $30,000:

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.

How Can You Afford Surrogacy?

Break your journey into pieces:

You don’t have to pay for your entire journey upfront, which allows you to approach and pay for your gay surrogacy process piece by piece.

Surrogacy loans:

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.

Employer assisted benefits:

More and more employers are covering certain elements of a surrogacy journey for their employees.

Altruistic surrogates and known egg donors:

Some gay men may have friends or family members in their lives who are willing to serve as an "altruistic" surrogate or a known egg donor — meaning they will do so without compensation.

Yes, surrogacy is expensive — but planning ahead for your journey can help put this path to parenthood within your reach. For more information, visit our comprehensive guide to surrogacy costs — which includes breaks down ways to make your journey more affordable.

International Surrogacy

The United States is one of the only countries in the world where compensated gestational surrogacy is not only legal, but highly regulated. Working with reputable surrogacy professionals will ensure your surrogacy journey is highly ethical and safe for you, your surrogate and egg donor, and your baby.

The good news is the U.S. surrogacy process doesn't differ that much for those living abroad than for locals. But there are some key differences you should be aware of and prepare for. Some of these are listed below, but also be sure to check out our comprehensive guide to gay surrogacy in the U.S. for international intended parents.

How is U.S. Surrogacy Different for International Intended Parents?

Travel

It may be obvious — but if you are pursuing surrogacy in the United States from abroad, international travel will be a factor in your journey. You can conduct the bulk of your journey remotely — and will undergo all needed screenings including your semen analysis at a local IVF lab. But you may want to travel to the U.S. to meet your surrogate in person, for example, or to be present for specific doctor's appointments. You will also obviously want to be in the country for your baby's birth — and will need to be present to secure your parenting rights and obtain all needed legal documentation.

Insurance

Many international intended parents are confused by the insurance system in the United States (and we don't blame them!) Like all intended dads, you will need to explore insurance options for your surrogate and egg donor. But international intended parents will also need to take out an insurance policy for your newborn baby.

Obtaining documents

All children born in the United States are automatically U.S. citizens — including those born via surrogacy. You will likely need to expedite the processing of your baby's birth certificate, a process that can normally take several months. Once you have your birth certificate in hand, you can then petition for your baby's U.S. passport as well.

Your home country's laws

You will need to determine the laws in your country — and what you will need to do to safely return with your baby. You will need a home country lawyer (in addition to a U.S.-based attorney) who will help guide you through any legal considerations based on your home country's laws.

Surrogacy and HIV+ Gay Men

Can HIV+ gay men become biological dads? Thanks to a procedure known as sperm washing, the answer is yes! Here is what you need to know about approaching surrogacy and IVF as an HIV positive gay man.

The "sperm washing" technique has been used since the mid 1990s — and today allows gay, bi and trans men living with HIV to safely become biological dads through surrogacy and IVF, without transmitting the HIV virus on to their surrogate or baby. Read on for more, and check out our comprehensive guide to pursuing surrogacy as an HIV-positive gay man here.

What to Know About Surrogacy & HIV

Sperm washing

To conduct sperm washing, semen is first collected from the HIV positive partner. Through a separation process known as centrifugation, the sperm is removed from the seminal fluid. Since the HIV virus is carried in the seminal fluid, and not the sperm, this allows for a vastly decreased risk of HIV transmission to either the gestational carrier in a surrogacy arrangement, or the resulting child.

Fertility clinics

Your fertility clinic may conduct sperm washing in house — but many others will contract with an outside clinic that specializes in the procedure. One of the longest-established and most reputable programs is called the Special Program of Assisted Reproduction (SPAR) — a project of the Bedford Research Foundation Clinical Laboratory.

Transmission risks

While professional will never tell you there is no risk, the research is pretty clear on the subject — there have been no documented cases of transmission when sperm washing has been conducted as a part of an IVF procedure. In fact, in 2016, Fertility and Sterility published a meta-analysis of 40 studies on the subject — and found zero transmissions of HIV following 11,585 sperm washing procedures with 4,000 wome

Surrogacy & IVF Learning Center

Still have questions about approaching surrogacy and IVF as a gay, bi or trans man? Use our Surrogacy Learning Center to search for videos, articles, webinars and more — on topics covering every last detail of your surrogacy journey.

Surrogacy & IVF Learning Center

See some examples below to frequently asked surrogacy and IVF questions. But we're rolling out new resources, alongside our GWK Partners to Fatherhood, each and every month — so bookmark this page and be sure to check back often! Have a specific question you want answered? Email us at dads@gayswithkids.com.