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(s). For queer men, a gestational surrogacy journey will require an advanced fertility treatment known as in vitro fertilization (IVF). During this process, a fertility center will create embryos — using sperm from an intended father and an egg donor — which are in turn transferred to the surrogate's uterus.
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.
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 guide you throughout your journey.
First, you will need to work with a reproductive endocrinologist — who will conduct medical screenings, create embryos and help your surrogate achieve pregnancy. A reproductive endocrinologist is a medical doctor who has completed 7 years of training after medical school who is sub specialized in using advanced fertility technology to help you have your child. You should be sure to work with a reproductive physician and IVF center who 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:
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 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.
Surrogacy agencies will take on the task of finding gestational carriers. Many people wonder who are the type of women who become surrogates — they tend to be women who have already completed their own families and have a genuine interest in helping others who can’t do so on their own, like gay men. This is not by accident — your surrogacy agency carefully screens surrogates through a rigorous process involving multiple interviews, and a rigorous physical and mental health screening. In fact, most reputable surrogacy agencies accept fewer than 5% of their applicants. Many of the more reputable agencies will pre-screen your surrogate, so by the time you are shown her profile, you can be confident in her qualifications. Surrogates are screened according to the following guidelines:
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. Here are some tips for matching with a surrogate.Your surrogacy agency will also be responsible for matching you with a surrogate based on many factors — including:
Your agency 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 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 even 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. Here are some tips for choosing a surrogacy agency.
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:
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 are four main areas that impact surrogacy costs:
How can I afford surrogacy? Yes, surrogacy is expensive — but here are some suggestions for helping to put this path to parenthood within your reach:
Get inspired by these stories of other gay, bi and trans men who became dads through surrogacy and IVF.