Chapter 1: An Introduction to Surrogacy & In Vitro Fertilization

Surrogacy and In Vitro Fertilization (IVF) are lengthy and complicated processes — but there are some predetermined steps that can help you understand your journey

Surrogacy is a process that helps those who are unable to have children — such as same-sex couples, single people and those experiencing infertility — become parents with the help of reproductive technologies and a third party carrier. Despite this simple purpose, surrogacy is a lengthy, complicated and often confusing process, leaving many gay, bi and trans men approaching their first journeys overwhelmed. Fortunately, most journeys share many of the same, predetermined steps — which can help you begin to wrap your mind around the process. 

 

But before we break down the steps involved, let’s first define some of the most common terms you’re likely to encounter throughout your journey (which, by the way, is the word the industry uses to refer to the overall surrogacy process — start to finish.)


Surrogacy & IVF Terminology

Family building through surrogacy comes with its own language, and it can be confusing for those who are just starting to navigate the process to understand all the jargon. So here is quick glossary of some of the most common terms you’re likely to come across:

Surrogacy Journey: The assisted reproductive field uses this term to refer to the entire surrogacy process, start to finish — this includes matching with a surrogate, completing an embryo transfer, and delivering of a child. 

Intended Parent(s): Term for a person or couple building their family via surrogacy.

Surrogacy Agency: An organization that helps intended parents and surrogates navigate a surrogacy journey, including screening, matching, contract design, and more.

Fertility Center or Clinic: A medical organization made of physicians, nurses, embryologists and support staff that will conduct medical screenings, complete the IVF process of embryo creation, embryo cryopreservation, embryo transfer processes, and more. 

Surrogate: Also known as a “gestational surrogate,” “surrogate mother,” “gestational carrier,” or "GC," this is the person who will carry and deliver a child for intended parents.

Egg Donor: A woman who donates a number of her eggs to intended parent(s) for use in an IVF procedure. This can be someone you know (a “known” donor) or from a donor program.

Gestational Surrogacy vs. Traditional Surrogacy: In gestational surrogacy, surrogates carry an embryo created with eggs that are not her own, but from a donor, or from the intended parents. Therefore, a gestational surrogate is not genetically related to the baby. This is contrasted with traditional surrogacy, whereby the carrier also serves as the egg donor, and thus is biologically related to the resulting child. In traditional surrogacy, it can be more difficult to navigate psychosocial issues, establish legal parentage for the intended parents, and is therefore hardly practiced today secondary to advances in the IVF laboratory which allows for embryo cryopreservation. Nearly every journey in the United States is a gestational surrogacy journey, as very few states have a legal environment conducive to traditional surrogacy.

Altruistic Surrogacy vs. Commercial Compensated Surrogacy: Altruistic surrogacy refers to surrogates — who is often a relative or a friend — that carry a pregnancy for intended parents without any financial compensation other than perhaps covering out-of-pocket medical expenses. Commercial Compensated surrogacy, in contrast, refers to surrogates who receive compensation for all the medical testing, screening, physical stress of pregnancy, medical risks, and actual work of delivery.  This often goes beyond medical expenses and any out-of-pocket expenses to include a fee for her role helping the intended parents have a child.

How Do I Get Started on My Surrogacy Journey?

Now that we’ve developed a common language around the process, let’s take a look at how you can get started on your journey:

You’ll find there are two main ways to start your surrogacy journey: first, you can select a fertility clinic and start the process of creating your embryos. This can be a particularly helpful way to start if you’re interested in splitting your journey, and the costs, into smaller, more manageable portions, or if you already have a friend or family member who plans on serving as your altruistic surrogate, or egg donor.

Alternatively, you can decide to first contract with a surrogacy agency, who will help guide the process start to finish. Neither approach is inherently better than the other — your choice will ultimately be dependent on your own unique set of circumstances. 

A note on "independent" surrogacy journeys 

The surrogacy field is very loosely regulated in the United States, and there is nothing mandating the use of a surrogacy agency. Undertaking the process on your own is known as an “independent journey,” but most experts caution against this option. An agency is paid to handle all of the many, complicated pieces of the journey and can help to mitigate any unforeseen complications that can arise during the process. “Most people find that an agency coordinating the whole process really allows them to enjoy the process, and not have to sweat the small details,” said Kristen Hanson, Co-Owner and Director of Finance and Legal at Simple Surrogacy. “And there are a lot of small details.”

Having an agency who has experienced any number of the complications that can arise throughout the process can help prevent unforeseen circumstances from derailing your journey. But if you do decide to go it alone, your first step in the process should be to hire a qualified reproductive attorney, who understands the laws in your state and can help guide you through the process. The Academy of Adoption and Assisted Reproduction Attorneys (AAAA) is the best place to start your search for a lawyer.

Phases of a surrogacy and IVF journey

On average, a surrogacy journey – from start to finish – will take about 18 to 24 months to complete. “And sometimes even longer if you run into a bump in the road,” said Sam Hyde, President and CEO of Circle Surrogacy. “So make sure you’re planning a good amount of time to undertake this.” In the best-case scenario, Hyde says journeys can be completed in 12 to 13 months. “But that would be rare.” When you’re eager to start your family, the length of an average surrogacy journey can sound like a lifetime, but also remember — nine months of this time is your surrogate’s pregnancy.

Once you’ve contracted with a surrogacy agency and chosen your fertility doctor and center, your journey will typically take place over three phases:

Phase 1. Matching & Embryo Creation: Once you’ve selected your surrogacy agency, you will begin the process of matching with your surrogate, which can take several months. “You will have a case manager who will be in touch with you on a regular basis to let you know how the search is going,” said Victoria T. Ferrara, Founder and Legal Director, of Worldwide Surrogacy Specialists. “And then eventually that case manager will show you profiles.” A reputable surrogacy agency, Ferrara continued, will have conducted comprehensive screenings of potential matches to ensure the best possible fit — in terms of genetic screening, scheduling, and personality — between you and your potential surrogate matches.

 

During the matching process, with the help of your fertility clinic and egg donor agency, you can also select your egg donor and start creating your embryos. Your attorney will assist you in conducting all legal work related to your egg donor during this time. Most experts recommend having your embryos in the process of being created, or even already created, before matching with a surrogate to avoid unnecessary delays or costs that might arise throughout the egg donation and embryos creation process. Having embryos already created will also make you a more attractive potential match to surrogates. “Intended parents who already have embryos created or well on their way are much more likely to be selected by a surrogate considering their profile against other intended parents,” said Hanson of Simple Surrogacy.

 

Phase 2. Medical: Prior to preparing your surrogate for the IVF embryo transfer, your reproductive lawyer will first create a draft of a legal contract between you and your surrogate. “This is a lengthy document between the parents and the surrogate, and it will cover issues that can come up during a pregnancy, as well as the compensation terms so they are really clear and set out,” said Ferrara of Worldwide Surrogacy, who is also a reproductive attorney. The contract will necessarily be very detailed — touching on everything from pregnancy termination to who will be allowed to be present at doctor's appointments and the delivery room — and will serve as the guiding document for the rest of the journey.

 

Prior to transfer, your fertility clinic will also conduct a comprehensive screening of your surrogate to ensure a proper medical match. This is in accordance with Food and Drug Administration (FDA)  regulations and guidelines put forward by the American Society for Reproductive Medicine (ASRM).“Surrogacy agencies rely on the IVF clinics and your doctor, specifically, to help make that judgment,” said Hyde of Circle Surrogacy. Once your surrogate has passed screening, and all legal contracts have been completed, you will open an escrow account. Once funded, your surrogate will start medications to prepare her for the IVF transfer, which involves implanting one or two of the embryos you’ve created with the help of your clinic into the uterus of your gestational carrier.

“Once the transfer has occurred, the clinic and the surrogacy agency will monitor the surrogate to see if that embryo transfers was successful,” said Hyde. “About 10 to 12 days after the transfer you get to have this really magical moment where you get this phone call or some other form of communication that tells you, ‘congratulations you’re pregnant.’”

 

Phase 3. Pregnancy: Once you’ve achieved a healthy pregnancy, the rest of the process will proceed, more or less, like any other pregnancy. You’ll maintain regular contact with your surrogate, as determined by your legal agreement. There is also some remaining legal work to finalize during the pregnancy to ensure you establish legal parentage of your child. “One of the most important things about the pregnancy phase is the legal work that gets done during that time,” said Ferrara of Worldwide Surrogacy. “We want to make sure that the intended parents become the legal parents of the baby before the birth.” This legal process can happen at different stages of the pregnancy, but usually takes place in the second trimester, Ferrera said.

Experts interviewed for this article:

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