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There are lots of different ways to make a family.
If families are having a hard time conceiving a baby, for one reason or another, they may want to try a surrogate. “A surrogate, now often referred to as a ‘gestational carrier,’ is a woman who carries a child for another couple,” says Jasmine Johnson, M.D., a maternal-fetal medicine fellow. “This can be due to infertility, medical conditions that make pregnancy difficult or life-threatening, or personal preference, which is rare.”
Still, it can be a great option for lots of families. Kim and Kanye West used one, after all. So did Ellen Pompeo. And while it may be a fantastic solution for some, there a lot of factors to consider before going the surrogate route.
Note: This article assumes that there is a female surrogate, and a set of parents that includes a male and female partner. Of course, this is not always the case.
One is ‘gestational carrier surrogacy,’ or GC, which is what most people think about when they picture a surrogate, and the other is a ‘traditional surrogacy,’ which is much less common. In both cases, the surrogate carries the pregnancy to term and delivers the baby for the intended parents, or IPs.
“Traditional surrogacy involves impregnating the surrogate with the IP male partner’s sperm,” says Richard Lucidi, M.D., director of the division of reproductive endocrinology and infertility at VCU Health. “This process is rarely done because the it’s the surrogate’s egg that results in the embryo that she then carries.” That means that 50% of the baby’s DNA comes from the surrogate, and the other half comes from the father. This may open up potential legal issues when it comes to the custody of the child.
It’s much more common to go the GC route. “This process involves using the IP’s eggs and sperm to create embryos via in vitro fertilization, or IVF, and transferring the resulting embryo into the GC’s uterus,” Dr. Lucidi says. Since the GC’s eggs aren’t used in the process, the baby does not have any of the surrogate’s DNA. There’s also far less of a chance that legal custody becomes an issue later on.
You’ve all see the viral stories about sisters who surrogate for one another, or moms who give birth to their own grandchildren. “Some couples elect to use a surrogate that they know who is a close friend or family member,” Dr. Johnson says. But that’s a huge ask, and if IPs don’t know anyone who’ll do it for them, they can still find a GC through other avenues.
“Finding a surrogate can be done through an infertility specialist’s office,” she says. “They may be able to refer you to an agency. Those usually have a very strict criteria for surrogacy eligibility and should be transparent about the history of their surrogacy candidates. You can find information on this process for various agencies online, some agencies also may allow you to ‘preview’ surrogate profiles without seeing their identities.” You can find out more information at agencies like Circle Surrogacy, Conceivabilities, and The Center for Surrogacy and Egg Donation; a GC must be over 18 years of age and must have had children of her own previously.
It’s also important to note that local laws may govern who you can use as a GC, if it’s allowed at all: Three states — New York, Michigan, and Louisiana — ban compensated surrogacy contracts entirely.
Since surrogacy is such a huge decision, there are lots of legal and medical steps that parents have to go through.
Of course, there can be other variations to this process, too. For example, if the couple hasn’t found a GC by the time of their egg retrieval, they can still go through with it and freeze the eggs for a later transfer. Some couples may also require donated sperm and/or eggs.
Between the agency, the lawyers, insurance, the surrogate, and all the medical procedures, there is a hefty price tag associated with this process. “Typically the IPs pay all expenses,” Dr. Lucidi says. “The cost for IVF can range from $8,000 to $20,000. Fees to the GC can range from $0, if the GC is a friend or family member, to $100,000. Legal costs, costs for medication, and the cost for prenatal care and delivery are in addition to these fees.”
Then again, many say that finding a surrogate is worth it. “I think that in the media surrogacy is seen as something that only rich people do,” Dr. Johnson says. “While the financial investment can be cost-prohibitive for some families, surrogacy may offer couples the chance to have a child that is biologically related who otherwise would not have been able to have the chance.”
Despite the cost, it seems like surrogacy is becoming more commonly accepted. Research done by Marie Claire reports that 23 percent of millennial women said they would consider surrogacy if they couldn’t conceive naturally, compared to just 9 percent of Gen-X women.
Using a GC doesn’t have to dictate feeding plans. “The parents will first have to decide they want to feed the baby with breast milk or formula,” Linda Hanna, co-founder and Chief Nursing Officer at Mahmee, a platform that helps coordinate postpartum medical care. “They may end up using a combination of the two, but the mother needs to determine early on if she wants the infant to receive any breast milk at all, because the next question is ‘breast milk from whom?’”
If the IPs are set on breast milk, they could get it from the IP mother, the GC, or donors. “The surrogate may or may not be open to this,” Hanna says. “If she is, the parents should find out if the surrogate will pump for a negotiated period of time in order to supply some breast milk while the parenting mom is either building up her own milk supply or waiting to receive donor milk.”
An IP mom should decide by late in the second trimester or early in the third trimester if she wants to try to get her own milk supply flowing. “If the parenting mother wants to induce lactation, there are specific steps that need to be taken to ensure she can produce enough for her infant,” Hanna says. “It can be a complex process. She’ll have to pump, and whether milk comes or not depends on things like whether she has had a pregnancy in the past.“
Hanna says that moms have to pump multiple times over the course of a 24-hour period, for a total of two to three hours of pumping time. She has to do this for eight to 10 weeks to maximize her chances of inducing of milk production; six of those weeks should be before the delivery, and at least two of the weeks should be after delivery. She can also talk to her doctor about foods, supplements, prescribed medications that might also increase the chances of success.
“These are time and emotional commitments,” Hanna says. “If milk doesn’t come, she has to be prepared for that. Some mothers can produce a small amount of milk, but others find they can produce significantly more based on their own pregnancy and breastfeeding history.”