Choosing to have a baby with your partner is a life-changing decision, one that is a lot more complex than simply “doing the deed.” And if you are one of the estimated 10-15% of couples experiencing difficulty conceiving, you may need to bring a third person into the bedroom with you: a fertility specialist.
Fertility treatments range from lifestyle changes, like weight loss and a change in diet, to medical procedures such as IVF and the use of egg or sperm donors. For some couples, a woman may be unable to carry a child, which is when a conversation about surrogacy might begin. If the use of a surrogate or gestational carrier is something you and your partner are considering, there is a seemingly endless amount of information that can be intimidating and difficult to navigate. We spoke with Dr. Alex J. Polotsky, MD, MS, an associate professor of Obstetrics and Gynecology as well as the Division and Fellowship Director of Reproductive Endocrinology and Infertility at the University of Colorado Denver, about the important things couples should know, discuss, and consider if they are interested working with a gestational carrier. The topic of surrogacy is big and complicated, but it doesn’t have to be scary, and being informed is the first step.
There are a few common terms used within the realm of surrogacy that every couple should understand:
A Traditional Surrogate is a woman who is both a carrier and the source of the egg.
A Gestational Carrier is a woman who is only a carrier, but does not provide the egg.
A Private Arrangement occurs when the couple sources a gestational carrier or surrogate without the use of an agency.
A Surrogacy Agency screen individuals and help match the couple with a gestational carrier who fits their needs, and charges an additional fee for the screening and matching service.
Start the Conversation
There are two main ways the possibility of using a gestational carrier is brought up between a couple: First, some patients know that they will, for medical reasons, need to take advantage of a gestational carrier in order to become parents. “Couples in this scenario may have an easier time discussing topic because, based on their medical history, they know that it may be necessary,” says Dr. Polotsky. In the second scenario, the use of a gestational carrier is suggested by a doctor as part of a conversation about the couple’s fertility options. “This instance is much more emotional, because the topic is often unexpected,” Dr. Polotsky continues.
In either context, it’s imperative that both partners feel comfortable with the process. “You are trusting a stranger to carry your child, which can be hard for some couples to come to terms with,” says Dr. Polotsky. “You won’t be able to control every detail of the process, and there are often unexpected changes or occurrences, so it is crucial that the couple both be on the same page before they begin the process of finding a gestational carrier.”
Know Your Options
The first thing a couple will need to decide is whether they will use a traditional surrogate or a gestational carrier. “I, along with the majority of fertility providers, strongly recommend the use of a gestational carrier. In this case, an embryo will be fertilized before being implanted into the carrier’s uterus. That embryo can use the couple’s sperm and eggs, or can make use of a sperm or egg donor,” says Dr. Polotsky.
You will also have to decide if you will be pursuing a private arrangement or will be working with an agency. “Private arrangements are sometimes entertained because they can be less expensive than an agency,” Dr. Polotsky explains. “However, we do not recommend private arrangements because the carrier is not screened in the same way that they are through an agency.” The only exception he would consider is if the carrier is to be a family member, however all parties involved should proceed carefully and make sure they are legally protected. “Reputable agencies have a better track record of screening individuals who are deemed to be stable and successful options. It is more expensive than a private arrangement, but the work that goes into identifying a perfect match for the couple gives extra assurance and comfort in the arrangement.”
Know What to Expect
“There are no shortcuts, which means finding a gestational carrier is not a quick process,” says Dr. Polotsky. “All of the medical, psychological, and legal steps are necessary to protect all parties involved.” If you decide to interview multiple agencies or consider multiple gestational carriers, the time interval can also be much longer. “Generally, once a couple initiates a conversation with an agency, it will take several months before a gestational carrier is selected, the arrangements are made, and everyone is ready to proceed.”
Find the Right Agency
The best place to start looking for an agency to help you find a gestational carrier? Your fertility doctor. “We have a number of agencies we recommend that can help our patients start the process,” says Dr. Polotsky. And when talking to the agency, ask for references! “Just as you would with any other major service, ask the agency to connect you with recent couples who have worked with them. Many couples who have had a good outcome are more than willing to discuss their experience and educate you about what to expect.”
Whether you’re working with an agency your doctor knows well or have found an agency elsewhere, make sure your doctor is involved every step of the way. “Your physician should have the opportunity to review all of the steps, including a mandatory psychological screening of the selected carrier, to ensure that everything is proceeding as it should,” Dr. Polotsky says.
Ask Good Questions
Once you’ve chosen an agency to work with, keep asking questions! Your agency will also complete thorough background and medical checks to help match you with a strong gestational carrier candidate. “You want a carrier who is both in good overall health and has a strong obstetrical history,” says Dr. Polotsky. Has the individual completed childbearing before? Have they undergone a psychosocial evaluation? What about STIs? The agency and your physician should follow the recommendations set forth by the American Society for Reproductive Medicine.
“We recommend that all of our patients have a consultation with a reproductive lawyer,” Dr. Polotsky advises. “They specialize in protecting those seeking treatment, and will be invaluable in drafting the appropriate documents throughout the process.” Polotsky also recommends that all parties in the arrangement—including the carrier—have their own counsel to ensure everyone’s interests are adequately represented.
One thing you’ll really want a lawyer’s help with? The birth certificate. “There is an option of placing the intended parents (i.e. the couple seeking a gestational carrier) on the birth certificate, and not the gestational carrier,” says Dr. Polotsky. “Having the intended parents’ name on the birth certificate from the moment the child is born can ease many parts of the process after birth—particularly because this is what allows the two of you to take the child home. Otherwise, the hospital may not legally be able to release the child to you.” The geographic location of the intended parents, the gestational carrier, and the hospital where the child will be born all come into play here, and the regulations can vary from state to state—and even within a single state. “If you don’t have a lawyer assist you with the birth certificate, it may be drafted in a way that does not reflect the intended parents, or the fact that the woman giving birth is not actually the mother,” Dr. Polotsky continues.
In addition to learning about the process of finding and working with a gestational carrier, it’s important to look into cases where the process doesn’t go well. Says Dr. Polotsky, “There are a number of high-profile stories where unexpected issues arise, especially where the gestational carrier is diagnosed with an abnormal pregnancy. In those instances, there are often disagreements about how to proceed, and it really is something important to discuss and prepare for in advance.” Working with both your physician and your lawyer (and possibly also a counselor), talk through the options and come up with a solid plan for any possible abnormalities so you can continue to move forward instead of stalling the process to decide what to do. You will also want to be upfront with your gestational carrier about your plans, should an abnormal pregnancy occur.
Keep Emotions in Check
Having a baby is a big, emotional deal, and doing so with the help of a gestational carrier comes with its own layer of feelings. “We advise our patients to avoid premature emotional attachment,” says Dr. Polotsky. “It’s perfectly understandable and easy to see how it happens, but before all of the steps are complete, it’s best to approach the process tentatively and carefully.” There are so many things that can happen along the way—even before an embryo is implanted—and it will be much easier to address any issues that come up and find a good solution if fewer emotions are involved.