Surrogate Mothers: The 6-Step Process to Carrying a Surrogate Pregnancy

pregnant woman faces another woman who is holding a crying newborn baby

Have you ever wondered about the process of using a surrogate to carry a baby? We mostly hear about it with celebrities, but it’s a very real-life thing, as those of us who have experienced recurrent miscarriage and infertility know.

In this article, we welcome Petra Hollosi, a former IVF nurse who now works for Extraordinary Conceptions, a surrogacy and egg donation clinic based in San Diego. Petra sheds light on a unique end of surrogacy: what it’s like for the surrogate.

Hollosi’s respect for women who choose to become surrogates shines through in this article. Having a surrogate pregnancy might not be for everyone, but Petra explains the ins and outs of the process in order to help parents considering this option better understand the surrogacy process.

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What Is a Surrogate Mother?

Understanding the surrogacy process can be confusing if you aren’t familiar with it.

According to the American Society for Reproductive Medicine, using a surrogate (also called a gestational carrier) “is an arrangement where a woman carries and delivers a child for another couple or person (intended parent[s].)”

Usually, gestational surrogates don’t use their own eggs. Instead, they generally go through in vitro fertilization (IVF) at a fertility clinic to transfer the biological parents’ embryo(s) into her uterus.

In simpler terms: a surrogate mother carries the biological child of another couple. So though she grows and births the baby, she usually has no biological connection to that child.

Why Do People Use Gestational Surrogates?

Most parents use a surrogate when they have “a medical condition that would prevent carrying a pregnancy safely.”

According to journalist Natalia Lusinski’s article in Bustle, some women are born without a functioning uterus or vagina and cannot carry safely.

Other reasons women may need to consider using a gestational carrier:

  • Uterine scarring 
  • Organ damage
  • Serious heart, liver, or kidney disease
  • Severe diabetes
  • Required medications that are not compatible with pregnancy
  • A history of infertility, recurrent miscarriage, or other major pregnancy complications

Surrogacy is also a common family-growing option for same-sex couples, especially among gay men. In these cases, gay couples will likely use donor eggs or donor sperm to grow an embryo at an IVF clinic. Then, they’ll begin the process of working with a surrogate or surrogacy agency.

An Insider Understanding of Surrogate Pregnancy

As a former IVF nurse and Electronic Medical Record (EMR) specialist, stepping into my role as a client liaison at a surrogacy and egg donation clinic felt natural. After years in this sector, I was aware of the many intricacies involved with fertility treatments as well as the emotional ups and downs experienced by those involved.

Editorial note: “What is Infertility?” Check out our in-depth article on the subject.

I have an endless respect for women who choose to carry a child for another family.

pregnant woman is a surrogate mother for two men, one is holding a girl sign and the other is holding a boy sign

The fact that surrogates altruistically take on this endeavor is something that, surely, anyone would admire. Every day, I am in awe of the selflessness of these amazing women who, while juggling their own lives (children, a spouse, bills to pay, a job, daily responsibilities), want so badly to help another family feel complete.

How to Be a Surrogate: The Gestational Surrogacy Process

Although the process of becoming a surrogate is relatively straightforward, it does require time and energy.

All candidates and eventual surrogates will all follow the same main 6-step process:

(1) Make a Profile

The first step to becoming a surrogate mother is something most of us have become quite familiar with over the years— creating an online profile. This application and profile will outline your medical and personal information and is very comprehensive.

Much like a dating profile— but far more invasive!

Personal as it may be, these profiles are very important. For an agency to determine that a woman is able to be a healthy surrogate, they need to have all of the information possible.

(2) Match with a Family

Once her profile and application has been approved, a gestational carrier is ready to start looking for a family match.

This requires careful consideration and the willingness to be totally honest with yourself. After all, it is crucial that the values of a surrogate and the intended parents are somewhat aligned.

I urge potential matches to discuss even the more uncomfortable details of their arrangement to determine whether the process will work for your pairing.

Consider difficult questions like:

  • Does everyone have the same preferences regarding the level of contact they would have with each other throughout the pregnancy? 
  • Do you have the same values related to invasive testing and termination, if needed?

(3) Undergoing Screening

Once a surrogate mother has found her intended parental match, she will begin the screening process. This is a necessary step that every gestational carrier must undergo; it’s essential to meet surrogate requirements for physical health to increase the chances of carrying a healthy surrogate pregnancy.

All potential surrogates will complete the following tests, and possibly more:

  • Blood work
  • Urine tests
  • Swabs
  • Sonohysterogram (or HSG) (It’s an awkward test, but not usually painful. Taking ibuprofen before can really help!)

If the surrogate has a partner, the partner must also complete blood work to screen for infectious diseases.

This entire process generally takes around three weeks. Once the results roll in and show that all is as healthy as expected, a physician will officially give clearance for the procedure.

(4) Working with Lawyers

Once the surrogate screening has been completed and approved, it’s time to move forward with the legal side of things.

For this stage of the process, both the gestational carrier and the intended parents choose and work with their own legal representatives. As a group, they will work together to create an extensive contractual agreement.

Generally, this requires multiple passes back and forth between the parties and will result in a lengthy final product of legal papers that are about 40 pages.

This process can take a few weeks.

(5) Getting Pregnant

Though all approved surrogate mothers have been pregnant and given birth in the past, the process will likely be a bit more involved than what they have experienced previously.

As conception will involve an embryo transfer, the surrogate will need to physically prepare herself before it takes place. She will be required to take medication during the two weeks leading up to conception and will continue to take them for the first twelve weeks of her pregnancy.

Typically, surrogates take two main medications: estrogen and progesterone. While the former is usually a pill, progesterone is most often administered by intramuscular injection to the upper buttocks.

It’s the most effective method, but it can be quite uncomfortable for the surrogate.

(6) Pregnancy and Delivery

Once the twelve weeks of medication have passed, a surrogate’s pregnancy will look a lot like her previous ones or like any other woman’s gestational period.

The actual delivery will depend on the preferences and plans of the intended parents and the surrogate. Often, this time period is very special for both the surrogate mother and the intended family as they support each other and anticipate the upcoming birth.

Choosing to Carry a Surrogate Pregnancy

Choosing to become a gestational carrier is an incredibly personal choice, and there are many factors to consider as you approach this decision, such as:

  • The  and emotional cost of surrogacy
  • The impact of having a surrogate pregnancy will have on your family
  • What type of family you’re willing to carry for and whether there are deal-breakers that would prevent you from carrying for a family
  • Whether you’re willing and able to go through the legal aspects of surrogacy
  • The psychological aspects of surrogacy 
  • How you’ll handle the emotional let down of not successfully getting pregnant. (Remember, many of the families you may carry for have struggled with pregnancy in the past, and it’s possible the pregnancy you agree to carry won’t be successful either)

Despite the length of the process and the (necessary) red tape surrounding it, either becoming a surrogate or becoming a parent via surrogacy can be overwhelmingly rewarding.

If you are one of these amazing women who want to become a surrogate, our team at Extraordinary Conceptions is here to support you. To learn more about the work we do at our US and Canadian fertility centers, please get in touch with our team.

Have you ever been a surrogate mother? Tell us all about your experience!

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