Intended parents and gestational carriers make matches to build families.
This article is based on reporting that features expert sources.
How Does Surrogacy Work?
When people pursue surrogacy, it’s a journey fueled by a strong commitment to becoming parents. When a woman carries an embryo and goes through pregnancy to help someone else have a child, it’s a unique contribution.
Gestational surrogacy is uncommon, representing only about 2% of all U.S. medical procedures to address infertility, according to the National Assisted Reproductive Technology Surveillance System Group. It’s much less common than treatments like intrauterine insemination or fertility drugs. However, it’s a real option and in some cases, the only option for an individual or couple to have a child.
Experts describe what happens as intended families and gestational carriers go through the surrogacy process.
It helps to understand the language used in this field:
Types of Surrogacy
- Gestational surrogacy. “Gestational surrogacy typically means that an embryo is placed into the uterus of a gestational carrier,” says Dr. Dorette Noorhasan, the medical director and co-founder of CCRM Fertility in Dallas–Fort Worth. “The sole purpose is for that person to carry the pregnancy and give birth nine months later.” The woman carrying the embryo has no biological relationship to the egg or sperm that created it.
- Compassionate surrogacy. A surrogate does a carrier cycle for someone they know – a family member or friend – and is not financially compensated.
- Compensated surrogacy. “This is where the gestational carrier received compensation for her time and effort in carrying the pregnancy,” says Dr. Jamie Massie, an OB-GYN, reproductive endocrinologist and infertility specialist at the ORM Fertility Clinic in Bellevue, Washington.
- Traditional surrogacy. Rarely practiced in the U.S. because of the legal and emotional complexities, traditional surrogacy is when the surrogate uses her own egg and is artificially inseminated with sperm from a donor or the intended father, so she is actually the biological mother.
- Gestational carrier. Also called a gestational surrogate, this woman carries and gives birth to a baby for another individual or family. This encompasses both compassionate and compensated surrogacies.
- Carrier cycle. This process involves an in vitro fertilization cycle (see definition below) to produce the embryo, which is then transferred to the gestational carrier at the chosen time. Pregnancy is the next phase.
- In vitro fertilization (IVF). A technique, done in a laboratory, which uses the egg and sperm from the intended parents to create the embryo.
- Embryo transfer. In this procedure, which is typically done in a fertility clinic, the embryo is placed in the uterus of the gestational carrier.
- Third-party reproduction. In this approach, someone other than the intended parents is involved in the process of reproduction, through egg donation, sperm donation or an embryo-gestational carrier arrangement.
- Intended family/parents. People who seek gestational surrogacy to have a child are called intended parents. “A lot of people do surrogacy because they have to,” says Noorhasan, author of the book “Miracle Baby: A Fertility Doctor’s Fight for Motherhood” published in 2019, which describes her personal experience as an intended parent.
- Reproductive attorney. Attorneys who specialize in assisted reproduction are experts in legal issues such as gestational carrier contracts, parental rights and widely varying state laws regarding surrogacy arrangements.
- Surrogacy agency. This type of business screens potential gestational carriers and helps match them with intended families. Agencies coordinate between all parties including clinics and surrogacy attorneys, mediate contracts between the intended parents and surrogate and provide counseling and support.
Pathway to Parenthood
Two main paths lead people to a fertility clinic to consider surrogacy, Massie says. One is the inability to carry a child whatsoever, such as for same-sex male couples. “So they need somebody to participate in their family building.” Similarly, there are people who come to a fertility clinic already aware that an existing medical condition prevents them from safely carrying a pregnancy.