How does surrogacy work?

How Does Surrogacy Work?

5 min read

The path to parenthood is not always a straightforward journey, and while fertility treatment can (and does) help many people get and stay pregnancy, surrogacy can be another way to build a family. Unfortunately, surrogacy is often the subject of undeserved stigma and cloaked in misinformation. Here, we answer your surrogacy questions and help to dispel some of the negativity that surrounds the topic.

What is surrogacy?

Put simply, surrogacy is the act of a person gestating a pregnancy on behalf of an intended parent (IP) or parents. For prospective parents, it’s often viewed as an incredibly selfless act, and forges lifelong friendships between the families involved.

Who is surrogacy for?

There are a variety of reasons an individual or couple might choose to pursue surrogacy:

  • History of recurrent pregnancy loss
  • Previous pregnancy complications
  • Unexplained infertility
  • Chronic conditions requiring medication not safe for pregnancy
  • Chronic conditions or disability that makes pregnancy unsafe
  • Those born without a uterus (including women who have MRKH and single men pursuing parenthood)
  • LGBTQ+ parents who are unable to gestate 

Remember: asking a person to share why they are not pregnant is always inappropriate. Many individuals building their family through surrogacy are uncomfortable disclosing the reasons that led to their decision, and from the outside can appear healthy and able to carry a pregnancy.

Are there different types of surrogacy?

There are two types of surrogates: traditional and gestational.

Gestational Surrogacy

Gestational surrogates share no genetic connection to the baby they are carrying. This means that intended parents supply the embryo (often through IVF treatments—more on that below) and the embryo is then transferred to the surrogate.

Traditional Surrogacy

In addition to carrying the pregnancy, traditional surrogates also act as an egg donor. This can include treatment like IVF or IUI, or it can also mean home insemination.

Does surrogacy require medical intervention or reproductive technology?

Let’s start with a clarification: conception for surrogacy never includes sexual intercourse to achieve pregnancy. Surrogates typically become pregnant through IVF, though some traditional surrogates will conceive through IUI or home insemination.

Most intended parents create embryos ahead of their surrogacy journey. This process can look like an IVF journey for a parent or couple hoping to carry the pregnancy themselves and can include medications and treatments to support healthy eggs, sperm and, ultimately, the embryo. Additional screening may be done on the embryo to ensure that it does not pose a risk to the surrogate.

For anyone who is providing eggs or sperm to achieve pregnancy (no matter the method used to get there), it’s recommended to take a prenatal at least three months before conception in tandem with opting for healthier lifestyle choices.

How do you find a surrogate?

There are a few different ways to find a surrogate including using a surrogacy agency, mining your own personal network and connections and using social media. Read more about how to find a surrogate here.

Does surrogacy require a legal contract?

All surrogacy journeys include a legal contract between the intended parents, surrogate and the surrogate’s partner. This agreement outlines the responsibilities each party has to each other. Both parties retain separate legal counsel for this contract, with the IPs covering the cost of both.

Things to include in a surrogacy contract

This is by no means an exhaustive list, but here are a few things to consider adding to your surrogacy contract (along with anything else that is important to your or your surrogate):

  • The number of embryo transfers the surrogate agrees to undergo
  • Restrictions surrounding risky activity (extreme sports, alcohol consumption, abstinence from intercourse as advised by a physician, etc.)
  • The agreed-upon compensation (in areas where legal surrogacy compensation is allowed)
  • The maximum monthly reimbursement for pregnancy-related expenses (in areas where altruistic surrogacy is legal)
  • Alignment on invasive procedures and termination
  • Preferences around labor and delivery

Contract negotiations don’t need to be tense or awkward – in fact, many surrogates and intended parents informally discuss what they would like their contracts to look like even before involving the lawyers. A strong, mutually agreed upon contract protects everyone involved and sets the stage for a wonderful experience.

Is a surrogate listed as a parent on a baby’s birth certificate?

Birth registration differs vastly by jurisdiction. Some states and provinces allow genetic parents to be established as legal parents from day one (meaning the surrogate is never the “parent”), while others will require them to assume their parental rights through the adoption or judicial process (meaning the surrogate is the “parent” until this adoption takes place). The surrogacy community often flags certain jurisdictions as “surrogacy friendly” (or not) based on how easily IPs can establish parentage following the birth. Surrogacy contracts often limit surrogates from traveling to non-surrogacy friendly locations after a certain point in the pregnancy to avoid potential challenges should they go into labor and deliver while away from home.

How much does surrogacy cost?

While celebrity magazines and television would have you believe surrogacy is exclusively for the wealthy, this is far from the case. While not inexpensive, surrogacy costs can range from contract to contract and place to place

Surrogacy costs in Canada

Many countries, like Canada, operate on a model of altruistic surrogacy, meaning that surrogates cannot profit from their journey. This doesn’t mean that surrogacy is free—intended parents reimburse surrogates for pregnancy-related expenses like maternity clothing, mileage to-and-from appointments, prenatal massages and lost wages. It is often difficult to predict what a surrogacy journey will cost, as every pregnancy is different—some may require bedrest leading to additional time off work or have conditions or illnesses that require additional treatment. A surrogacy journey from finding a surrogate through to the end of the postpartum period and fourth trimester (the three months following birth) can range in Canada from as low as $30,000 CAD to $100,000 CAD.

Surrogacy costs in the United States

In the United States surrogates can legally be compensated by intended parents in many states. Their compensation amount will vary based on factors like experience (number of previous pregnancies as a surrogate), whether they are carrying a singleton or multiples pregnancy and they feel is right for themselves. It is important to note that even in countries where surrogate compensation is legal, there will be instances where a surrogate does not request compensation. 

Will my insurance benefits cover surrogacy costs?

Unfortunately, there is no simple answer to this question as each insurance plan varies. Call your insurance provider directly to ask about fertility and surrogacy coverage on your plan.