We have been considering gestational surrogacy for about a year now and have learned a lot along the way. It can be quite complicated, so I just wanted to share what I have learned thus far. Typically, surrogacy is outrageously expensive, but there are some ways to make it happen for less. And, it is my hope that this information might help others re-evaluate surrogacy as an option for a biological child.
What is gestational surrogacy?
Gestational surrogacy is where a gestational carrier becomes pregnant with the genetic embryo of another couple through IVF, carries the fetus throughout the pregnancy and delivers the child for the intended parents.
Why use a surrogate?
Usually a surrogate is needed when there is a problem with the uterine environment, with repeat loss or being able to carry a child to term. For me, we think it’s a complex reproductive immunological issue and that my body attacks a perfectly normal baby.
Is surrogacy legal?
Yes, it is legal in Virginia, but it is not in some states. Surrogacy laws vary widely from state to state, so you’ll have to do research in your state.
In addition to state laws, your clinic must operate under FDA rules and regulations, which essentially is to prevent the spread of disease. So, intended parents and the gestational carrier need to be free of disease so as not to infect the carrier or the baby. Here is the page on the FDA’s website where the information is provided on this issue.
There are two ways to handle surrogacy in Virginia: pre-approved and non pre-approved. To my knowledge, hardly anyone ever does it as pre-approved, which would require both couples to have home studies done. Here are the basic requirements:
- The carrier must have had at least one live birth.
- If the carrier is married, then her husband must be a party to the surrogacy contract. All parties must enter into the surrogacy agreement.
- All parties must receive counseling — both intended parents, the surrogate and her husband (if applicable)
Steps to take
These steps are not set in stone as to the order. One through five is a good place to start, but after that, you can do things in a different order. For me, it was about doing the deal-breaker type things first and the less expensive things first.
- Come up with a budget.
- Talk to your clinic.
- Find a surrogate.
- Discuss money and treatment decisions with the surrogate and come to an agreement.
- Review her insurance policy.
- FDA Testing Requirements
- Do psychological pre-screening for surrogate and counseling for intended parents and surrogate and her husband.
- Find an experienced attorney for the legal agreement.
- More Pre-IVF screening for surrogate (hysterosalpinogram and trial embryo transfer)
- Get started!
Steps 1-2: Come up with a budget / Talk to your clinic
You need to know what the maximum amount you can spend will be. Then, go about figuring out how much surrogacy might cost you and keep trying until you find a situation that fits your budget. The best place to start is with your clinic. Is a round of IVF with a surrogate the same price as a regular IVF cycle? Are you part of a shared-risk IVF program? Will that program allow you to use a surrogate as part of your program or do you have to pay more? Are there other things your clinic needs to you know?
Total Cost Estimate
This will vary greatly depending on many things, but here’s an idea if you do it on your own without an agency. There are three huge factors here: fees to be paid to surrogate, IVF costs and prenatal and birth costs.
These are all estimates based on my own experience in Virginia in 2012.
|IVF pre-tests for surrogate||$1,500|
|IVF||$0 – $10,000*|
|Anesthesia for egg retrieval||$500|
|IVF Meds||$2,000 – $3,000|
|Surrogate Reimbursements||$0 – 20,000|
|Prenatal and birth costs||$0 – $10,000|
|Total||$9,300 – $50,300*|
*If surrogacy were included in an IVF Success or shared-risk program that you have already paid for, then this would not add on to the cost as it’s already paid for. This is the case for me. We have to pay a nominal extra fee to continue in our program with a surrogate. We were the first couple to request this at our clinic.
Between $17,000 and $50,000 is drastically different than the up to $100,000 or more price tag that you would find with most agencies.
Example 1: Pay surrogate $20,000, IVF is $8,400 and her insurance pays everything for prenatal — $36,700
Example 2: Pay surrogate $10,000, IVF is included in shared-risk program and insurance pays prenatal — $19,300
Example 3: Pay surrogate $15,000, IVF is $10,000 and prenatal is $4000 — $38,300
Example 4: Surrogate is your sister and you pay her nothing, IVF is $10,000 and her insurance pays prenatal — $18,600
Example 5: Pay surrogate $15,000, IVF is $9000, and prenatal is $10,000 — $43,300
Step 3-4: Find a surrogate / Review her insurance
Who can be a surrogate in Virginia?
Any woman that has had at least one live birth. I do not agree with this law and it eliminates a lot of good potential candidates. Sure, if I had my pick, I would pick someone who was proven. But, as with most scenarios surrounding infertility, we don’t always have the ideal situation and this law is limiting. See the Virginia code.
How do you find a surrogate?
Either on your own or through an out-of-state agency. Surrogacy “brokering” is illegal in Virginia, therefore there are no surrogacy agencies here. I would suggest telling everyone you know that you are interested in pursuing surrogacy — your doctors, your family, your friends, your blog readers, your Twitter followers, Facebook friends, anyone. You never know who might have a heart to do it for you, but they have to know you are interested first. Or, they may know someone who would be interested. The key is to find a surrogate who will accept less money because they truly want to help and finding someone with great insurance. Go here to join my Surrogacy Meet-up group on Facebook that I created to help intended parents and gestational carriers find one another.
Review the gestational carrier’s insurance
This is an important step because you want to make sure that the surrogate has good health insurance and surrogacy is not excluded from her policy. You want to see her full policy, not the fun little booklet that the employer might provide. You need the fine print. This can be a major deal-breaker as medical costs could be $10-15,000. If her insurance excludes surrogacy, then you could look into buying a separate policy for her, but you’d have to buy the policy and a maternity rider and wait for the 6-9 waiting period.
We had a situation where a potential surrogate’s insurance did not exclude surrogacy, however her deductible was $10,000 so it didn’t really matter as nothing was covered anyway. We considered the extra policy, but ultimately it didn’t work out. It was just too expensive no matter how we did it.
Step 5: Discuss money and treatment with the surrogate
It is illegal in Virginia to pay someone to be a surrogate. However, you can reimburse a surrogate for expenses.
Average reimbursement amounts
Average reimbursement amounts for the gestational surrogate range from $15,000 to $20,000. Every woman that we have talked to about being a surrogate for us has wanted to do it to help us and therefore is willing to accept less reimbursement money, as in about half of the average amount. Many times, a close family member or friend, will do it for someone and accept no money whatsoever. If you are using an agency, then a surrogate would be paid anywhere from $20,000 – $25,000 and the total cost to you could be $50, 000 – $100,000. So, it’s best if you can avoid using an agency, to avoid unnecessary expenses and the middle man.
Agreement with your gestational carrier
You will need to come to a monetary agreement with your surrogate. For us, we knew what we could spend and either the surrogate would say yes or no — it was that simple. You also need to discuss other specifics with her to make sure you are on the same page, such as:
- How many times is she willing to try? We wanted to make sure she would try at least twice, because by the time you get to transfer you have already invested significantly and you can skip all of those steps and costs on a second try.
- What happens if she miscarries?
- How many embryos is she willing to have transferred?
- Is she willing to carry twins?
- What about selective reduction?
- Etc. — Lots to discuss
How to pay
After doing research and speaking with an attorney, it seemed that the norm for surrogacy arrangements was to pay a set amount upon signing the agreement, then a set amount after the embryo transfer and then equal payments of the rest of the entire sum monthly for the duration of the pregnancy. This protects both of you — the surrogate gets paid something for her trouble even if she doesn’t get pregnant and you are not out the entire sum if she doesn’t get pregnant. Plus, it’s easier to pay over time instead of one lump sum making it more affordable.
Step 6: FDA Testing Requirements
The FDA regulates anything where something biological passes from one person to another to prevent the spreading of disease. In this case, both intended parents, the surrogate and her husband have to get tested for infectious diseases. Also, both of the intended parents have to have a physical exam and fill out a medical history questionnaire. Also, when it gets closer to time, both intended parents must repeat the infectious disease testing and it must be done at a specific FDA approved lab.
Also, my doctors also examined our surrogate and her gynecologist sent a letter to our clinic stating that she was in good health and that she was a good candidate for surrogacy.
Step 7: Psychological Screening and Counseling
Our clinic wanted us to use a psychologist they recommended who is a specialist in surrogacy, which required us to go to our state’s capital. This particular person offered a pre-screening process for $200 that consisted of a phone interview with the surrogate and a personality test for the surrogate. I wasn’t crazy about the personality test part. I took this same test in college and “failed.” The second part is the counseling, which will be $900 (or $1100 if you didn’t do the pre-screening) and will consist of:
- Interview with intended parents
- Interview with gestational carrier
- Interview with gestational carrier and her husband
- Interview with all four parties (intended parents and gestational carrier/husband)
All of these steps are to protect us as the intended parents, to make sure that the carrier is not suffering from psychosis of any kind and that they are emotionally prepared for what would take place. However, it was a lengthy and frustrating process and required multiple out-of-town trips for our GC.
Important Note: We found out later that this step is neither required by the FDA, nor the state of Virginia. It is highly recommended to the clinics by ASRM. I note that because we had a few hiccups here and I was very frustrated and wondered what would happen if the psychologist didn’t recommend the GC? Evidently, our clinic could have made the call if it had come to that, which it didn’t.
Step 8: Find attorney / Legal agreement
Early on, we found an attorney that specializes in surrogacy and I called and talked to her paralegal for a while asking questions. She was so informative and knowledgeable that I felt really good about using them. They charge $2000 for the legal agreement and $1500 for the amending the birth certificate process later. Also, typically the intended parents are responsible for paying the carrier’s legal fees to have her own attorney review the agreement on their behalf. So we paid $700 for our carrier’s attorney fees.
Step 9: More medical tests
The final medical tests need to be performed prior to getting started. These are the standard pre-IVF tests: a hysterosalpinogram and a trial embryo transfer.
Step 10: IVF
Here’s the step that many of your are already very familiar with. Only you do the egg retrieval and the carrier does the transfer.
It’s not easy, but possible
None of this has been easy, but it was possible. I want all of you that are considering surrogacy or are currently pursuing it to know that to make this affordable, it has taken over two years to find the right person and situation. Along the way, we had five other surrogates that volunteered and fell through for various reasons: one didn’t meet state requirements (as in she didn’t have a child), one wanted to do it but her husband didn’t, one had the most terrible health insurance on the planet, one wasn’t really serious yet and one backed out because her husband changed his mind. We finally found the right person, but it was not easy. Each time that a possible surrogate didn’t work out, it was devastating and then kept happening over and over. It was hard.
Update on our situation (September 2013)
We are very happy to report that we are currently 29 weeks pregnant with twins via our gestational carrier. Also, we have a very good friend who is looking for a surrogate. She can’t afford much in the way of compensation though. If you are interested, please contact me.
I would love to hear your stories of successful surrogate cycles or your trials in pursuing surrogacy.
Resources + Connect
- View all surrogacy related posts.
- Are you pursuing surrogacy as an intended parent? Email me and I’ll add you to a private (and secret) surrogacy support group on Facebook.
- Join my Surrogacy Meet-up group on Facebook that I created to help intended parents and gestational carriers find one another.
- Subscribe to my blog with RSS or by email.
- Like my infertility advocacy page on Facebook.
- Follow me on Twitter.