Surrogacy

Who to Choose First – the IVF Clinic or Surrogacy Agency?

by Richard Westoby

From the series, Our Guide to Surrogacy in the U.S.

March 21, 2014

Knowing what I now know, this is a super simple question to answer.  Without hesitation I recommend that you pick the Doctor first, then the clinic then the people that will help you with the rest of the process!

I very much doubt that you would go for heart surgery by choosing the hospital without researching the Doctor performing the surgery, so why create your family any differently?  Research your Doctor, check their pregnancy success rates, live birth rates, how many transfers they do, single or twin transfers and most importantly TALK TO THEM – you must follow your instinct.  If you like the Doctor that is wonderful, if not then find one that you do.

At the time we were making the choice of which route to go first we had no idea what we were supposed to be doing!  We naively believed that by getting in touch with an agency we would be guided by them to make the right choices.

Not necessarily so.  I might be tarring all agencies with the same brush but bear in mind that what is in the best interest of the agency is not necessarily in your best interest.  Two classic examples are where you are "guided" towards an IVF clinic that just happens to have a tie-in to the agency!  Or they guide you towards an insurance broker in which they just happen to have a minority stake.... Surrogacy is a business, and a profitable one, so make sure you know who does what, how they fit in to the picture and make decisions that are right for you.

At the same time, I have also heard that some IVF clinics are trying to get more involved in the whole puzzle and are starting to act like a surrogacy agency by matching patients and surrogates.  That is wrong too, but when money is talking it is amazing what ideas start cropping up.  I also think that agencies should not have egg donor banks as typically the egg donors have not been medically screened for their viability in producing suitable quality or quantity of eggs and you an get your heart set on a donor that ultimately doesn't work.

So, in a nutshell I think let the agency find you a surrogate, look after all the paperwork, manage your escrow account and basically handle all of the "case management" bureaucracy.  And let the IVF clinic medically screen and assess the suitability of the egg donors and evaluate them before you see them.  Let the clinic manage the IVF protocols (drug doses etc) and do the retrieval, fertilisation and transfer... after all that is why you are paying each of them a vast sum of money!

I believe that your Doctor is THE most important part of making your IVF family so maybe I'm missing something but I say let the Doctor do the medical stuff and let the agency do the legal stuff... After all that is what they should be good at doing.

Why We Chose Surrogacy in the U.S.
by Richard Westoby
From the series, Our Guide to Surrogacy in the U.S.
March 10, 2014

Surrogacy in the US is definitely the most expensive place to go through the process and I am regularly asked why chose it instead of doing it in a “cheaper” jurisdiction.  We had the choice of going to multiple countries namely the US, Thailand, the Ukraine, Georgia and India.  India is now not an option for same-sex couples (as the law is changing), but why the US?

 In all honesty the answer is very simple – we felt that the tried and tested legal framework in the US would offer us and our children the best protection.  The US is a country where surrogacy has been going for years and as such it is an “understood” concept.

We wanted our family to be created in a country where we would be recognised as the parents of the children immediately and have all of the associated rights.

 In the UK surrogacy contracts are unenforceable and the surrogate mother has rights for the first 6 weeks of the child’s life.  We felt that Eastern Europe and Thailand were not advanced enough for us to gain the level of comfort we wanted and that left the US.

About Richard
Richard and his partner Steven undertook surrogacy in the United States and learned everything about the process during the process.  Since the twins were born, Richard has become an advocate helping prospective parents (both gay and straight) learn more about surrogacy in general but predominantly about doing it in the US.  In doing so Richard aims to help parents make informed decisions from the outset which should hopefully save them not only a lot of hassle but also a lot of money.

Richard has always had a fascination with biology and on the back of his experiences and his advocacy work he now also helps US fertility clinics in the UK reach out to prospective parents.

Richard's basic step-by-step guide featured in the We are Family Magazine Winter 2013 edition.  Richard is also actively involved within the UK gay dads community in organisations such as GaySurrogacyUK and Families Thru Surrogacy.

Biography and photo courtesy of Richard Westoby and www.guidetosurrogacy.com

Follow Richard on Twitter @RW1602

Buy, "Our Journey: One Couple's Guide to U.S. Surrogacy" available now!


How To Become A Surrogate Mother

Becoming a Surrogate Mother is harder than it sounds, but very worth the energy and commitment. Surrogate Mothers are unlike any other women on the planet. They are beyond giving. A super woman of sorts! Surrogate Mothers are women who are empowered by the desire to give themselves completely to another.  If this is you, you are already asking yourself:  How do you go about becoming a surrogate mother?

Independent or Agency? There are pros and cons to both. Independent surrogate mothers often make a fraction of what surrogate mothers at agencies do. Right now, the compensation at most good agencies is about $24,000 for a first time surrogate mother. As an independent surrogate, the range can be anywhere from $10,000 on the low side to $24,000. There is a lot of legwork to becoming an independent surrogate mother. You have to find your own lawyer, screen your recipients,  obtain surrogacy-friendly insurance; all of these things can be challenging but they are not impossible. Agencies do all the work for you, but some of them have bad reputations and down right suck!

How To Choose an Agency? The most important thing is fit. Next is reputation. Does the agency have a good reputation? Google them and find out if there are bad reviews or complaints from surrogates who haven’t been paid. Surrogates who have been burned are the first to blast an agency in one of the online message boards. Ask around!  Do you have to sign a contract giving them a length of time to match you? How many surrogate mothers do they already have in their database? How many recipients a month do they match? Do they have any former surrogates on staff that can help you with issues or questions? How long does it take them to return your phone call or email? Who do you call in an emergency at 2am?

Creating an Independent Ad: If you decide the agency route isn’t for you, the next step is to create an ad and place it on one of the surrogate mother matching boards.  Highlight things that make you stand out, but be honest! Talk about your home life, height and weight, exercise and diet. Do you have  insurance that will cover not just pregnancy, but a surrogacy-related pregnancy? How many children do you have? MAKE SURE TO USE PROPER GRAMMAR AND SPELLING. No slang or shorthand! Surrogates who create ads which are well written stand out! When you stand out, you can ask for more compensation and get a high quality recipient responding to you.

Matching: If you are going through an agency, they will set up  a “match call.” A match call is a conference call facilitated by the agency where the surrogate mother and recipient parent have an opportunity to speak with each other with a representative of the agency also on the phone. If this call goes favorably, it may  lead to a in-person meeting (depending on the agency). Of course, if the potential recipient is located overseas, you may not have a chance to meet them until you deliver the baby.  If you and the recipient parent decide you’re a good fit, you will take the necessary steps to move forward, which vary between agencies. If you are independent, you should start by exchanging emails with a perspective recipient parent. Continue to narrow the recipients you like the best, talk to each of them on the phone, and screen them very carefully! Make sure they are not sex offenders, bankrupt or have financial issues. Ask if they would be willing to submit to a background check or provide documentation that they can afford the process and the child they are intending to bring in the world. SOMETIMES INDEPENDENT RECIPIENTS WILL SAY THEY CAN ONLY AFFORD $8,000 OR OTHER SIMILAR DOLLAR AMOUNT. STAY AWAY!!! You deserve a decent amount of compensation for carrying a child for 9 months — 24 hours a day, 7 days a week! Yes, children need lots of love, but they also need necessities such as diapers,formula etc… If the recipient has that little left, they SHOULD NOT have a child until they can properly afford it. Recipients don’t have to be rich, but they need to be able to properly provide for the child which will be brought into the world.

BACKGROUND CHECK: Most recipients and agencies will check your and your husband’s or boyfriend’s background. They are looking for criminal issues. Have you ever sued anyone or been sued? Bankruptcies, repossessions or evictions? Can you be a surrogate mother if you or your spouse have a lengthy rap sheet of issues? Maybe!  Depends on the agency or recipient. Should you be a surrogate if you have those issues?  No! Surrogates need to be stable, responsible people!

Physical and Psychological Evaluation: You will be examined by the recipient’s fertility doctor. He or she will go over all your pregnancy-related medical records. (Note: if you're going independent get those now!) They will order tests to draw blood from you and your partner to screen for STDS, drugs, etc… Then he or she will do an ultrasound and pap smear to make sure you have no blockages in your tubes or uterus that would prevent you from becoming pregnant; pap checks for abnormal cervical cells. The psychological evaluation is done by a licensed therapist who has experience dealing with surrogacy-related issues. This person can ask you anything they want. The evaluation is designed to find red flags that becoming a surrogate could cause emotional problems for you now and in the future. The questions are based on a test called the MMPI-2. You may also be given an Intelligence Quotient (IQ) test.

Legal: Once your psych and physical are clear, you will begin contracts between yourself and the recipient parents. When contracts are final, legal clearance will be issued to your IVF doctor letting them know it’s OK to start cycle.

Starting Cycle and Transfer: Once all the leg work is done, you and your recipients are free to start attempting to get pregnant. Usually cycle starts with birth control pills, moves on to Lupron injections, then progesterone injections. During this time, you will be monitored by ultrasound routinely. Expect numerous trips to the IVF clinic prior to transfer. If you are doing a fresh cycle, transfer will be after the eggs are retrieved  from the IM (Intended Mother) or Egg Donor and grown either 3 or 5 days. Once this is done, they will be transferred into your uterus. After transfer, you will rest at the clinic for about 20 minutes, then be on strict bed rest for 48 hours. After that, you will be ordered to participate in only light activities until your HCG Blood test 10 days later.

Surrogacy Terms

Short Hand Meanings

GS- Gestational Surrogate
TS – Traditional Surrogate
TTC- Trying To Conceive
LMP- Last Menstrual Period
SAHM- Stay At Home Mom
RE- Reproductive Endocrinologist
ED- Egg Donor
IVF- In vitro Fertilization
IUI -Intrauterine Insemination
BMI- Body Mass Index
BC- Birth Control
2WW- Two Week Wait
HPT- Home Pregnancy Test
IP- Intended Parents AKA Recipient Parents
IM- Intended Mother
IF- Intended Father
ET- Embryo Transfer
FET- Frozen Embryo Transfer
US- Ultrasound
AI- Artificial Insemination
PG- Pregnant
POB- Pre-Birth Order  AKA Parental Establishment Agreement
MMPI- Minnesota Multiphasic Personality Inventory

Surrogacy Terms

Gestational Surrogate- A Surrogate mom who becomes pregnant with donor eggs or eggs of couple she is carrying for. Gestational surrogates ARE NOT the biological mother of the child they are carrying.

Traditional Surrogate- A Surrogate mom who becomes pregnant using her own eggs and the sperm of the person she is carrying for. Traditional Surrogate is also the BIOLOGICAL MOTHER of  the child she is carrying.

Egg Donor- A woman who donates her eggs usually for a fee.

Agency- A company which for a fee handles matching surrogates with recipient parents and oversees all aspects of the entire process.

Independent-  A surrogacy done without the assistance of a surrogacy agency.

Recipient Parent/Intended Parent- Person the surrogate mother is carrying the child for.

Surrogacy Exclusion- A insurance term where the insurance company WILL NOT cover a surrogate pregnancy.

Transfer- Where the eggs created via IVF are then implanted in the surrogate mom.

Bed Rest- Where you must stay in bed for a length of time.

In Vitro Fertilization- A process where sperm and egg are put together while they are in a laboratory dish.

Pregnancy Complication- A health condition during pregnancy that could put you or the unborn child at risk.

Beta HCG- Blood test done to confirm pregnancy. This number needs to double to confirm pregnancy.

Base Fee- The amount of compensation a surrogate will be paid to carry the pregnancy without extras.

Extras- Items a surrogate will be paid for above and beyond the base fee. Example (maternity clothing, food etc..)

Termination- Ending a pregnancy completely usually for medical or genetic reason.

Reduction- A medical procedure used to reduce a multiple pregnancy with a large number of fetuses usually three or more  without entirely terminating the pregnancy. This procedure is usually advised due to the risks to surrogate and baby from carrying a large number of fetuses at one time.

Fertility Medication- Usually Lupron and progesterone oil. Theses meds are usually injected by the surrogate mom into her body and prepare her body for embryo transfer and upcoming pregnancy.

Pre-Birth Order State- A State when surrogate mother resides where a court order can be handed down while the surrogate mother is still pregnant giving legal rights to the recipient parents.

Reproductive Lawyer- A attorney who specializes in issues related to surrogacy and egg donation.

Surrogacy Agreement- A legally binding contract a surrogate enters with the recipients. Where she agrees to carry a child for them to the best of her ability and they agree to compensate her and cover all expenses related to the pregnancy. This agreement should be drafted by a reproductive attorney

Minnesota Multiphasic Personality Inventory (MMPI or MMPI2)- A mandatory test administered by a psychologist  which determines if a women is mentally competent and able to handle entering into a surrogacy agreement.