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Surrogacy: Getting Into the Details

there's a lot more to it than what Hollywood portrays

When it comes to building your family, there are many pathways available. If having a child the typical way isn’t an option for you, you may have looked at IVF and other assisted reproductive technologies. Surrogacy, on the other hand, may be something you haven’t explored.

Have you seen the Tina Fey and Amy Poehler movie Baby Mama? It’s the first thing I think of when surrogacy is brought up. And like with most Hollywood interpretations, it’s not a reflection of reality.

I spoke to Dr. Julian Escobar, fertility specialist at Conceive Fertility Center in Irving, about all things surrogacy, including some common misconceptions and his own experience using surrogacy.

We always hear about IVF; that seems to be really common now. What about surrogacy? The rarest thing we do infertility is surrogacy, partially, because it’s so expensive and complicated. Most fertility doctors will only do one or two cases a year.

Are the parents and surrogates typically local? I have patients that come from China, Australia, Europe, America. All over the US and, obviously, from here, just for [surrogacy]. This is just not available in most of the world, and we have great laws in Texas that protect people. People come all the way here for that.

How does the surrogacy process typically begin? I think the couple needs to start by meeting with the fertility doctor, discussing their overall family building [plan]. I like to say, “What kind of family do you want to build and how can we build it?” Have expectations, and then, we can go into the process of creating embryos, and [then], we can start looking for a gestational carrier surrogate. That process may take three months, six months, a year before they’re ready for a surrogate.

So you start with the embryos? I would say that most fertility doctors [would say] you have to do IVF to do surrogacy. You need to create embryos to be able to put them into a surrogate, and therefore, a woman needs to undergo an egg retrieval, which women always produce multiple eggs a month, but one of them ovulates and the rest die. When they do IVF, we can rescue all the other ones—so in a single month, a woman can produce five, 10, 15, 20 eggs.

What about egg donors? Usually, if the woman wanted to do surrogacy, still can produce eggs, and is young enough, then she would get stimulated. If she’s older, then she may use an egg donor. If you have a single guy or you have a gay couple, then they’ll use an egg donor.

Then, obviously, you need a guy to produce a sperm sample. Most of the time, it’ll be the husband, but sometimes they may need a sperm donor. Then, what happens is all these eggs get fertilized and that’s the IVF process, which is super efficient. And we normally grow these embryos for five days.

And after those five days? In nature, those five days of embryotic growth occur in the fallopian tube, and so, what happens in the fallopian tube, before it enters the womb, it’s happening now in the IVF lab. That becomes, nowadays, a stopping point where we freeze the embryos. Having said that, for surrogacy, I’m testing the embryos to make sure the chromosomes are normal. It’s called pre-implantation genetic screening. Why? Because now, you’re going to put an embryo into a third person. So we test the embryos. We freeze them, and then the surrogate component comes.

What’s the most difficult aspect of surrogacy? What’s complicated about surrogacy is everything else. How do you find a surrogate? How do you engage her, and match with her, and sign all the contracts? But you have to remember, at the end of the day you cannot force her to do anything because it’s her own body.

At what point do you find the surrogate? I think most people who need a surrogate, just exactly like you said, they know they need a surrogate, and so, they start searching for the surrogate, first. That is the opposite of what they should do. That’s extremely backwards. What happens is [because] it’s such an expensive [process]—you’ll find agencies helping people match and charging you $15,000-25,000 just to match a couple—but no surrogate is going to take [the intended parents] seriously because they don’t even have embryos.

Do you have to go through an agency? Some people, while they go into it, as they [tell] family and friends that they’re going through this process, they may be able to find someone who knows someone, or someone offers to carry for them. Anyone you know is going to give you a better [experience]—I mean you’re entrusting a woman with the life of your child, so if you know this person, or at least know of this person, that’s so much better than meeting a complete stranger. I think that’s the way to go. Then [some] people can try to find someone on their own. I’ve done this enough where I can guide patients, [tell them where to go]. But before you’re going to ask someone to carry for you, it doesn’t matter how great she looks on paper, you have to see if you click. If you don’t click, you can’t go forward.

Are there any age restrictions for the surrogate? Surrogates, as opposed to egg donors, can be older. They can be 34, 38 years old, and do perfectly well. There’s more room there because really what gives you the good pregnancy rates is the egg. Also, a woman cannot carry as a surrogate if she has never carried for herself. The rest [of the requirements] are kind of loosey-goosey, but obviously, you would want someone who’s had a healthy pregnancy before. Ideally, vaginal deliveries rather than C-sections. [And] someone who’s delivered recently, not like 15 years ago.

What about concerns surrounding exploitation of women? When finding a surrogate, you want someone who is financially and socially stable. You don’t want someone who’s doing this because they’re starving. Because that’s where you get a power struggle, and someone is doing it not for the correct altruistic reason. They’re doing it out of need. Because you’ve selected a disadvantaged person [than] that can lead to some abuse, where you’re taking advantage of a woman and paying her to carry. So I think the ideal surrogate has a good support system, has a good life.

You mentioned Texas has good laws surrounding surrogacy. How so? The contract that the intended parents and the surrogate sign are valid under the law, and so [it states] she doesn’t want to be the mom and [the intended parents] don’t want her to be the mom, and what’s written is valid. Now, if you go to Louisiana, those contracts have no value. It’s my understanding that if you do surrogacy [in Louisiana], she’s the mom because she has the kid, so that is very problematic.

How does a couple or individual determine if surrogacy is the right fit? Obviously, if it’s a single guy or a gay couple, 100% before they start the process, they know they’ll need a surrogate. A lot of the time, I take half of my female patients and go into it knowing that they’re doing IVF for surrogacy. For example, they had a child and were crippled by the delivery and they don’t want to go through that. Or they had some complication. They lost their uterus. They were born without the uterus. So I take half of the women and already kind of know.

And the other half? The other half are going to be people who may have difficulties going into a fertility process. Maybe you don’t know, but then you either confirm or realize as you go through the fertility treatments, that there are issues with implantation, or severe recurrent pregnancy loss, so they could be a person that even after you put normal embryos into her uterus, she keeps miscarrying. Someone who has recurring implantation failure and they just cannot get pregnant even if you’re putting normal embryos and are doing all the possible workup. [Using a surrogate] is a last resort. The least common scenario is going to be the one that people hear the most, which is going to be the Kim Kardashian’s and Beyonce’s. We don’t really see that often.

You mentioned a hefty price earlier; what does the total cost typically come out to? So the cost to find a surrogate can be around $15,000–20,000. I think $20,000 is kind of an average. The legal is going to cost you about $8,000; then the IVF process itself can cost you $20,000–30,000 depending on where you do it. Then the [fee for the] surrogate, herself, can be $25,000–50,0000.

That’s a lot of money. Right. And that doesn’t include all the extras, like the extra clothes, the transportation, the taking time off work. If she gets put on bed rest because of whatever issue. If she works, you need to pay her. If she normally cleans her house and the doctor’s saying she shouldn’t clean the house, then, you have to find someone to clean her house. If she normally picks up her kids from school and she can’t do that, you have to find someone to pick up the kids from school. Understanding the life of the carrier is extremely important, because it’s going to affect you. But you don’t need to have all the money from the get-go.

Does the intended parent, or parents, typically spend a lot of time with the surrogate throughout the pregnancy? It just depends. That’s what I did. But the Chinese intended parents that I have [typically] have very little relationship because their time zones are so different, and because of the language and cultural differences. But there’s going to be [some kind of] a relationship, and I think [finding] a healthy medium is not easy. I went to every single obstetrical appointment, but she was local. If she lived three hours away or five hours away, that would be impossible. Usually, even before COVID, there was always a lot of picture-taking, videos, FaceTime, and WhatsApp.

Can you tell us more about your own experience with surrogacy? We did it in 2014, and it was super simple. Someone told me of someone who’d been a surrogate and we just met for brunch and met her with her husband; we clicked immediately. She got an evaluation and everything done, but since we couldn’t get pregnant, we wanted to go through the experience and be part of it as much as possible. Both of us always went to every single appointment, so we built a very strong relationship. My kids know her, we see her maybe once a year. They know exactly who she is; they know that we needed her to have babies.

To learn more about assisted reproductive options, including surrogacy, or to reach out for a consultation, visit the Conceive Fertility Center’s website.

Image courtesy of iStock.