Your Pregnancy Matters
What to expect when you’re expecting – via gestational surrogacy
February 11, 2020
One of the most exciting parts of being an Ob/Gyn is introducing a newborn to his or her parents. While traditionally those parents have been the mother who delivered the baby and her partner, we're seeing more families and individuals choosing gestational surrogacy as a path to parenthood.
Gestational surrogacy is a legal arrangement in which a woman (gestational surrogate or gestational carrier) agrees to carry a baby that has been conceived using the egg of the intended mother or an egg donor and sperm from the intended father or sperm donor for another individual or couple, who will become the parents after birth. This arrangement ensures the baby is not genetically related to the gestational carrier (GC).
At UT Southwestern, we consider gestational surrogacy to be a form of fertility treatment. Often people who pursue that route can't conceive on their own due to reproductive conditions, being in a same-sex relationship, or being single and wanting to become a parent on their own terms.
I’ve had the opportunity to work with many intended parents and provide Ob/Gyn care for many GCs at William P. Clements Jr. University Hospital. If you are considering this option, you will need to take certain steps to ensure you are pursuing pregnancy safely for your baby and the GC, as well as within the parameters of your budget and the law.
Prepare for the associated costs
Insurance coverage varies for in vitro fertilization (IVF), prenatal care, and delivery, recovery, and newborn care costs.
Gestational surrogacy can cost approximately $150,000 over the course of the journey, depending on your insurance coverage and where you live. The cost often is double or even triple that of an unassisted conception because GC pregnancies typically require fees for a gestational surrogacy agency, an attorney, the gestational carrier, her prenatal care, and your baby's delivery and newborn care.
Find a gestational surrogacy agency and attorney
The Metroplex is home to several reputable agencies that can help you connect with a potential gestational carrier, donor eggs, and/or donor sperm, depending on your needs. Intended parents might have access to the GC's health history as well as other pertinent lifestyle information.
Reputable agencies work only with women who have proven ability to carry pregnancies to term. Going through an agency can reduce the risk of working with a GC who changes her mind about participating. The emotional toll of such a situation can be devastating, not to mention the legal fees you might incur from a lengthy custody battle.
Which brings us to the next step – working with an experienced attorney.
A lawyer will draft a contract laying out the terms decided upon by you as the intended parent and the gestational carrier. These could include whether you have access to the gestational carrier’s protected health information, how prenatal and postpartum care will be covered, termination of the gestational carrier’s parental rights, and adoption by you or your partner if necessary.
'There is a huge element of trust in gestational surrogacy. Open communication between the intended parents, gestational carrier, and Ob/Gyn is key to a smooth process over the coming months.'
You can also include certain preferences. We've seen cases in which the GC agreed to eat a certain diet or forgo specific activities during the pregnancy. Some intended parents request that a specific doctor or hospital conduct the prenatal care, while others defer to the GC's preferences.
Surrogacy laws differ dramatically from state to state, and the GC with whom you're matched might not be local. For example, in Texas, the gestational surrogate cannot use her own eggs – this regulation is not the same everywhere. So, it’s important to find an attorney who specializes in family and reproductive law.
Related reading: What Texas couples need to know about gestational surrogacy
Meet with a fertility specialist – all parties involved
Some intended parents can use their own eggs and/or sperm, and others need one or both from donors. If the latter, intended parents often ask why they still need to meet with a fertility doctor.
It's because these appointments include more than testing. The process starts with gathering full health histories and performing Food and Drug Administration-mandated health screenings of the intended parents and GC.
Testing alerts the parties to genetic mutations or inheritable conditions, if any, that might affect the baby. It's also necessary to minimize pregnancy-related risks for the GC.
The GC (and her spouse if she has one) also will meet with a psychologist to confirm that she fully understands the emotional implications of pregnancy and that she has volunteered to help the intended parents of her own free will.
There are many good fertility programs in our community and at UT Southwestern. If you don’t already have one, we’d be happy to refer one.
Once the GC is deemed physically and emotionally healthy enough to carry the pregnancy, the next step is to proceed with conception through IVF. In many cases, multiple IVF attempts are required. This can increase your costs, so stay in close communication with your fertility specialist and insurance provider to avoid surprise bills later.
The baton is passed to the Ob/Gyn once the gestational carrier is pregnant. This is a special transition because it’s often the first time I get to meet everyone involved.
Establish Ob/Gyn care for the pregnancy
As an Ob/Gyn in a GC pregnancy, the first agreement we make together is that the GC is my patient, first and foremost. My role is to support her health during the pregnancy, with the ultimate goal of delivering a healthy baby.
There is a huge element of trust in gestational surrogacy. Open communication between the intended parents, gestational carrier, and Ob/Gyn is key to a smooth process over the coming months.
In every gestational surrogacy I’ve worked with, the intended parents have had full access to the gestational carrier’s health information. This allows me to talk openly in front of all parties.
I urge intended parents who are in the same city as the GC to attend the prenatal care visits and stay involved throughout the pregnancy. Doing so encourages bonding with the baby-to-be and ensures everyone gets the same information in a timely fashion.
It can also lead to more cohesive joint decision-making if potentially tough choices must be made, such as unexpected issues with the GC's health. If she develops a condition such as blood clots, preeclampsia, or gestational diabetes, her health is the first priority.
While the gestational carrier and baby are our main priorities, we try to do everything we can to make the experience inclusive for intended parents – it's an exciting moment in their lives!
Plan your baby's birth experience
Open up to your Ob/Gyn about your preferences regarding the birth of your baby.
- Do you want to be in the room for the birth?
- Will friends or family visit your baby at the hospital?
- Are specific religious or cultural birth details important to you?
While your birth plan will be different from a traditional one, it's important we know how to best support you when the big day arrives.
At Clements, we feel strongly that the intended parents should get to witness their child's birth if they wish, and we will do everything we can to make it happen.
For example, we normally allow one person in the operating room if a woman needs a cesarean section (C-section). In GC deliveries, we may be able to make an exception and have two intended parents in the room.
We also try to provide a separate room for the intended parents to bond with their baby after birth. We try to reserve a room next to the GC's recovery room so our care team can go in and out of both rooms as needed.
A few closing thoughts
Many people underestimate the meaningful relationships that can develop between intended parents and their gestational carriers over the course of a pregnancy.
Some parents choose to cut ties with their GC after the delivery, which is entirely your decision. However, some parents continue the relationship. We've seen parents take pictures of the newborn with the GC, and some GCs offer to donate breast milk. If you choose to stay in touch, you might find that you can learn a lot from her about newborn care.
Gestational surrogacy is a unique pregnancy journey, and it's humbling and exciting to be involved.