How the Surrogacy Process Works
THE FIRST STEP
1. Your initial consultation
The choice to become a surrogate is life-changing and we want you to feel confident in knowing you have all the information you need before applying. Although it's not required, we offer a free 60-minute consultation where we will happily answer any questions or doubts you may have. This is a chance to learn more about our process of surrogacy and program and your options so you understand what to expect throughout the entire process. Our consultations are currently held through video conferencing and are offered in either English or Spanish.
If you're considering surrogacy, you may be wondering about the different types of surrogates available. One option is finding a surrogate, which involves the intended parent(s) locating a surrogate on their own. Another option is assisted reproduction, where a fertility clinic or agency matches intended parents with a surrogate. Exist two main types of surrogates: traditional surrogacy and gestational surrogacy. Traditional surrogacy involves the surrogate using her own eggs to become pregnant, while gestational surrogacy involves using the intended mother's or donor's eggs and the intended father's or donor's sperm.
2. Application and screening
If you feel passionate about continuing with the surrogacy journey, you will fill out our detailed online application. This is the official first step of the process of surrogacy!. We need to get to know you and your preferences in greater detail in order to match you with the perfect intended parent(s). If your application is accepted, we’ll schedule a meeting with your Case Manager who will conduct an in-depth interview with you to ask about your motivations for becoming a surrogate, your family/close relationships and support system, your interests and lifestyle, your pregnancy history, and more. We’ll want to understand what you are looking for in a surrogacy journey, which population groups you feel comfortable working with, and your views on termination and selective reduction. This will all be important for finding a parent match that shares similar views. Your Case Manager will also walk you through surrogate expectations, next steps and will provide you with support throughout the remainder of your surrogacy journey.
At this stage, we will help you understand some of the legalities of surrogacy and offer guidance to find a reproductive lawyer if you don't already have one. Your attorney fees will be paid for by your intended parents. We will also determine if your health insurance can be used for a surrogate pregnancy or if additional insurance would have to be purchased by the intended parents. We ask that you take a pregnancy test before matching begins to ensure you are not currently pregnant and that you begin using contraceptives consistently to prevent an accidental pregnancy of your own.
In order to officially become a First Step surrogate, you must complete all of the requirements of our screening process before the matching process begins. Requirements include passing a criminal background check and drug tests, completing preliminary medical exams, and undergoing a psychological evaluation.
3. Matching and legal contracts/escrow
At First Step, we put a lot of effort into finding the best match possible for both the intended parent(s) and the found surrogate. We don’t just hand over a database of surrogate profiles for intended parents to sift through but rather, we personally review and hand-select potential matches that fit the predetermined preferences and criteria for both parties. We never want a match to feel forced so we match based on the following criteria:
Personality fit: Compatibility matters because we want you to have a comfortable and natural relationship with your intended parent(s) throughout the entire process.
Surrogacy expectations: This includes the number of embryos to transfer and preferred level of communication throughout the journey.
Views on termination and selective reduction: This is particularly important in that if a situation ensues where a reduction or termination must be considered, we want the views of both parties to coincide.
Location of surrogate and legalities: Surrogacy laws vary state by state so we want to ensure that the laws from each party's home state complement each other.
After being matched, each party will work with its legal representative to discuss risks and responsibilities, negotiate legal contracts, and draft up an agreement to be reviewed and approved by both parties. This is the time to discuss and mutually agree on any issues regarding the pregnancy. An escrow account will be established for your surrogacy compensation. Your intended parent(s) escrow or trust account must be funded before the medical cycle can begin. Funds will be paid to you in amounts predetermined by both parties and as specified in the agreed-upon contract. Your contract may include restrictions on travel during surrogacy.
SURROGACY MEDICAL PROCESS
4. The Medical Cycle
Once everyone is in agreement and the contracts are signed, to continue with the process of surrogacy, you will start to be prepped for the embryo transfer process at the IVF clinic your intended parents have chosen. If your intended parent(s) require an egg donor, they would have already matched, completed legal contracts, and completed medical screenings for the donor by this point. Your reproductive endocrinologist will provide a more extensive medical screening and a cycle calendar that details the date of embryo transfer. From this point on, the general surrogacy medical process will look something like this:
Preparing the embryo for transfer
You will be prescribed self-administered hormones to prepare your body to accept the pregnancy, as well as estrogen patches to help thicken the lining of your uterus. The timing and process of transfer will depend on whether your intended parents are using frozen or fresh embryos. If using frozen embryos, the transfer will be done according to your cycle.
With a fresh cycle, your intended mother or the chosen egg donor will make the embryos to be transferred. First, your intended mother (or the egg donor) will be given birth control. Then in order to synchronize your cycles, you and your intended mother (or the egg donor) will be given Lupron injections which suppresses hormone production, helping create more balanced hormone levels and giving the physician more control over both cycles. This also ensures that your uterus will be ready to receive the embryos at exactly the right time.
Following Lupron, your intended mother (or the egg donor) will begin taking fertility hormones (FSH) which stimulates the ovaries to produce several eggs. Once ready, your intended mother (or the egg donor) will be given an HCG shot which will prepare the egg(s) for retrieval 36 hours later. On the day of retrieval, you will begin your hormone shots to prep the lining of the uterus and will continue on hormones through the 12th week of the pregnancy.
Transferring the embryo
Depending on the agreement laid out in your contract with your intended parent, one or two embryos will be drawn up into a thin, flexible catheter and then transferred into your uterus using an abdominal ultrasound to ensure exact placement of the embryo. Embryo transfer will take approximately 30 minutes. The transfer tends to be a quick and painless process.
If possible, your intended parent(s) may be there for support as this is an exciting step in the process of growing their family!
Around 9 days after the embryo transfer, you will have your first pregnancy test via a blood test. If you are pregnant, you will be monitored to ensure your HCG levels continue to rise and that the pregnancy remains viable. If this is the case, an ultrasound will be conducted around week 5 or 6 of the pregnancy to check if a heartbeat is detected. If the heartbeat is heard, you can officially be considered pregnant.
You will continue to be monitored at the fertility clinic until the end of the first trimester (around the 12 week mark). You will also begin to see your OB/GYN between week 6-8 and continue for the remainder of the pregnancy. Intended parents can feel anxious as you transition from their IVF doctor to your OB/GYN. We ask that you keep open communication with your intended parent(s) and potentially include them in your appointments if possible to help reduce their anxiety.
About 6 weeks before the birth we will begin to prepare you, your intended parents, and the hospital for the delivery of the baby. The goal is for everyone to be prepared and for expectations to be addressed before you arrive at the hospital to give birth.
7. Labor and delivery
Intended parents usually want to be a part of the labor and delivery if possible. However, hospital policy and your preference will determine who will actually be present in the delivery room. After delivery, the baby(ies) will not be released from the hospital until you have been released. Providing breast milk is not mandatory but should be discussed during the surrogacy, with expectations and compensation agreed upon beforehand and included in the contract.
The baby(ies) will be released to the intended parents and they will have some legal paperwork to complete in order to obtain the birth certificate(s) (and passport(s) if the parents are international). You will be required to fill out some paperwork as well to help the parents establish guardianship and legal rights to their child(ren).