Overview

Donate-Or-Surrogate through its seamless processes and services guides Surrogates and Intended Parents from the beginning of their journey to the end. Our agency will match Intended Parents with the right Surrogate for them. Intended Parents can choose a Surrogate from amongst our available Surrogate candidates, or we can conduct a custom search for surrogates meeting Intended Parents’ unique criteria.

Upon being matched with a Surrogate, we will refer Intended Parents and their Surrogate to reputable third-party reproduction attorneys. These attorneys will facilitate the contractual agreements between both parties by drafting, reviewing, and finalizing the surrogacy contract, as well as handling the legal complexities associated with birth orders and, if applicable, post-birth adoptions.

We will refer Intended Parents to reputable third-party reproduction attorneys or insurance brokers, who will review their Surrogate’ health insurance policy for surrogacy exclusion clauses. We will also refer Intended Parents to insurance brokers who can assist them in coordinating maternity health insurance coverage for their Surrogates, as well as arrangements for life insurance to cover unexpected medical complications that may arise over the course of the surrogacy cycle or pregnancy.

We will refer Intended Parents to a third-party reproduction trust account specialist, who will set up and manage a fund management account on the behalf of the Intended Parents. This account will be used to distribute funds, as needed, for the successful completion of the surrogacy cycle.

We will refer Intended Parents to reputable IVF clinics and reproductive endocrinologists if requested. We will assist in managing the Surrogate’s medical and psychological appointments.

Finally, we will guide and support both Intended Parents and Surrogates through the entire surrogacy process. We understand that surrogacy is an important and complex undertaking, and we are here to be your “helping hand” throughout the process.

 

The Matching Process

The following steps describe the typical surrogacy matching process at Donate-Or-Surrogate:

• The Surrogate submits a Surrogate application/profile to Donate-Or-Surrogate. Each profile includes information regarding the Surrogate’s medical, personal, and family background, as well as photos of the Surrogate and her family. The Surrogate also signs a medical release, which releases all her pre-natal and delivery medical records for prior births.
• Donate-Or-Surrogate reviews the application to ensure that the Surrogate meets basic screening criteria. A telephonic interview is then scheduled. During the phone interview, the Surrogate is further screened, and the surrogacy process is reviewed in detail with her.
• If the Surrogate resides within driving distance of one of our offices, an in-person interview in the Surrogate’s home (the “home visit”) will then be scheduled. The Surrogate’s partner/spouse should be present at that interview. If the Surrogate resides in an area that is not within driving distance of our office, the home visit may occur later in the process.
• During or immediately after the home visit, the Surrogate will complete a paper-and-pencil psychological/personality test (the PAI or MMPI), which screens for psychopathology.
• A background criminal check is performed on the Surrogate and her partner/spouse, as well as on any other adults residing in the Surrogate’s home.

Once these steps are complete, the Surrogate’s profile is released to Intended Parents for consideration. No identifying information, such as the Surrogate’s name, address, or contact information will be released to Intended Parents at this time.

Prospective Parents interested in working with the Surrogate will complete a profile about themselves, which will be provided to the surrogate they are interested in working with. Like the Surrogate’s profile, the Intended Parents’ profile will not contain identifying information, such as their names, address, or contact information. The purpose of this profile is for the Surrogate to determine if she is interested in meeting the Intended Parents.

If the Surrogate determines she is interested in meeting the Intended Parents, Donate-Or-Surrogate will arrange for the Intended Parents and Surrogate to have a phone meeting. The Surrogate’s partner/spouse is encouraged to participate in this phone meeting.

If both the Surrogate and Intended Parents decide they would like to meet in person after the phone meeting, Donate-Or-Surrogate will then coordinate the in-person meeting. It is recommended that the Surrogate’s partner/spouse participates in this meeting, if possible. If the Surrogate and Intended Parents reside within driving distance of Donate-Or-Surrogate’ office, the meeting will occur at this office location. Otherwise, the meeting may occur at a location convenient for the Surrogate (e.g., near her home) or at a location convenient to the Intended Parents (e.g., near their home). If the Surrogate is willing to travel for this meeting, Donate-Or-Surrogate will make the necessary travel arrangements and the Intended Parents will be required to cover travel expenses.

Once the Surrogate and Intended Parents determine they would like to work together after the in-person meeting, the Surrogate will then be medically and psychologically screened by the Intended Parents’ IVF clinic. The IVF clinic will determine exactly what type of screening the Surrogate must undergo (see Medical & Psychological Screening Process). Prior to initiating this screening, the Intended Parents will deposit funds into a Fund Management Account to cover the costs for medical and psychological screening of the Surrogate and her partner, as well as to cover legal expenses for the surrogacy contract.

Once the Surrogate passes medical and psychological screening, the surrogacy contract will be negotiated, reviewed, and signed by both parties. The Intended Parents and Surrogate will be referred to independent third-party reproduction attorneys for the drafting and review of this contract, which will address legal implications of the surrogacy cycle, including legal responsibilities of both parties, compensation and expense coverage terms, parentage of children resulting from the surrogacy cycle, etc. Both parties are represented by independent attorneys to ensure that their legal interests are protected. The Intended Parents are required to cover all legal expenses, including the cost of the Surrogate’s attorney. Once the contract is signed, “legal clearance” is provided for the Surrogate to move onto the next step in the IVF cycle.

The Intended Parents will then deposit additional funds into the fund management account to cover the remaining costs associated with the surrogacy arrangement.

 

Medical & Psychological Screening

All medical and psychological screening must be completed before the IVF process begins. The initial consultation and screening appointment may require the presence of the Surrogate and her partner/spouse for several hours at the Intended Parents’ IVF clinic, depending on the IVF clinic’s screening protocol. The Surrogate’s screening protocol is determined by the IVF clinic and may include the following:

Psychological Screening: Conducted by a psychologist or social worker to ensure that the Surrogate and her partner/spouse are aware of psychological implications associated with the surrogacy process. This screening will also help determine whether the Surrogate is psychologically sound enough to undergo surrogacy.

Medical Screening: Generally, consists of a series of blood tests, gynecological exam, cervical culture, examination of the uterine cavity (via hysterosalpingogram/HSG, hysteroscopy, or hysterosonogram) and a physical exam. This screening is completed to confirm that the Surrogate is healthy and medically fit to undergo surrogacy.

Partner/Spouse Screening: If the Surrogate has a partner or spouse, s/he may also be required to undergo blood tests to screen for sexually transmitted diseases.

 

Surrogacy IVF Cycle

Once the Surrogate is medically and psychologically “cleared,” the surrogacy IVF cycle may be initiated. This cycle typically consists of the following:

• The Surrogate may be required to take birth control pills to help regulate her menstrual cycle and to synchronize it with the Mother’s and the Egg Donor’s menstrual cycle.
• The Surrogate may be required to take several medications prior to and after the embryo transfer process, starting approximately two to four weeks prior to embryo transfer, and potentially continuing throughout the first trimester of pregnancy, as follows:
  • An injectable hormone medication known as a Gonadotropin releasing hormone (GnRH) agonist, such as Lupron, is usually taken daily for a few weeks prior to the embryo transfer to control the surrogate’s bodily hormone production/menstrual cycle.
  • Estrogen in the form of injections, pills, or patches is usually administered twice weekly to stimulate the development (thickening) of the endometrial lining (the lining of the uterus). This medication is usually started a couple of weeks before embryo transfer and may continue through the first trimester of pregnancy (approximately 10 to 12 weeks after embryo transfer).
  • Progesterone is usually started around the time the Intended Mother or Egg Donor has her egg retrieval (typically three to five days prior to embryo transfer) and is taken daily, likely in the form of injections or vaginal suppositories, to improve the uterine lining and assist with embryo implantation. This medication may continue throughout the first pregnancy trimester (approximately 10 to 12 weeks after embryo transfer). Other medications may be required, such as antibiotics (e.g., Doxycycline) to prevent potential infection before and/or after the embryo transfer.

It is important to note that IVF clinics’ medication protocols may vary widely, so a Surrogate’s specific medication protocol cannot be predicted prior to initiating the surrogacy process. The Surrogate will, however, have an opportunity to discuss the protocol in detail with the IVF clinic’s physician and/or medical team during the initial consultation. It is also notable that a variety of medication forms (e.g., injections, patches, pills, suppositories, vaginal gels, or nasal sprays) may be used in medication protocols.

The Surrogate will attend a few monitoring appointments, during which her hormonal levels are monitored via blood tests and the development (thickness) of her endometrial lining is monitored via ultrasounds.

The date of the Intended Mother’s or Egg Donor’s retrieval will be known two days in advance. An estimated date range for the retrieval will be known prior to that, but the exact date is usually unknown until two days prior to the retrieval, as the retrieval timing depends on the body’s response to stimulation medications. The retrieved eggs will be fertilized with the sperm on the day of retrieval. The fertilized embryos will then develop for three to five days before the embryo transfer occurs.

The embryo transfer is generally completed in a short period of time (approximately 15 to 30 minutes) and should be painless, although some surrogates may experience mild cramping. The procedure may feel similar to that of a pap smear. Neither anesthesia nor intravenous sedation is required for the procedure. The transfer procedure involves a very thin catheter, which contains the embryos, being inserted in the vagina, and passed through the cervix into the Surrogate’s uterus. The embryos are pushed through the catheter and transferred to the endometrial lining. The physician uses an ultrasound to guide the catheter during the procedure.

Most IVF clinics require the Surrogate to rest and lay flat for 30 to 60 minutes after the embryo transfer. Instructions for post-transfer will vary from clinic to clinic, but many will require that the Surrogate abstain from strenuous physical activity or heavy lifting for 48 hours following the procedure. The Surrogate should consult with the IVF clinic regarding whether she can return to her normal work activities, engage in light housework, and/or travel the day after the procedure, as some IVF clinics may require bed rest for 24 to 48 hours following the embryo transfer.

A blood test is usually performed approximately 14 days after egg retrieval/fertilization (9 to 11 days after embryo transfer) to determine if the Surrogate is pregnant. If the blood test is positive, the Surrogate may be required to return for another blood test approximately a week later to confirm that her beta level is increasing, as would be expected for a normal pregnancy.

It is important for Surrogates to be aware that, for a variety of reasons, the initial embryo transfer may be unsuccessful (not result in pregnancy) and additional embryo transfers may be required. The Surrogate and Intended Parents will agree, in advance, on how many embryo transfers the Surrogate is willing to undergo for the surrogacy process. Donate-Or-Surrogate recommends that the Surrogate be willing to undergo at least three embryo transfers for the Intended Parents, although Intended Parents may or may not want to undergo this number of embryo transfers. Their physician/medical team will advise them on how they should proceed if the initial embryo transfer is unsuccessful.

Once pregnancy is verified via blood test(s), an ultrasound is usually scheduled four weeks after the embryo transfer to test for fetal heartbeat; this ultrasound should indicate how many fetuses exist.

From that point on, the Surrogate may be required to attend one or two more ultrasound appointments every two weeks, until she is cleared to be followed by a standard obstetrician for pre-natal care for the remainder of the pregnancy through to delivery.

 

Health Insurance

While it is preferable that a gestational surrogate be covered by her own health insurance policy, not having health insurance will not preclude a woman from being a Surrogate candidate. In general, most Surrogates’ health insurances will not cover the expenses associated with medical/psychological screening or IVF procedures for the surrogacy cycle. Once the Surrogate is pregnant, her health insurance may or may not cover pre-natal/maternity medical care and delivery expenses. Many insurance policies have surrogacy exclusion clauses, rendering such expenses ineligible for coverage. Given the complexity of navigating health insurance coverage for surrogacy-related medical expenses, Donate-Or-Surrogate will refer the Intended Parents to an attorney and/or insurance broker who will provide assistance in investigating the Surrogate’s health insurance policy to assess which medical expenses, if any, may or may not be covered by the policy.

The Intended Parents will be responsible for any expenses not covered by the Surrogate’s health insurance (e.g., co-pays, deductibles, ineligible expenses). If the Surrogate’s health insurance will not cover pre-natal/maternity medical care and delivery expenses, the Intended Parents will be required to purchase a health insurance policy for the Surrogate. Donate-Or-Surrogate will refer the Intended Parents to an insurance broker who will assist them with making arrangements to purchase this health insurance policy for the Surrogate. Funds for the cost of health insurance premiums and/or medical expenses, including co-pays and deductibles, will be deposited in a fund management account by the Intended Parents to ensure that these funds have been secured for the surrogacy arrangement.

Arrangements for health insurance coverage for the newborn delivered via surrogacy must also be handled prior to delivery. Intended Parents will have to make arrangements for their newborn to be added as a dependent to their family health insurance policy to ensure proper medical coverage. Intended Parents are responsible for making these arrangements with their health insurance carrier directly.

 

Legal Services

All surrogacy arrangements coordinated by Donate-Or-Surrogate require a surrogacy contract between the Surrogate and Intended Parents. This contract will address important legal implications pertaining to the surrogacy arrangement, including legal responsibilities of both parties, compensation and reimbursement agreement terms, parentage of children resulting from the surrogacy, etc. The Surrogate and Intended Parents must be represented by independent attorneys, who will draft and review the surrogacy contract for them, explain their legal rights to them, and address any legal concerns they may have regarding the surrogacy process. Intended Parents will also work with their attorney to make arrangements for legalization of their parentage. Their attorney may provide additional services, such as:

• Fund management account services
• Review of health insurance for surrogacy exclusion clauses
• Post-birth adoption for second parent, if required for legalizing parentage
• Court appearances, if required for legalizing parentage
• Health insurance appeals for denied medical expense coverage
• Negotiating medical expenses with medical providers if health insurance coverage is denied

Donate-Or-Surrogate has good working relationships with many attorneys who specialize in third-party reproductive law and will refer Intended Parents and surrogates to these attorneys. Intended Parents may opt to identify their own third-party reproduction attorney, as they are not required to work with any of the attorneys Donate-Or-Surrogate refers them to.

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