surrogacy: a step-by-step guide

SURROGACY:A Step-by-Step Guide

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Is Surrogacy for Me?The desire to have children and see in them a reflection of oneself is one of the most basic human instincts. In the past, the one in seven heterosexual couples who struggle with infertility, gay men, and singles were not able to realize this desire. Over the past 20 years, advances in Assisted Reproductive Technology (ART) have expanded the options for hopeful would-be parents (called Intended Parents or IPs) who wish to have a genetic tie to their children.

What Is Assisted Reproductive Technology (ART)? Assisted Reproductive Technology (ART) refers broadly to medical procedures that allow a person or couple to conceive through the use of one or more of the following:

• In vitro fertilization (IVF). • Donor eggs.• Gestational surrogacy.• Donor sperm.

These practices and procedures may also be referred to as “third-party reproduction.”

In the past few years, medical advances in cryopreservation of eggs and the introduction of shared-donor and shared-risk programs have lowered the cost of IVF with donor eggs, making surrogacy an option for more Intended Parents.

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What Is Surrogacy?There are two types of surrogacy:

• Traditional surrogacy: A surrogacy arrangement in which the surrogate is also the egg donor.

• Gestational surrogacy: A surrogacy arrangement in which the surrogate does not contribute any genetic material to the embryo and has no genetic relation-ship to the baby.

Family Forward Surrogacy facilitates only gestational surrogacy arrangements because gestational surrogacy better protects the Intended Parents’ rights to become legal parents to a baby born through surrogacy. Throughout this document, “surrogacy” or “surrogate” refers only to gestational surrogacy.

Surrogacy or Adoption?When deciding between surrogacy and adoption, there are a number of factors to consider. One of the main considerations is how important it is to the Intended Parents to have a biological link to the child. If a biological link is not a major issue in the decision-making process, then adoption is a wonderful means of having a family and a blessing for both the IPs and the child. Unfortunately, adoption can be a process over which IPs have very little control. The birth mother decides to whom her baby will be given. The birth mother may change her mind after delivery (in some states, for up to 12 months after birth) and assert her parental rights even after the child has been living in the IPs’ home. In addition, international adoptions from many countries have slowed or been closed to Americans altogether, either for political reasons or as a result of the introduction of the Hague Adoption Convention (intended to limit child trafficking). Some countries allow adoption only by married heterosexual couples.



Surrogacy Pros and ConsPROS:

• Genetic tie to one or both of the Intended Parents. • “Handpick” the genetics and background of the egg or sperm donor (if needed).

º Physical characteristics. º Detailed medical and family history of the donor. º Childhood pictures (adult pictures for approximately 50% of donors). º Level of education attained (or ongoing).

• More control over the process of becoming parents. º Legal certainty. º Timeline.

• IPs can attend prenatal appointments, sonograms and the birth of their child.

CONS:

• Surrogacy costs $80,000 to $120,000+. • Some cost variables are uncertain and could change the overall expense of the

surrogacy journey significantly. º Number of IVF cycles needed to achieve pregnancy. º Health insurance and health care for the surrogate. º Newborn insurance and/or health-care costs (for international Intended Parents or IPs with no U.S. health insurance).



Agency or Independent SurrogacyOnce a decision has been made to pursue surrogacy, Intended Parents must decide how they will go about the difficult process of finding a surrogate. Some IPs choose to work with an agency while others identify a surrogate on their own.

SHOULD I USE AN AGENCY?

• A reputable agency will perform extensive background screenings: FBI and ref-erence checks, in addition to obtaining all of the surrogate’s medical records.

• Some agencies will perform a home visit to ensure that the surrogate’s home is a safe environment for the child while in utero.

• An agency can act as an intermediary regarding difficult topics, e.g., surrogate compensation, expenses and reimbursements, issues with health insurance and emotional support.

• If IPs are from another country, an agency can assist with: º Language issues. º Cultural differences. º Accompanying a surrogate to specific appointments when IPs cannot attend because of the distance.



The jurisdiction for court orders, such as a Pre-Birth Order that names the Intended Parents as legal parents of the baby, is determined by where the Surrogate lives.

Most surrogates, particularly first-time surrogates, prefer to work with an agency. An agency establishes neutral “rules of the road” such as putting money in escrow, making sure that everyone is psychologically and medically screened, and providing best practices for financial compensation, expenses and reimbursement.

Another reason that many surrogates choose to work with an agency is simply because they would rather not have financial discussions directly with the Intended Parents. Surrogates would rather that conversations with the IPs be about a “first kick” or a sonogram appointment, not about money. They appreciate the fact that, if needed, the agency can act as an intermediary for sensitive issues or if conflicts arise.



Legal IssuesThe laws governing surrogacy differ greatly from state to state. For example, surrogacy is illegal in Washington, D.C. Some states are “surrogacy-friendly” only for traditional married couples, while others are surrogacy-friendly for couples or singles regardless of marital status or sexual orientation. Working with an agency that knows which states are appropriate for a particular client from a legal perspective will save time and protect Intended Parents interests. In addition, choosing an agency that can work across multiple “surrogate-friendly” jurisdictions may enable shorter time to match. Once matched, IPs will independently engage an ART attorney to draft the contract between them and their surrogate. This attorney will also file all necessary court documents to ensure that the IPs have full legal parental rights to a child born through surrogacy.

Whether or not IPs use a surrogacy agency, an attorney experienced in the practice of ART law and surrogacy should ALWAYS draft the surrogacy agreement/contract. It is also very important that the surrogate have independent legal representation. This protects both the surrogate and the IPs, as the contract could be contested if the surrogate did not have her own legal representation.

Choosing an AttorneyIt is very important that Intended Parents choose an attorney who:

• Has significant experience drafting surrogacy agreements.• Is a member of the bar in the state in which the surrogate lives.• Has experience obtaining Pre-Birth Orders (PBOs) in the state in

which the surrogate lives (if applicable).

A number of well-respected and competent reproductive-law attorneys have started surrogacy agencies. They provide both surrogacy matching and legal services. IPs should carefully consider the costs of these lawyer/agencies (they tend to be higher than paying an agency and an ART attorney separately), and also the inherent conflict of interest in providing legal representation to IPs while collecting a matching fee from them.


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Timeframe and Medical Process Once Intended Parents have engaged a surrogacy agency, finding a surrogate usually takes three to six months. When matched, both the surrogate and the IPs must go through medical and psychological screening, which typically takes two to six weeks, depending upon schedules and allowances for travel. This process includes infectious-disease testing for any party contributing genetic material to create the embryo, e.g., the Intended Father, who is contributing sperm, and the Intended Mother or Egg Donor (for the purposes of this document, the Intended Mother or an anonymous egg donor will be called the Egg Donor). The surrogate must also undergo infectious-disease testing for the protection of the baby.

Then the surrogate will have a gynecological exam and additional testing. Tests typically include a hysterosalpingogram (HSG) test (an x-ray test) and/or a hysterosonogram (ultrasound test), which allow a physician to visualize and evaluate the uterus. This testing is usually completed within a one or two day visit to an IVF clinic. After this, preparing for embryo transfer can take two to three months depending upon the protocol of the IVF clinic, what method of birth control the surrogate is using (if applicable), and the timing of the surrogate’s and Egg Donor’s menstrual cycles. Sometimes the physician will have the surrogate go through a “mock cycle” in which she takes hormones and the lining of her uterus is monitored. Performing a mock cycle can take two to four weeks, depending upon where the surrogate is in her menstrual cycle. Once the surrogate is medically cleared, the menstrual cycles of the surrogate and the Egg Donor must be synchronized so that when eggs are retrieved from the donor, the surrogate’s uterus is ready to accept them. Then the Egg Donor will begin the cycle to stimulate egg production. She will be put on a protocol of hormones and monitored until the eggs are ready for the retrieval procedure.

On the day of the egg retrieval, the physician will surgically remove the eggs from the donor and fertilize them with the Intended Father’s sperm. Three to five days later, one or two of the surviving embryos will be transferred to the uterus of the surrogate. Additional embryos can be frozen for use if the surrogate does not become pregnant after the first transfer. Frozen embryos can also be kept for later use in conceiving a sibling. Two weeks after embryo transfer, the surrogate will undergo a blood test to determine whether she is pregnant.



Limiting Costs and Mitigating RisksSome of the larger IVF clinics have developed “shared donor” programs in which eggs from one donor are shared among multiple recipients. For example, if one egg donor produces 20 eggs that are shared among three recipient couples, seven eggs would go to two couples and six eggs would go to the third couple. In this way, the cost of harvesting the eggs is divided among the three couples. In addition, to mitigate the risks of paying for multiple rounds of IVF treatments, some Intended Parents may prefer to use a “shared risk” or “money-back-guarantee” program offered by some of the larger IVF clinics. Such programs typically allow IPs up to six IVF cycles for a fixed price and will guarantee the IPs’ money back if they do not take a baby home from the hospital.

Family Forward Surrogacy offers the Family Forward Surrogacy Investment Protection Program (IPP) for clients who participate in certain IVF clinic’s money back programs. This program offers a refund of the surrogacy agency fee if the IPs do not bring a baby home from the hospital, allowing IPs to pursue other family-building options. Please see the Family Forward Surrogacy IPP brochure for details.



Insurance IssuesSecuring health insurance that provides maternity coverage for a surrogate pregnancy (and newborn care for families that do not have US health insurance) is a complex and evolving task. Even before the introduction of the Affordable Care Act (“Obamacare”), insurance coverage for surrogacy was unpredictable; and now it is even more of an unknown with major implications for surrogacy. Family Forward Surrogacy is committed to monitoring the status of healthcare coverage as it pertains to surrogacy, and providing information about programs that offer protections to our IPs and surrogates in this uncertain climate. There are programs designed to put an upper limit on the risk incurred by the Intended Parents. Family Forward Surrogacy can provide information about the options available and make introductions to the providers of such services. Please see the Family Forward Surrogacy Insurance Scenarios Whitepaper on our website for details.



The “New Normal”Many gay male couples will use the eggs from one Egg Donor and fertilize half with one partner’s sperm and the other half with the other man’s sperm. This way, if they have more than one child from this process, the children will be related to one another through the Egg Donor, and each man will have a genetic connection to one of the children. Depending upon the laws in the state where the children are born, both men will be named on the birth certificate, or the genetic father will be put on the birth certificate and the other father can obtain a second parent adoption so that both men are legal parents.

Why Family Forward Surrogacy?Family Forward Surrogacy (FFS) was founded by a former Intended Parent, now the mother of twins through surrogacy. We understand how difficult it can be to entrust the most important event in your life to someone you have only just met. FFS works hard to make the right match and remains active and engaged with the IPs and surrogates throughout the surrogacy journey. Our standards are high. We match IPs only with surrogates whom we would trust to carry our own children. FFS will always treat you with the utmost respect and compassion. At FFS we are committed to making your journey through surrogacy to parenthood as stress-free as possible.

GESTATIONAL SURROGATE SCREENING. Our team performs extensive background checks including FBI background checks, reference checks and in-home studies of the surrogate and her spouse or partner. We also require psychological evaluations of the gestational surrogate (and her spouse or partner, if applicable), conducted by a mental health professional specializing in surrogacy and Assisted Reproductive Technology. All reports are provided to the IPs.

COORDINATION. Surrogacy can be an overwhelming and time-consuming process. In working with our clients, FFS takes the lead in identifying and coordinating with the many professionals required to complete the surrogacy journey. Our IPs benefit from of our experience with and access to the top providers in the industry:

• Attorneys in the surrogate’s jurisdiction.• Health and life insurance agents who specialize in ART.• Escrow agents.• ART psychologists.• IVF clinics.



SUPPORT. FFS offers unparalleled support to its IPs and surrogates. As a former IP whose surrogate had a difficult twin pregnancy, the founder of FFS is

very sympathetic to IP emotions and concerns. In addition, FFS provides the surrogate with a dedicated case manager, herself a former gestational surrogate, who acts as her advocate. We find that having this additional support for the surrogate keeps the lines of communication open and helps to address any issues before they become problems. FFS will accompany the surrogate to her first appointment at the IVF clinic and to the embryo transfer (if in the Washington, D.C. area). FFS can also act as a liaison between the IVF clinic, the surrogate and the IPs.

FINANCIAL. FFS believes that finding a superior surrogate is of the utmost importance. To ensure that we attract the best candidates for gestational surrogacy, we charge about $5,000 to $10,000 less than most

agencies in matching fees, instead ensuring that our surrogates receive very competitive compensation packages. The end result is that the out-of-pocket

expenses for the IPs are the same, but more compensation goes directly to the surrogate. FFS can provide this advantage because it has a small, dedicated

team, and keeps its overhead low. For detailed financial information, please see the Family Forward Surrogacy Intended Parents’ Costs Worksheet.

LGBT-FOCUSED. More than half of our clients are gay men. We sponsor and support the Family Equality Council, the Human Rights Campaign, Men Having Babies and Rainbow Families DC.

INTENDED PARENT QUALIFICATIONS. In order to protect all parties, FFS requires IPs to provide proof of the ability to pay all fees associated with surrogacy, and requires clients to deposit the surrogate fee and certain anticipated expenses into an FDIC-insured escrow account before IVF treatments begin. FFS also requires that IPs attend a counseling session with a psychologist who specializes in Assisted Reproductive Technology as well as a joint session with their gestational surrogate (and her partner, if applicable).

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Contact MeI am passionate about Gestational Surrogacy and would like to help others experience the same joy that I now have with my family. If you are weighing your options, please feel free to call me directly. As a former Intended Parent who had children with the help of a Gestational Surrogate, I would be happy to personally guide you through all the steps in the process, and help you to decide whether surrogacy is right for you. There is much to consider. Let’s start the discussion…

Sandra LippardPresident and FounderFamily Forward Surrogacy

surrogacy: a step-by-step guide

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