Surrogacy is an arrangement often supported by a legal agreement, whereby a woman agrees to become pregnant, carry the pregnancy and deliver the child, all of this for another person or persons, who have always intended to be the parents or parents of the child.
There are many reasons why a person or persons need the assistance of a surrogate:
- No uterus or related structural problems such as scarring and the inability to develop a thick, supportive uterine lining.
- Advanced maternal age
- Difficult past pregnancies
- Delivery complications
- Serious medical conditions such as hypertension, heart disease, spinal issues, etc.
- Recurrent miscarriages or repeat failed IVF
- Single man or gay male couple who want to be parents
- Unexplained infertility
- Severe postpartum depression
- Medications that are essential, but unsafe to a pregnancy.
Surrogacy can be undertaken as a private/independent journey or alternatively with the assistance of a surrogacy agency. There are full-service agencies and matching services, and surrogacy agencies exist in numerous countries. Choosing the right agency for you is a critical part of the process. Here are 10 tips to guide you:
Choosing the Country
Surrogacy is offered in many countries around the world. In some, surrogacy is legal, and in others it is merely tolerated. When choosing a country for your journey the issue to resolve is the amount of risk you are willing to take. If there are no laws that permit surrogacy, then there is a high risk within that country. Whereas if there are laws that permit surrogacy, but with special rules attached, then there is a risk factor unless you comply 100% with the provisions. Be sure to retain an attorney/solicitor in your own country as well as in the country where your child will be born. Some countries will bestow citizenship upon a child born via surrogacy. If a country does not offer birth citizenship to a surrogate child, then it is important to understand in advance how your child will obtain citizenship from your country. If you do not carefully understand these important issues, then you may find yourself spending years and hundreds of thousands of dollars in legal fees trying to establish your child’s citizenship. In addition, you may find yourself spending months to years in a foreign country if your child is denied access to your home country. Think about the risks involved and then plan how you can deal with each along with assessing the potential cost. This will give you a clear idea of the scenarios and permit you the opportunity to assess the risk and decide your next steps in advance.
Surrogacy is expensive no matter where you go. The question is how expensive can it be? Each agency that you interview should provide you with an estimate of the costs for a typical surrogacy journey. Be sure to get these in writing. Ask what expense are not included in the costs that you will most likely incur. In addition, don’t forget to factor things in such as your travel costs, how much time you will spend away from home, legal fees to establish your parental rights, fees to establish your child’s citizenship and in obtaining a passport for your child. Ask what medical costs are not covered by the surrogate’s medical insurance and what costs will your newborn baby incur if born premature or, if in need of an operation at birth. The main point here is to ensure that you have adequately budgeted for every eventuality.
Experience of the Agency
How long have they been in business? – experience does matter in the field of surrogacy. Since this is a field which deals with people and not commodities or products, by its very nature, this automatically means that no two cases will be the same – as no two people are the same. You should ideally consider working with an agency that has at least 5 years of relevant experience. Of course, every agency may have started out with no experience and they may have grown to become well respected, but along the way many agencies don’t make it to the 5-year mark. So, you may wish to consider whether you want to be the ones helping them become established, or go for a more proven entity, the choice is yours. Also try to determine the experience of each staff member, as it is to your ultimate advantage to have employees who each have years of experience to offer you. Experience permits an agency to realistically set the expectations of the journey, whereas newer agencies may have little to draw upon. Inexperience could also mean that they are more likely to miss significant aspects of your case that will ultimately cause problems later in the journey.
Absolutely book a consultation with each agency you are considering. There is no replacement for that person-to-person interaction, even if the consultation takes place via Zoom. Consider things such as how easy was it to book the consultation, were they on time and prepared, do you feel they were transparent in answering questions, or did you get the impression they were being non-committal or elusive, and did they give you the time needed to answer your questions? The consultation gives you a unique the opportunity to ask questions and learn about the agency beyond what is presented on their website. A surrogacy journey is estimated to take around 18 months from retaining an agency to the birth of your baby. It is therefore important to spend some valuable time up front to ensure that you feel you have connected and trust the person who will be your representative. After all, you are going to be in their hands for a significant amount of time once you sign up, so ensure you do the research!
Each agency will offer specific services, so it’s important to know what is or is not offered. Do they offer full-time counseling services? Do their fees include legal services? Where will your surrogate deliver, and will the agency help in evaluating the delivering hospital? How many staff members are assigned to your case? What services are offered to your surrogate? How is the money you deposit into the escrow (trust) account for this surrogacy journey managed? How is your money safeguarded? How can you be assured your surrogate will receive her entire fee and reimbursements? Is the agency affiliated with any of the professionals that have been referred to you? If yes, discover the extent of that relationship, as you may not be getting the objective view that you may think.
Ask the agency for references and then follow up on them. Ideally, ask for a one from an intended parent that lives close to you. Although agencies are only going to give out names of intended parents that had a successful journey with them, the fact is that they have had a successful journey! They will have information to share with you, albeit only glowing reports, but it is information that is new to you. They may have tips to share about travel or how they developed their relationship with their surrogate, how they dealt with insurance issues, how they prepared to travel with a newborn etc. You can inquire as to which attorney they worked with, about the process and the costs involved. If you ever find yourself with a difficult situation, you may be able to contact this referance and ask for their advice or suggestions.
Screening of the Surrogate
Spend some time on the issue of how your surrogate is screened. It can be helpful to know about the process that your surrogate had to go through in order to get her to the point where she was able to offer you her help. Was the surrogate screened by a mental health professional? If yes, was testing undertaken? Inquire if you can consult with that counselor so that you can gain some insight into your surrogate beyond what is written on the application. Was she medically screened? The doctor that performs the embryo transfer should be the same doctor (or a colleague of the doctor) that screened your surrogate. If she is married or has a partner, was the husband/partner screened and to what extent? Some agencies will screen your surrogate before you meet her, and some agencies will screen her after you have agreed to work with her. There are no absolute rights or wrongs, and each agency has selected a process that works for them. It may, however, be important to understand the costs involved when a surrogate does not pass the screening process. If you, as the intended parent, decide to incur these costs, what are they likely to be. Similarly, are there limits to the amount you must pay for someone who cannot ultimately work with you?
The Matching Process
The matching process varies greatly from agency to agency. Some will ‘assign’ a surrogate to your case whereas other agencies will present several candidates for the intended parent(s) to choose from. If multiple candidates are offered, sometimes you will instinctively develop a relationship with one of the ladies. Once you have inquired and noted all the differences in the matching process, create a list of your pros and cons and decide in advance where your red line(s) lie. You should then take time to re-read your list of pros and cons – away from any influence of excitement or impulsiveness. It is at this stage that you should be ready to decide which process and/or surrogate resonates with you.
Involvement in the Pregnancy
How involved do you want to be in this pregnancy? Do you want to participate in some or all medical appointments? Do you want regular updates along the way? Do you want to be present for the birth of your baby? Some agencies will take care of the entire process, give you monthly updates, and, after the birth, present you with your newborn. Other agencies encourage interaction between the intended parent and surrogate directly. Once you have decided what level of involvement feels right for you, then choosing an agency that offers your preferred journey will make your choice that much easier.
Working Remotely & Pandemics
A lesson was taught to us all in 2020. Pandemics are a reality and will most likely happen again. Every company needs to equip itself to better cope with a pandemic or natural disaster. Part of evaluating agencies should include asking them how they coped with the COVID-19 pandemic. If the agency has paper files, how did they gain access to them? Does the agency have an online database system that was readily available to staff working from home? None of us know what the future holds, but we are all now better equipped and wiser as to what needs to happen to prepare for the future. You may want to inquire what the agency had done to date, or what their future plans are in order to prepare for potential future catastrophes. We have all read stories of babies being left isolated from parents because of Covid-19 – when travel between countries was restricted. A key question would be how and when were these agencies able to reunite their intended parents with their babies? What lessons were learned and how will these changes benefit you? Determining what level of risk is involved in working with this agency during another shutdown could be the best research you could ever do.
If you take your time and do your research ahead of time, then you can rest assured that you have mitigated your risk as much as possible and have made the best choice of agency available. Remember, there are mental health professionals, case managers and legal counsel that are all available to assist you in selecting the right one. While price is a factor in every decision, we encourage you to evaluate the risk factors as well.