Continuing our multi-part series on ‘How to Compare Agencies,’ we now focus on one of the more challenging aspects of the process that needs to be considered.
As mentioned, selecting a surrogate involves extensive screening to ensure a suitable match before proceeding with the embryo transfer. Agencies often report that they must carefully evaluate around 20 applicants before finding one exceptional candidate who meets all the necessary criteria to proceed with a pregnancy. These selected surrogates have successfully passed the rigorous application review session, indicating their suitability for the role. Due to their exceptional qualities, such surrogates are usually in high demand, but their availability is limited. As a result, intended parents may experience a waiting period before being matched with a surrogate.
Suppose an unforeseen event occurs, leading to a change in circumstances or medical considerations. In that case, the intended parents may need to restart the matching process or find a new surrogate (“re-matching”). This can cause heartache and further delays in the overall surrogacy journey.
In addition, when an intended parent requires rematching with a second surrogate, that surrogate is no longer available for matching with the agency’s intended parents on their waitlist, leading to an increase in the waitlist. As a result, those intended parents often report their frustration to the agency over the extended waiting period to be matched with a surrogate.
Understanding the potential challenges and waiting periods in surrogacy can help intended parents prepare mentally and emotionally while they await a second match. While the process may require patience and flexibility, knowing the reasons behind potential delays can alleviate some stress and uncertainty. Communication with the surrogacy agency can provide support and a clearer understanding of the process.
Rematch
Some reasons why an intended parent may need to be re-matched with a different surrogate are as follows:
- The Surrogate drops out of the process for personal reasons – undue pressure from family members, illness (herself or family members), relocation, unforeseen stressful times in her life, marriage problems, new job, or she cannot take off excessive time.
- The surrogate’s bloodwork comes back showing a problem. This could be as simple as having a low Vitamin D level but also more severe, e.g., a thyroid level or a previously unknown social disease. In most cases, within a few months and medication, these issues can be resolved, and everyone is back on the journey. However, in some cases, the resolution could take over six months to a year. This is a long time to wait without the assurance that the surrogate can proceed.
- Relationship between the parties falls apart during the contract stage.
- A surrogate undergoes one or more embryo transfer(s), and the fertility doctor determines that no further transfers should occur.
- The surrogate is confirmed pregnant, but the pregnancy is lost in the first trimester, and the fertility doctor requests a rematch of the surrogate.
- The fertility doctor rejects the surrogate. This could be due to a thin uterus lining, fluid in the uterus, or the doctor seeing a problem. Some doctors insist on doing an Endometrial Receptivity Analysis (ERA)[1], which can also reveal a medical concern.
- A surrogate undergoes one or more unsuccessful embryo transfers(s), and the intended parents elect to discontinue work with her and request another surrogate, i.e., request a re-match.
- Tragically, a stillborn baby occurs, but the intended parents want to proceed toward parenting with another surrogate.
- The pregnancy must be terminated for medical reasons, and the intended parents want to proceed with their journey toward parenting with another surrogate.
As you can imagine, any surrogacy journey touches the lives of multiple people. Any unexpected change in one person’s life can affect that entire chain and their ability to continue that journey. For surrogates, their desire to help intended parents is deep-rooted and a dream they wish to become a reality. They typically feel compassion towards their intended parent(s), regardless of whether they receive compensation. Because of these feelings and desires, it is not uncommon for most surrogates to be reluctant to stop trying, even if they should discontinue this journey.
For intended parents, trusting a stranger with their baby’s life is unimaginable but a necessity if they are to become parents. Once an intended parent finds a surrogate they can trust, letting her go is extremely difficult. Sometimes, these intended parents will spend a vast sum of money to try to “fix” their surrogate and wait for long periods so that she can carry their baby. Sometimes, it can be challenging for them to put aside their deep feelings of trust and loyalty and consider working with a different surrogate to achieve their parenthood aspirations.
It is essential to acknowledge that every surrogate’s goal is to assist the intended parents in creating their own family. However, when the journey does not unfold as planned, it may become necessary to reevaluate the relationship with the surrogate to ensure that the goal of parenthood can still be achieved. While it can be emotionally challenging, reimagining the relationship is a step toward making the dream of becoming a parent a reality.
Once a decision has been made to find a different surrogate, the journey needs to start in its entirety for a second time. Therefore, intended parents need to look closely at each agency to determine the policies and costs involved when rematching is required.
The term “rematch” is not uniformly used in surrogacy. Please ensure that you are specific when asking about the agency’s policy. One website reported:
“In most cases, our matches are successful, but if for some reason our match is not successful, we will rematch our Intended Parent and Surrogate until they are comfortable moving forward.”
This is different from what is meant by a rematch. In the case above, the agency presented or introduced the intended parents and surrogates to each other. For various reasons, the parties decided not to proceed with each other. Of course, the agency should continue to match the intended parents with another surrogate! There is no “rematch” because there was no match, only an introduction of parties to each other.
What exactly is meant by a rematch? Three elements should be present for a rematch to exist:
- A rematch is when a surrogate has undergone at least one embryo transfer and then
- cannot, for whatever reason, continue with another transfer, and
- the intended parents want to be matched with another surrogate.
Things to Consider
- Each agency will have its solution as to what to charge for a rematch. An agency puts considerable time and money into screening surrogates, and it is only fair that they are reimbursed for these expenditures.
- An agency earns its full fee when it matches a surrogate with a newly retained intended parent. Therefore, money is lost by the agency when they take an available surrogate and have to offer a second match for an intended parent.
- If an intended parent requests a different surrogate (without any medical justification), and the surrogate is willing to continue working with them, there is a strong argument that the agency is entitled to an additional payment.
- If a surrogate decides to discontinue participation in surrogacy or does not want to continue to assist, then there is a strong argument that the intended parents should NOT incur the cost of paying another complete agency fee.
- If a surrogate has undergone several transfers, but no pregnancy was achieved, there is an argument that the surrogacy agency should be entitled to an additional payment to rematch the intended parent.
- If, after one transfer, the fertility doctor declares that the surrogate should not undergo another transfer, there is an argument that the intended parents should NOT incur the cost of paying another complete agency fee.
Other Considerations
Other factors that need to be explored revolve around the time it takes for any rematch to occur and the process used. For example, if an intended parent subsequently needs to be rematched (and has agreed to the agency’s fees for the rematch), will they be moved to the top of the intended parent’s waiting list, or will they be added to the bottom?
It is also worth asking about the agencies’ average expected time for an intended parent to be rematched. We know of situations where they have waited almost two years.
Finally, is the process used for the first match the same as that used for rematches? E.g., do they do the same or provide a lesser service? If not, what are the differences?
As indicated above, there are several factors to consider when exploring how the agency defines a rematch and its terms of a rematch. Each agency will handle each scenario differently, and the options will undoubtedly be varied. If not researched or understood in advance, you may find yourself disappointed or, at worst, feel conned or misled. The key is to discuss these matters with agencies before retaining their services. This will also help build trust and provide a clear understanding of what is expected and deliverable.
This series of articles: How to Compare Agencies has been divided into 4 Parts:
Part 1: Types of Surrogacy Agencies
Part 2: When the Match Falls Apart
Part 3: Cost Analysis (USA Agencies)
Part 4: Selecting an Agency
Author: Karen Synesiou, Infertility Portal, Inc.
[1]What is an ERA? The endometrium is the tissue that lines the uterus. The uterus lining must thicken to enable the embryo to implant. Before the ERA test was developed, the fertility doctor would observe the endometrial lining with an ultrasound and confirm that the endometrium was of a sufficient thickness and then proceed with the embryo transfer. The ERA is a genetic test performed on a small sample of a woman’s endometrial lining to determine which day would be the best day to transfer the embryo during an in vitro fertilization cycle. This “window of implantation” differs for each person. The ERA permits the fertility doctor to schedule and tailor the embryo transfer around exactly when the endometrial receptivity is at its most optimal for implantation. Some fertility doctors perform this on all surrogates, but others believe it should only be done for patients who have had more than 2 unsuccessful embryo transfers, have had a problem with their lining, and have prior unsuccessful implantations with high-quality embryos. The use of ERA testing is controversial and not standard practice in all fertility clinics.
