Getting Started as a Surrogate: What You Need to Know

If you’re looking for information on how to become a surrogate, you’ve come to the right place!

Surrogacy is an amazing process, and when you become a surrogate you will be making the dreams of another couple/person come true. That is truly an amazing feeling.

However, as with anything, you need to do your research before jumping in. To help you do just that, we’ve compiled a list of a few things you need to know about surrogacy and the surrogacy processes before you become a surrogate.

Let’s start at the beginning:

Basic Requirements for Becoming a Surrogate

Regardless of whether you choose to sign on with a surrogacy agency or go the independent route, there will be a standard set of requirements that a woman must meet in order to be considered as a surrogate. These requirements reflect the guidelines the American Society for Reproductive Medicine (ASRM) has set in place, and these same guidelines will also be required by the fertility clinic the Intended Parents are using. This is to ensure the safest, healthiest possible pregnancy and relationship between the surrogate and Intended Parents.

These basic requirements are as follows:

You must have previously given birth to at least one (live) child.
You are between 21 – 42 years old, and in good health.
You are a non-smoker and do not use drugs.
You are of a healthy weight with a BMI in the normal range. Some will allow a little wiggle room here, with the maximum BMI allowed usually a 32.
Have healthy pregnancies with no complications.
Be financially stable, and not on any form of public assistance.

Aside from the requirements list, there are a few things we would like to add:

Complete your own family before moving onto surrogacy. As with any pregnancy, complications can happen, and if you were to experience complications that resulted in your not being able to carry a pregnancy again, would you be okay with that?
Take the time you need to breastfeed and wean your child. The medications taken during surrogacy are not safe for breastfeeding.
Remove your IUD, if you have one. Please note that if you’ve had Essure, it’s likely you won’t be accepted as a surrogate. Tubal ligation is fine.
Be absolutely sure you can follow through with everything! This includes: responding to communications in a timely manner, taking your medications exactly as prescribed and instructed, and sticking to your agreed upon terms within your surrogacy contract.

If you meet these few requirements, great! Please continue on to see if surrogacy is right for you. If you do not meet all of these requirements, you may still be able to become a surrogate. For instance, if your BMI is a little higher than 32, dropping a few pounds will get you where you need to be, and you can then pursue looking into becoming a surrogate.

Are You Prepared to Commit to Surrogacy and your Intended Parents?

Before you get started as a surrogate, you need to understand that surrogacy is a lengthy process that can sometimes take years to complete (depending on various factors). From start to finish you will need to pass medical and psychological exams, find your match couple or person, complete legal contracts, have your cycle synced with the Doctor’s orders (based on egg donors, so on) with medications and injections, become pregnant, and deliver the baby/babies. If the first attempt at pregnancy is unsuccessful then you will have to repeat the medication and embryo transfers again.

Many issues can arise during surrogacy that change things, such as:

the viability of the eggs and/or embryos
egg donor or sperm donor issues
whether or not your body is responding on time to prescribed medications
scheduling conflicts

So much goes into the surrogacy process, as many people are working together to get everything just right. You need to make sure you are ready to commit, should anything arise, and be prepared to wait at times and possibly be in limbo.

Finding your Right Match with Intended Parents

First and foremost you, as the surrogate, need to have your mind prepared with what you are and are not comfortable with in surrogacy. So you are able to match with an Intended Parent, or set of Intended Parents, who will be the most compatible.

Some questions you may want to consider:

Are you okay with carrying for any and all couples, or single individuals, gay (LGBT), straight, foreign, and domestic?
How many babies are you willing to carry?
Have you looked into the risks involved with carrying multiples?
Are you aware that each embryo has the possibility of splitting?
What are your views on termination and selective reduction? Genetic testing? Amniocentesis?
Are you willing to pump breastmilk for the baby/babies after delivery?
What kind of relationship would you like to have with your Intended Parents – before, during, and after the surrogacy journey?

Is your head spinning yet? These are important questions you need to be educated on and have answers to in regards to what you will and won’t do in your surrogacy.

While it is your body that will be pregnant, and you do have rights to say what you will and won’t do with your own body, this is the Intended Parents’ baby/babies, and they have the right to choose what they want for their children. So while you may be able to properly care for surprise triplets or a special needs child, they may not be, or may not want to. You have to think about it from their standpoint, and what they would do if they were given the chance to carry the baby/babies themselves. That being said, whatever you decide on, do not match with Intended Parents whose views differ from yours. It will not work out.

Many times when you meet an Intended Parent (or are presented with their profile in the case of agencies) you will have a feeling of whether or not it’s a right match. Some surrogates explain it as a feeling of butterflies. For me, I had an overwhelming feeling that they were the ones. Still, there are great matches that happen with no overwhelming “sign” or feeling, so don’t worry if you do not feel it at first.

If you review a parent profile or meet potential Intended Parents and do not have a good feeling about it, do not proceed with them. Not everyone is meant to work together, and eventually, you will find the right Intended Parents for you. It is important to match with Intended Parents who are on the same page as you in regards to carrying a singleton or multiples, termination, reduction, any religious views that may come into play, and so on.

Medical and Psychological Screening

Whether you go with an agency or contract independently, medical and psychological screenings are part of all standard surrogacy processes. The fertility clinic in which your Intended Parents are working with will be the one to conduct your medical screening. This will consist of the clinic reviewing your past pregnancy history, some blood work, and an exam of your uterus.

A licensed therapist will conduct the psychological screening. Most screenings will include an online (emailed) exam and a phone conversation with the therapist. The purpose behind the psychological screening is to ensure you are of sound mind, have the best of intentions, and are not in any mental distress.

Not everyone is able to be a surrogate. These screenings are extra (necessary) precautions to ensure the health and safety of everyone going into the surrogacy agreement. We do not want anyone falling victim to the next Lifetime movie plot!

Surrogacy Medications and Injections

As a surrogate, you will undergo IVF procedures and be required to take a handful of medications, and possibly receive injections nightly for approximately 4 months (before the pregnancy, and then up until 1st trimester is complete, depending on your levels and the Doctor’s advice). These medications and injections are to ensure the best chances possible for a successful pregnancy, and will differ from clinic to clinic and what each Reproductive Endocrinologist recommends.

Some common medications used in surrogacy are as follows:

Birth Control Pills – Your clinic will use the BCPs to manipulate your cycle to get it on the schedule it needs to be on, often syncing with the egg donor (if applicable).

Lupron – Leuprolide Acetate Injection is commonly referred to as Lupron, and is given to stop the surrogate from ovulating during the cycle. Lupron is (usually) administered in the stomach area through a small 23 gauge needle. To learn more about Lupron follow this link: Lupron

Progesterone -is given as a supplement to thicken the uterine lining and prepare the body to store the embryo. There are a few types of progesterone that can be prescribed by the RE:

progesterone in oil, which is an intramuscular injection, commonly referred to as PIO
vaginal gel, such as Crinone or Prochieve
vaginal tablets such as Endometrin
oral tablets such as Prometrium, which is also prescribed to use vaginally
progesterone suppositories made to order by a pharmacist
progesterone lozenges

Delestrogen – is an injectable form of estrogen that is occasionally used for fertility treatments. It is oil based and must be injected intramuscularly like progesterone described above. The injection is usually not given every day.

Medrol – is a light steroid used to prevent any inflammation of the uterine lining that could prevent the embryo from successfully implanting.

Doxycycline – is an antibiotic used to ensure the uterus is free of any bacteria before the embryo transfer, and also to prevent any possible infection.

Prenatal Vitamins – prenatal vitamins are recommended throughout the cycle and pregnancy as they have essential vitamins and nutrients such as folic acid.

*If you have any questions regarding any of the medication your doctor prescribes you, please ask your doctor or nurse. They are there to assist you in anything you made need. They are there to make sure you are comfortable and know what you are taking, and how to properly take or administer it.

Possible Complications in Surrogacy

No one can guarantee a complication-free pregnancy or delivery, and at times it comes on unexpectedly. With a surrogate pregnancy, a whole new realm of complications come into play, as IVF is known to have an increased risk in pregnancy.

Bleeding, Subchronic Hematoma, Subchronic Hemorrhage (SCH) – a pocket of blood in the uterus that causes bleeding during pregnancy. This affects about 25% of women in IVF pregnancies. An ultrasound will be done to check on the baby/babies, the size of the hematoma, and decide on your resulting diagnosis. It is likely you will be placed on limited activity or bed rest while the SCH is present. The clinic/doctor will monitor closely with ultrasounds. If at any time you experience bleeding during your surrogate pregnancy, get checked out by a doctor and inform your Intended Parents and clinic.
Miscarriage – there is no guarantee that just because the embryo transfer was successful that it will remain a healthy pregnancy. Miscarriages happen, even to the healthiest surrogate and the healthiest embryo(s).
Blighted Ovum – A blighted ovum occurs when a fertilized egg implants in the uterus but doesn’t develop into an embryo. It is also referred to as an anembryonic (no embryo) pregnancy and is a leading cause of early pregnancy failure or miscarriage.
Failed Transfer – the embryo(s) did not attach, and the surrogate does not become pregnant.
Allergic Reactions to Medications – There are times when one might have a reaction to one, or more, of the prescribed medications. Some experience hives, redness, swollen and itchy patches, breathing troubles, and more. If at any time you experience a reaction to any medication you need to notify your clinic immediately so the medication can be changed.
Reductions/Terminations – Selective reduction/termination is done for both medical and non-medical reasons. This is something you need to have in contracts, to detail what you all will do in the event there is a need to consider reduction/termination.
Bed rest at home or hospital – Bleeding, carrying multiples, high blood pressure, placenta complications, and pre-term labor can all lead to being put on bed rest. Make sure you have childcare, lost wages, (if applicable), and housekeeping in place in your contract in the event of required bed rest; you do not want to add any further stress during this time.

The Bonds in Surrogacy

Many myths surrounding surrogacy lead people to believe the women acting as surrogates are “giving up babies” that they’ve grown and become attached to for the last 40 weeks. Let me tell you from experience, carrying a surrogate baby feels completely different from the get go than carrying a baby of your own. I personally do not know any surrogates who have become attached to the baby/babies. You may be reading this thinking this is weird… but it is something that cannot fully be understood until you are in that position.

However, you will more than likely create an amazing bond with your Intended Parents. This is an incredible bond that will last a lifetime. Surrogacy is amazing like that.

Ready to get started?? Let us help you! We can help you match with intended parents for an independent journey, or help you find an agency that fits your needs. Follow the link here to begin your surrogacy journey: Surrogate Application