Frequently asked questions
Starting the Surrogacy Process
Why should I work with Fertility Alternatives?
Fertility Alternatives has been successfully facilitating surrogacy and egg donation arrangements for over 22 years, longer than most agencies out there.
What requirements must I fulfill in order to be accepted into the Gestational Carrier Program?
Industry standard requirements for surrogacy can be very strict for medical and ethical reasons, but may vary slightly from agency to agency. With all programs applicants will be required to submit/release pregnancy and delivery records for all available pregnancies.
A qualified Gestational Carrier in our program is a mother between the ages of 22-40 with no history of major health, psychological issues, or pregnancy complications (gestational diabetes, preeclampsia, preterm births, etc). All candidates must be healthy (physically and emotionally), drug & nicotine free, and must be at low risk for any and all infectious diseases or pregnancy complications. In addition, a potential Carrier must not be on any medications for depression, anxiety, or ADD/ADHD, or other medications that could be dangerous to a growing fetus.
Experienced or Jewish Carriers may be accepted until age 43.
Candidates will need to be detail oriented, and have a strong desire to fulfill the necessary requirements. You will need to have a flexible schedule to attend a number of clinical visits throughout the process. You must be mature and able to follow through with the necessary requirements, meetings and medical instructions. Your commitment is of utmost importance.
Candidates must have a stable home and/or family life and not be under financial duress or on government assistance other than a state provided health plan. Surrogacy compensation is supplemental and never to be considered reliable or long term income. Pregnancy results can vary, so applicants’ families should already have a regular stream of income that provides for their needs.
Candidates will live in a safe neighborhood, safe and healthy environment, have a healthy lifestyle, and have a good support system of family and/or friends. Your spouse/partner, if any, is fully supportive as well.
Candidates will live and give birth in a Surrogacy friendly state.
Candidates who have recent tattoos or body piercings will need to get documentation the procedures were performed under sterile conditions, from their tattoo/piercing facility.
Candidates must be height/weight proportionate, and have a healthy BMI (body-mass-index). An unhealthy BMI affects conception rates and is cause for higher risk pregnancies and therefore most IVF doctors require that gestational carriers’ BMI be under 31. BMI under 28 is preferred by the best IVF clinics and will significantly raise your chance of being
matched. CHECK YOUR BMI HERE
Candidates should have no more than 2 C-sections, due to the risks of uterine rupture with future pregnancies. This is a requirement of most IVF clinics.
Candidates and their partners must also be willing to have a criminal background check, and pass a psychological evaluation.
Candidates must not have (or had sexual contact with anyone who has) travelled to any country on the Center for Disease Control and Prevention’s “active” Zika virus list within 6 months of the embryo transfer procedure, and must not travel to any of these countries while pregnant. Visit the CDC website for an updated list of countries affected by the Zika virus ZIKA TRAVEL INFORMATION.
Explain the application processes.
As a Gestational Carrier candidate, you will submit a full application, personal bio and a few photos of you and your family. It is important that all the questions are answered completely and honestly to find your ideal match.
Once your full application, photos, and pregnancy/delivery records are received, and it is determined that you may be a good candidate, a phone or in-person consultation will be arranged.
In the interview, we will discuss:
- Benefits package, compensation, lost wages and other expenses that will be covered in a Surrogacy Contract for your individual case.
- Carrying multiples and associated risks.
- Pregnancy termination and selective reduction.
- Possible invasive procedures during pregnancy like amniocentesis.
- Your health, psychological, and pregnancy histories as well as medical insurance possibilities.
- Your emotional support system. (i.e. spouse, extended family, friends, etc)
- Expectations, industry standards, and travel requirements.
- Relationship expectations with your potential Intended Parents.
How will I be matched with potential Intended Parents?
My goal is to match you with a couple or individual who has the same ideals about pregnancy, childbirth and the relationship during and after pregnancy.
It is important that you think about the different possibilities occurring from pregnancy, multiples, termination, selective reduction, amniocentesis, and possible health risks (Gestational Diabetes, C-Section surgery, preeclampsia, etc).
Will you work with single parents-to-be or same-sex couples? Will you work with couples who do not speak English? Are you able/willing to travel?
It is also important to consider the type of relationship you want with your Intended Parents. Some Carriers prefer a close relationship during and after pregnancy. The Intended Parents may attend many or all the OB appointments, ultrasounds, birth, etc.
Other Carriers prefer more personal independence. Communication is typically regular, however due to distance, language barrier, or a Carrier’s busy schedule with life and family, personal contact with her Intended Parents may be more limited.
Some Intended Parents out there require total anonymity. I do not work with these types of Intended Parents. I believe that, the Carriers should receive recognition for their gift, and the Intended Parents should be the ones to provide that. I also believe that establishing a relationship is very healthy for both sides.
Your profile will be provided to potential Intended Parents with similar expectations. You will also be provided with Intended Parent profiles. If agreeable, I will arrange a meeting between you either by Skype or in-person, depending on location of the Parties.
Once the Parties agree they are a good fit, then we will arrange for screening and insurance, as needed.
Unlike most surrogacy agencies, I will give you my honest opinion about any Intended Parent prospect so you can make a good decision for your own life and experience. Many agencies, simply want to match a Carrier with any available Intended Parent prospect immediately available. If I believe any set of Intended Parent prospects have qualities that are not conducive to your lifestyle or what you are hoping to experience during this process, I will absolutely give you my opinion so you can decide.
What will be expected of me during the process?
Because surrogacy is such a highly emotional and costly endeavor for infertile couples and individuals, Carriers are expected to be committed, and to conduct themselves in a responsible, reliable and mature manner from the moment they apply with the program.
Because we are dealing with menstrual cycles and potential timing limitations, you may need to work quickly to complete screening, medical visits, and obtain medical records, as needed.
It is important that all of the information in your profile is truthful and up-to-date and can be validated by your medical records.
Medical appointments must be kept and doctors' orders followed exactly as instructed.
Carriers will also be required to abstain from sexual intercourse for a short amount of time while attempting pregnancy.
Carriers really need to be flexible, as this is such a time specific process.
Describe the Intended Parents candidates you typically work with.
Intended Parents come in a variety of forms. I work with married couples, unmarried heterosexual couples, single moms and dads-to-be, same-sex couples, and Intended parents from other countries. You choose the fit that you feel comfortable with.
How long will it take to match me with Intended Parents?
Unfortunately, it is hard to predict how long it will take to find a match. It is common to take anywhere from 2 weeks to 5 months.
The Carrier’s location, personal requirements of each Party, and, the IVF clinic requirements play factors in finding an ideal match. Some Carriers are matched immediately because of their favorable profile, pregnancy history, BMI, and location.
You will be notified immediately if a couple expresses interest in your profile. Carriers in California tend to be matched more quickly due to the favorable laws in the state.
We typically have a waiting list of Intended Parent clients hoping to find a well-qualified candidate.
What is a Gestational Carrier/Surrogate?
A Gestational Carrier/Surrogate uses her uterus to carry the fetus of another couple or individual to term. There is no genetic relationship to you or your partner. You do not use your own eggs to create embryos. The Intended Parents create their own embryos .You are in essence babysitting for someone who is unable to carry a pregnancy for themselves.
I meet all the surrogacy qualifications. What are the ideal criteria?
A number of Intended Parents and their clinics have especially strict requirements for their ideal gestational carrier. As a result, my clients may provide a special $5,000 bonus to applicants who meet this ideal criteria.
Explain the screening process after I am matched.
You will be required to undergo a full medical and psychological evaluation at the cost of the Intended Parents. Your spouse/partner will also be required to undergo infectious disease screening.
The medical evaluation includes drug, nicotine, infectious disease, Pap smear and vaginal cultures. You may also undergo a Hysterosalpingogram or hysteroscopy which are procedures performed to confirm your uterus is conducive to implantation. Neither procedure is painful, but typically performed around day 12 of your menstrual cycle.
Your pregnancy/delivery records will be reviewed by the attending physician to confirm you medically qualify. You may also need to get a medical clearance note from your own doctor confirming you are healthy enough for another pregnancy.
The psychological evaluation will take about 2 hours. You can expect to take a personality test called the MMPI or PAI. This test helps to determine whether or not you may be at higher risk for psychological issues or stresses in your life that may affect your eligibility as a Gestational Carrier.
You will also have an interview with the psychologist, who will discuss the issues of surrogacy with you (i.e. Post Partum depression, separation issues, dealing with family/friend, etc.) to confirm you are committed, will follow through, have a reasonable support system, and are not under a significant amount of stress.
The Psychologist will want to see that you have a complete understanding of the process and what to expect. He/she will also discuss your motivations for surrogacy to confirm, you do not expect compensation to be a main source of income and that you are living in a financially stable environment. Your spouse or partner will be required to attend this interview.
If you don’t already have a health plan, together we will start the application process for a PPO or other available individual health plan at open enrollment, to cover your pregnancy. PPOs are the preferred plan as they provide coverage for the best doctors and medical care, but not all companies provide PPOs in your state.
I am a carrier of HPV (Human Papilloma Virus) or Herpes. Can I still be a Gestational Carrier?
Yes, for HPV you must have undergone a Colposcopy or cone biopsy of your cervix with your own personal physician and continue to have clean Pap smears. This is usually easy to arrange. Typically as a Herpes carrier, you will be prescribed anti-viral medication to suppress outbreaks, especially before birth.
Explain the medical procedures.
Once you are medically cleared by the IVF clinic and the Surrogacy Agreement between yourself and your Intended Parents have been finalized, you will be able to start the medical process.
You can expect to start birth control pills, if you are not already taking them. Birth control pills are meant to regulate your cycle in order to get your system in synchronization with the Intended Mother’s (or an egg donor’s) menstrual cycle or to more easily plan the date of the embryo transfer.
After 2-3 weeks you will then administer a small subcutaneous hormone injection into the skin for approximately 2-3 weeks to prevent the ovaries from ovulation. You will not be using your own eggs for fertilization, so this medication must suppress your ovaries, while your uterine lining grows for implantation.
Because you are not releasing your own eggs, you will not have follicles in your ovaries that would normally release the hormone Estrogen needed to build the endometrial lining of your uterus. As a result, it is necessary for you to administer Estrogen and Progesterone injections to build your uterine lining and sustain a potential pregnancy. Some doctors will prescribe these hormones in pill or patch form, but most prefer injectable oils that contain Estrogen and Progesterone as they are more easily absorbed into the body.
The IVF clinic and I will provide you with instructions and videos on injection techniques.
I strongly recommend to all Carriers that they learn to administer their own injections as there may not always be someone available to administer for you.
Self injecting is a little awkward at first, especially for intramuscular injections, but once you get the hang of it, it will be very easy. I will help you along the way. I have plenty of tips, and practice makes perfect.
You will be required to attend a number of clinical visits, on specific days, for vaginal ultrasounds and blood draws. Example:
1-2 for screening
1 prior to start of injectable medications
2-3 after the start of injectable medications
1 for the embryo transfer procedure. (plus 2 days bed rest at home/hotel)
Once the Intended Mother (or egg donor) has harvested her eggs and those eggs have been fertilized, you can expect your embryo transfer to happen about 3-5 days later. If the embryos are already created and frozen, your embryo transfer date will have already been planned in advance.
What can I expect during the embryo transfer procedure?
The embryo transfer procedure is virtually painless. Typically the doctor may prescribe medication to relax you, if you prefer. You may not need it, but it makes the process just a little more calming as the embryo transfer is done in very calm conditions. After all, you are preparing to grow a new person inside of you.
A thin catheter will be inserted through your cervix, into your uterus and 1 or 2 embryos will be injected with a syringe through the catheter. You can go home/hotel within 1-2 hours after the procedure, and you may be asked to stay in bed for 1-3 days after. If you decide to take relaxation medication, you will need to have a friend or family member take you to and from your embryo transfer. If you travelled long distance to the main clinic for your embryo transfer procedure, your companion will have been arranged to take you back to your hotel room.
I have work or school to attend. Can my appointments and the embryo transfer be scheduled on a weekend or holiday?
For a successful cycle to occur, you will be required to attend a number (3-5) of clinical visits throughout the cycle to include weekdays and some weekends to make sure you are doing well on the medications. Your screening will also need to be completed during normal business hours Monday through Friday. You can typically arrange your appointments fairly early in the morning, if necessary, however most clinics open around 8am on average. In many cases, only labs are needed, and can be done locally and early.
We are dealing with menstrual cycles so we cannot plan, to the day, when the embryo transfer will occur, you can expect 1 month advance notice of approximate dates of your embryo transfer procedure so you can arrange time off from school or work. We will have exact dates when the Intended Mother’s (egg donor’s) egg retrieval is confirmed.
Embryos that are already created and frozen, now allow for the embryo transfer to be planned for exact dates and is becoming more common.
If you have specific blackout dates for the embryo transfer to avoid, just let us know, so we can work around those. If you would like a medical note for the time you will be required to be away from work or school, we can arrange that for you.
What if I become pregnant? Now what?
Congratulations!! Approximately 2 weeks after your embryo transfer you will have your first blood pregnancy HCG test. The second test will occur a few days later to confirm your HCG is rising appropriately.
Approximately 3 weeks after your positive blood test, you will visit a local fertility clinic for a vaginal ultrasound to establish a fetal pole and a yolk sac. If more than one embryo was transferred, the doctor should be able to see two embryos growing if both embryos attached.
You can expect to continue appointments with your local fertility doctor every two weeks or so for ultrasounds and blood testing, to monitor your progress. You will continue to take your Estrogen and Progesterone supplements until you are about 9-11 weeks pregnant, at which time you should have already scheduled your first appointment with an Obstetrician.
You may choose the Obstetrician and hospital for your maternity and delivery care. However, ideally, you and your Intended Parents will have worked together to choose an Obstetrician and hospital or birthing center that everyone is comfortable with, and is “in-network” with your health plan.
I have had my tubes tied/I am using Birth control. Can I still be a Gestational Carrier?
If you have had your tubes tied, you can still be a Carrier.
Birth control pills: BC pill is the preferred method of birth control for a prospective GC. The attending physician will tell you when to stop, when required, and may change your prescription for a portion of the cycle.
Injectible birth control/Norplant/Mirena (any long term hormonal birth control): These birth control methods will need to be cancelled or removed, and allow for 1-3 normal periods before you can start the medical screening process.
I just delivered a baby/I am currently nursing. When can I start the surrogacy process?
Before you can get pregnant again, most IVF doctors recommend a 9-12 month rest on your body. You may apply about 6 months after delivery. If you are currently nursing, you can apply when you have completely weaned your baby. After 3 months of normal periods you can start the process with Intended Parents.
How do the Legal Agreements with the Intended Parents work?
You will be provided with an attorney referral to represent you at no cost to you.
In most cases the Intended Parents' attorney will draft the Surrogacy Agreement, based on important terms and benefits required by Fertility Alternatives and your personal needs.
These terms include your compensation, when it is paid, and other industry standard expenses that are to be reimbursed to you, such as lost wages, compensation for multiples and invasive procedures, etc.
It will also address your responsibilities a gestational carrier, such as following medical protocols, taking excellent care of yourself, regular obstetrical appointments, etc.
The draft of Surrogacy Agreement will be forwarded to you and your attorney for review and discussion. Your attorney may request changes to the Agreement on your behalf.
The Agreement also discusses parental rights and obligations of the Intended Parents, when their baby is born. Once the Agreement is finalized by the Parties, the fund management accounts will be funded, and the medical protocol can begin.
When the Carrier is about 14 weeks pregnant, additional legal paperwork will be submitted to finalize the Pre-Birth Order that establishes parental rights to the Intended Parents before birth. This order will be provided to the birthing facility prior to birth. The attorneys will handle this officially with the courts.
Side effects and Discomfort
Can you tell me about the medications? What kind of side effects or discomfort can I expect?
There are a number of different brands/types of medications a clinic may use for the cycle.
Lupron (Leuprolide Acetate): This medication is used to keep you from ovulating and to help get your cycle in synch with the Intended Mother, egg donor, or simply to plan ahead. Lupron is very similar to the use of birth control pills but is administered by a small daily injection. Side effects are rare, but may include:
1. Vaginal Dryness
4. Hot flashes
5. You may feel emotionally spacey.
6. Irritation at the site of the injection.
7. You may feel no side effects of Lupron
Estrogen (injectable oil, pill, vaginal gel, patch)
This hormone is typically administered twice a week because you will not ovulate. When the follicles in your ovaries develop each month, they secrete Estrogen which in turn allows the uterine lining to grow, preparing for a fertilized egg. Because you are on birth control pills or taking Lupron, your ovaries will not be able to produce estrogen to grow an endometrial lining. This Hormone will supply you with what you need to grow your uterine lining.
Common side effects that may or may not occur include:
1. A feeling of well being, happiness.
2. Sore or enlarged breasts
3. Pain, redness, and swelling at injection site
4. Slight nausea (similar to morning sickness)
Progesterone (injectable oil, pill, vaginal gel)
This hormone is administered daily about 1 week before your embryo transfer because you did not use your ovaries to become pregnant. After a woman ovulates she is left with a cyst called the Corpus Luteum which secretes high levels of Progesterone. This hormone helps to sustain the pregnancy before the placenta has had time to evolve and take over the job. Progesterone also plays a role in pregnancy and childbirth as it has a loosening effect on the skeleton and skeletal muscles preparing the body to stretch and carry a baby. This is taken with your estrogen.
The most common symptoms are mostly associated with pregnancy, and may include:
4. Pain, redness, and swelling at injection site
5. Trouble sleeping
6. Acid reflux
7. Loose feeling joint or muscles
What are the risks to my being a Gestational Carrier? Will this affect my ability to have children in the future?
The risks of being a Gestational Carrier are virtually the same as if you were to become pregnant on your own.
If both parties agree to transfer more than one embryo into your uterus, there is a chance you will get pregnant with multiples. This does offer a higher risk to the Carrier and the fetuses she is carrying. Thankfully, carrying twins is a common occurrence, and relatively safe. I do not recommend a triplet pregnancy as the risks are significantly higher for you and the babies. You want an amazing and safe experience, not a stressful or hazardous one.
Like most low-risk pregnancies and births there is no reason why you can’t choose to have another baby for yourself, or, to be a Gestational Carrier again for another set of Intended Parents. Many Carriers choose to become a surrogate again for another family!
Am I required to do any travelling?
Travel is not a requirement, however a huge advantage to your being matched. My program works with Intended Parents nationally and internationally, and IVF clinics, and Carriers all over the United States.
You are more likely to be matched if you are able and willing to travel. Most Intended Parents have an ideal fertility clinic they have chosen to work with, and you may live in another city or state.
Travel is typically up to about 3- 4 days for embryo transfer procedure and bed rest. In most cases, the clinic will require you to travel to them for screening, which is 1-2 days, depending on the location of the clinic in reference to where you live. If you are travelling, you will need to have a companion accompany you to your embryo transfer. No companion is necessary if you are travelling for screening.
Please have someone in mind (or a back up) who can potentially serve as your companion. They will need to accompany you at least for about 2-3 days as they must be available to take you to and from your Embryo Transfer procedure and potentially stay with you if you are prescribed bed rest. You will need to make childcare arrangements for this time.
I will make all of the travel arrangements and provide you with travel funds to cover your travel expenses, and lost wages per your Surrogacy Agreement.
Examples of expenses covered for travel are flights, meals, rental car or taxi/Uber/Lyft to and from the clinic, reasonably priced and comfortable hotel/lodging, airport shuttle/parking.
95% of the Carriers already in the program are willing and able to travel, with some advanced notice, and usually enjoy the trip.
Where are the funds held, and when are payments made?
The estimated funds for your case will be held in both an Agency Fund Management Account and an Escrow Account.
Reimbursements prior to pregnancy will be paid from the Agency Fund Management Account.
Payments and reimbursements after pregnancy has been established will be paid from the Escrow Account on the 1st of each month following the first ultrasound showing a fetal heartbeat.
What is included in the Gestational Carrier’s Compensation Package?
Our compensation package is highly competitive. Carriers are also entitled to choose a post-pregnancy mini-vacation, if they feel monthly Carrier Psychological Counseling is unnecessary. Based on the applicant, the total benefits package will average between $50,000-$75,000+.
- Surrogacy base compensation for providing childcare to the fetus. New insurance limitations may affect the amount of base compensation for California Carriers.
$40,000-$45,000+* 1st time California GC
$50,000-$60,000+* Experienced California GC
$38,000-$40,000+* 1st time GC in Western States.
$50,000*+ Experienced GC in Western States.
$32,000-$35,000+* 1st time GC other states
$45,000*+ Experienced carrier in other states
$45,000-$50,000+* 1st time Jewish GC
$60,000*+ Experienced Jewish GC
*These amounts are not set in stone. The GC is given the opportunity to decide a reasonable compensation around the guidelines set above.
Carriers already covered by a health plan that does not exclude surrogacy or require a lien, will receive compensation on the higher end.
Candidates that meet ideal surrogacy criteria may qualify for a $5,000 bonus added to her base compensation.
Insurance plan changes may affect the surrogacy compensation market.
My goal is to match you at your requested compensation.
*If Carrier does not have a surrogacy friendly health plan, the Intended Parents will pay for the monthly premiums, pregnancy deductibles and co-payments after the Carrier has applied during open-enrollment, and been accepted by the insurance company. Payments will continue for 3 months after birth. It will be up to the Carrier to cancel her policy or take responsibility over the premiums.
If Carrier already has a surrogacy friendly health plan, the Intended Parents will pay for the pregnancy deductibles and co-payments and the Carrier will receive the higher base compensation amount.
How can I expect to feel about carrying a baby for another family?
Everyone processes the experience in their own way.
If you have made the decision to be a gestational carrier with the clear understanding and intention that the baby you are growing inside your uterus is not genetically related to you or your partner, you are not interested in expanding your family at the moment, and you are providing generous “childcare services” for someone who is unable to do so for themselves, then you can rationally expect that you will not have an emotional attachment that extends beyond that if a person helping a friend in a unique way.
You will be able to meet the baby you help create, and have closure over this amazing experience. I am always happy to discuss my experiences with you. Just ask.
After I have given birth, what do I do about lactation?
You have several different options when you begin lactating.
I recommend to all Intended Parents, that they receive the colostrum from your breasts to help develop the baby’s immune system. This can be done by breast pump or temporarily by breast feeding.
You can decide if you prefer to pump colostrum and breast milk for the Intended Parents or, stop lactation all together. It is completely your choice. Additional compensation is provided to the Carrier for pumping and providing breast milk.
There are huge health benefits to the Carrier when pumping breast milk. It allows the uterus to contract back to pre-pregnancy size and also burns plenty of calories that can help the Carrier get back to her normal weight.
If the Intended Parents choose not to use your breast milk, you can choose to donate the milk to a milk bank or stop lactation altogether.
Can I withdraw from the program at anytime?
Yes, you are free to withdraw from the program at any time. However, I encourage you to learn as much as you can about the process, confirming you will have support from your spouse and family, and know you will be committed before applying with the program.
If you have already legally contracted with Intended Parents, you can withdraw as it specifically addressed in your Surrogacy Contract with them. If you need to postpone due to an emergency, a postponement can be arranged.
You are welcome to ask me any questions about the process if you do not have a clear understanding. It is reasonable and understandable to have some sort of hesitation about the process, simply because it is an unknown. I have been a Gestational Carrier twice and have first hand information about what to expect. I also have other Carrier references you can contact about their experiences. If you are great at pregnancy, you will be great as a Gestational Carrier.
I understand the process itself can be very involved, uncomfortable and require as much as a year or more of your time. I will help you along and provide any support you need.
Can I apply with other agencies or surrogacy programs?
Applicants who apply with the program are expressing their availability. I will not be able to share your profile with Intended Parents if there is a risk you will not be available or committed to them.
I strongly ask that you do not apply with other programs for a minimum of 6 months. If, however, you have not been matched within 6 months and you would like to apply with another program you are free to do so, keeping in mind there may be several reasons why it is taking longer to match you.
- Your age. After the age of 38, it becomes more difficult to match you.
- The supply of available Carriers far outweighs the demand of Intended Parents.
- Your profile indicates requests that are not preferable to most Intended Parents. (no-termination requirement, home-birth requirement, etc.).
- Your inability to travel for screening and embryo transfer.
- Your limited availability due to work or school commitments.
- Your state laws require step-parent/second-parent adoption or similar, for surrogacy cases.
- Your medical history is questionable or your BMI exceeds most IVF clinic requirements.
- Your most recent delivery occurred over 7 years ago.
- You don’t have a health plan already in place, and the open-enrollment period is in the distant future.
If I find, that I am having a difficult time matching you, I will work with you to find a way to get you matched sooner or suggest the prospect of applying with another agency, noting that other agencies may have the same issues matching you.