Gestational surrogacy is when a person carries and gives birth to a baby for another person or couple. It’s usually done through IVF (in vitro fertilization). The person who carries the pregnancy has no genetic relation to the baby.
Gestational surrogacy is when another person carries and delivers a child for another couple or person. The person who carries the pregnancy is called a gestational surrogate or gestational carrier. The couple or person who intends to raise the child is called the intended parents or intended parent.
Most pregnancies carried by a gestational surrogate are achieved through in vitro fertilization (IVF). IVF is when an embryo is created in a lab using an egg and sperm from the intended parents or an egg and/or sperm donor. The embryo is then transferred to the carrier’s uterus. Because the gestational carrier doesn’t provide an egg, there's no genetic connection between the carrier and the child.
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There are two kinds of surrogacy: gestational and traditional.
Gestational surrogacy is a type of surrogacy where the surrogate (or carrier of the pregnancy) isn’t genetically related to the fetus because they didn't provide the egg used for fertilization. The intended parent’s egg or a donor egg is used in this type of pregnancy. The gestational surrogate carries the pregnancy and gives birth to the baby. It’s the most common type of surrogacy. In most cases, at least one parent is genetically related to the child, but the carrier isn’t. This makes the process less legally complicated.
Traditional surrogacy is when the carrier of the pregnancy is genetically related to the fetus. Their eggs are used to create the pregnancy, and they carry and deliver the baby. Then, as the child’s biological parent, they must surrender parental rights to the intended parents (or parent). This type of surrogacy is illegal in many states and has many legal complications.
Many people or couples use a gestational carrier to grow their families. A gestational carrier may be needed when:
In gestational surrogacy, the embryo is created through IVF using the eggs and sperm of the intended parents (or donors). The embryo is then transferred to the surrogate who carries the pregnancy. The process starts with selecting a carrier. Next, the carrier and the intended parents sign legal contracts and have various medical and psychological screenings. Once that is finalized, the IVF treatment begins.
Most people interested in surrogacy meet with a surrogacy agency to discuss the process and costs of treatment. This agency helps match you with a gestational carrier. It helps establish legal agreements (contracts) between the intended parents and the carrier. Agencies are the middlemen between the carrier and the intended parents. Some couples or individuals choose family members or friends as their gestational carrier. This is generally OK; however, there may be more emotional complexities to selecting someone you know.
According to the American Society for Reproductive Medicine (ASRM), an ideal gestational carrier is a:
Ideally, the carrier should have a stable family environment with adequate emotional support to help with the added stress of pregnancy. Carriers will have completed a thorough background check. Intended parents typically have to share certain financial data to ensure they can afford gestational surrogacy.
The intended parents and the carrier must have a medical evaluation, including screening for psychological conditions like depression by meeting with a psychologist.
The American Society for Reproductive Medicine says carriers should get a comprehensive medical exam to ensure they are healthy to carry a pregnancy. The organization also suggests they get blood tests that check for:
Carriers should also be current on vaccinations like measles, mumps, rubella (MMR) and Tdap (diphtheria, tetanus and pertussis). Sometimes COVID vaccination is required. Intended parents (or the egg or sperm donors) will have genetic screening to assess the child's risk for congenital disabilities such as Down syndrome.
Legal contracts must be completed before IVF can begin. The agreement covers things like:
Surrogacy laws vary by state. Your surrogacy agency or attorney can help you navigate the legal side of the process, which can be complicated. Using a team of experienced lawyers and signing contracts guarantees that surrogacy is official from a legal perspective.
Your healthcare provider will gather your eggs and fertilize them with your partner's sperm in a lab. In some cases, donor eggs or donor sperm are used. If the intended parent uses her eggs, she will take fertility medication to produce as many eggs as possible for fertilization. An embryo forms after sperm fertilizes one or more eggs.
The gestational carrier takes fertility medicine to prepare the uterus for an embryo. Once the embryos form, they’re implanted into the gestational carrier’s uterus.
The gestational surrogacy process involves several people:
There are risks for couples or individuals who use a gestational carrier. Some of the most common risks are:
There are also risks to the carrier. They must get routine prenatal care throughout the pregnancy. Carriers inherit all the risks of pregnancy complications like high blood pressure, diabetes and infections. Carrying another person’s pregnancy can be emotional, time-consuming and challenging for the carrier’s spouse or children. While most carriers are happy to help a couple or person become a parent, they can still become attached to the baby after delivery.
Gestational surrogacy provides couples or individuals with an option to expand or build a family when it's not biologically or physically possible. This is often a dream come true for people who otherwise wouldn't be able to be a parent due to uterine problems, medical or psychological conditions, or marital status.
No, a gestational carrier can't keep the baby. A legal contract is signed by the intended parents and their gestational carrier before fertility treatments begin. This document states that the carrier must give the baby to the intended parents after delivery. The carrier also has no biological connection to the child and has no parental rights.
Many different factors go into the cost of surrogacy like legal fees, medical expenses, agency fees, compensation for the carrier, geographical location and other miscellaneous expenses. You can expect to spend at least $50,000 and up to $150,000 or more for a gestational carrier. Remember that IVF doesn't always work on the first try, so you may have to repeat the process.
A note from Cleveland Clinic
Gestational surrogacy is when the surrogate is not related to the child they're carrying. It's the most common type of surrogacy today. It helps thousands of people grow their families when they biologically or physically are unable to. The process involves finding a carrier, completing legal agreements and paperwork and transferring the embryo to the chosen carrier. While a long and challenging process, it's often the only way for certain people to experience parenthood. If you're interested in gestational surrogacy, talk to your healthcare provider about the process, costs, and getting started. They can usually refer you to a surrogacy agency for more information.
Last reviewed by a Cleveland Clinic medical professional on 06/07/2022.
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