Gestational Surrogacy Program

A gestational surrogate is a woman who has given birth to at least one child of her own without complication, lives in a stable home environment, and has a good health history. They must be within the ages of 21-45 and not have a BMI greater than 35. Gestational surrogates can be known (family member or friend) or compensated (paid through an agency).

It is important to identify a surrogate that will be aligned with the intended parent(s) views on pregnancy. The surrogate will carry the child as it grows and the surrogate’s demeanor can impact the intended child’s development. It is helpful to consider the following questions, therefore, when choosing a surrogate:

• Where does the gestational surrogate live and where would she deliver?
• Is attending OB visits important to you and will the surrogate be accommodating?
• Will the surrogate allow you to be there for the delivery?
• Does the surrogate have a healthy diet?
• Does the surrogate have the same lifestyle values as you?
• Does the surrogate have a support system in place?

Before the start of any medical procedures, both the intended parents and the surrogate must work with their legal representation to write, review, and sign a surrogacy agreement. This agreement is legally binding and enforceable in order to best protect the interests and rights of all parties involved.

The surrogacy agreement is a comprehensive document that describes the rights and responsibilities of the surrogate and the intended parent(s). While every surrogacy agreement is different based on state surrogacy laws and each party’s individual needs and circumstances, in general it should include the following elements:

• The surrogate’s compensation
• The risks and liabilities associated with pregnancy
• The surrogate’s responsibilities to take care of herself and the baby throughout the pregnancy
• An agreement on sensitive issues such as termination should it become necessary
• List of individuals permitted at prenatal appointments and the birth

Once the intended parent(s) choose a surrogate and all legal contracts are in place, the surrogate will begin screening to ensure that she is able to move forward with an embryo transfer. Both the surrogate and their intimate partner (if applicable) will undergo specific screening as directed by the FDA and ASRM. Screening includes:

• Infectious Disease Testing for the surrogate and partner (if applicable)
• Urine drug screening for the surrogate and partner (if applicable)
• Physical exam of the surrogate
• Saline Sonogram to assess the uterine cavity
• General bloodwork
• Psychological screening with Dr. Georgia Witkin for the surrogate, partner (if applicable), and the intended parent(s)

Because a gestational surrogate cannot donate their own eggs as part of the surrogacy agreement, intended parent(s) must identify a sperm and egg source. Often, the intended parent(s) choose to use donor sperm and/or eggs from a bank.

Individuals who may be unable to conceive due to azoospermia (the absence of sperm), severe male-factor infertility, are a single woman, or a partner in a same-sex female couple or cis-gender/trans-couple may consider using donor sperm from a licensed sperm bank or a known donor. Similarly, individuals who are unable to achieve pregnancy using their own eggs due to egg quality, genetic abnormalities, previous surgeries, or are a partner in a same-sex male couple, or cis-gender/trans couple trying to conceive may consider using a donor egg to build their family. Donor eggs can come from a variety of sources, including an anonymous egg donor, an agency egg donor, a donor egg bank, or a known donor.

FDA screening will occur prior to the creation of the embryos based on the egg and sperm source. This will include infectious disease and genetics screenings and a physical exam for both the egg and sperm sources.

RMA of New York highly recommends Preimplantation Genetic Testing (PGT) on embryos intended for transfer into a surrogate. PGT can be used to evaluate embryos for genetic abnormalities before they are transferred into the uterus to attempt pregnancy.

Once the previous steps are complete, the surrogate is cleared to begin a transfer cycle. She undergoes additional infectious disease testing, bloodwork, and a transvaginal ultrasound. When these results are collected, the Third Party Team advises the surrogate on medications to prepare her body for the transfer cycle. The surrogate comes in for monitoring appointments about once a week to review her progress and medications are adjusted as needed in order to increase the thickness of her uterine lining. After approximately two and a half weeks, and after adding progesterone to the treatment regimen, the surrogate’s uterine lining should be ready to accept an embryo. At that time, an embryo from the intended parents (previously created using either their own or donor egg and sperm) is thawed and transferred into the surrogate where hopefully it will implant.

Two weeks after the embryo has been implanted, the surrogate will take a pregnancy test to confirm a pregnancy. If she receives a positive result and has achieved a successful pregnancy, RMA of New York will continue to follow the surrogate until about 9 weeks of gestation when a heartbeat can be identified on ultrasound. At that time, RMA of New York will recommend that the surrogate continue to receive care through her OBGYN.

Understandably, the intended parent(s) may want to be involved in the pregnancy as much as possible, including attending regular pregnancy check-ups. Terms of the level of involvement should be pre-determined and a mutual agreement should be reached before a pregnancy is achieved. Oftentimes, the gestational surrogate is located in another state and in-person visits are not feasible. However, telemedicine now offers more opportunities to be involved despite distance.