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Surrogacy is the term most people think of when a woman carries a baby for someone else to parent. It’s an alternative path to parenthood for people who cannot carry a child themselves for physical, genetic, or gender-specific reasons but want to be related genetically to their child.
Surrogates are divided broadly into two categories: traditional surrogate and gestational carrier. Here, we look at the difference between them and how it affects the process, legal implications, and financial investment en route to parenthood.
The main difference between gestational carriers and traditional surrogates is that gestational carriers have no genetic connection to the baby. Traditional surrogates do have a biological connection to the child since the surrogate contributes the egg.
Which one is right for you depends on your situation, your state’s laws, and your financial means.
In traditional surrogacy, the surrogate is a woman who carries a child for another person or couple to parent that is created from her own egg and the sperm provided by the intended male parent. In a heterosexual couple, the male would obviously contribute sperm, but in a same-sex male couple, it could be either man contributing the sperm.
A gestational carrier is a woman who carries a child for another person or couple to parent that is created from genetic material that is not hers. For heterosexual couples, that could mean a donor egg and sperm from the intended parents. For same-sex couples, that could mean either egg or sperm from one of the intended parents plus a donor egg or sperm from a bank.
A gestational carrier may make it possible for people who cannot or should not carry a child for health reasons to be a parent. This includes [*]:
Traditional surrogacy is less common these days than gestational surrogacy but it can be a viable option for:
Surrogate is a word sometimes used to refer to a gestational carrier because many people don’t know the term gestational carrier. Beyond the fact that a gestational carrier does not share any genetic material with the baby and a traditional surrogate does, the two are different in several key ways that affect the process, cost, and potential outcome.
A surrogate is typically inseminated with donor sperm via artificial insemination (IUI, or intrauterine insemination). A gestational carrier must employ IVF to be implanted with the donors’ embryo(s), which are fertilized outside the womb, in a lab. Here’s why it matters:
The cost of IVF is about 5x higher per cycle than IUI. A single IVF cycle at a U.S. fertility clinic can run $15,000-$25,000 depending on where the clinic is located and whether you opt for injectable hormones and preimplantation genetic testing. Most people need at least 2 IVF cycles to conceive [*][*].
IUI costs between $500-$4,000 per cycle, with the high end based on the use of gonadotropins to encourage ovulation in the carrier.
IVF is more successful than IUI, with shorter times to pregnancy and a higher live birth rate, but on average, a gestational carrier will need 2.3 - 2.7 cycles before conceiving [*][*].
While the cost of IUI is considerably less than IVF, the success rate is only about 40.5% after 6 treatment cycles [*].
Finally, the risk of having multiples is markedly increased when fertility medications are used in tandem with artificial insemination. A woman under 38 undergoing artificial insemination with gonadotropin has a 32% chance of conceiving multiples, while that same woman has only a 1% risk of multiples with a single embryo transfer via IVF and a 30% risk with a double embryo transfer [*].
You’ll want to work out ahead of time with your gestational carrier or surrogate what you will do in the event she is pregnant with more than one fetus.
IVF offers the possibility of preimplantation genetic testing to screen for chromosomal abnormalities and heritable disorders that could lead to miscarriage or birth defects, something not possible with artificial insemination.
At the same time, IVF is linked with an increase in certain complications of pregnancy, including pregnancy-related high blood pressure, diabetes, preeclampsia, and placenta disorders [*].
State laws vary widely regarding paid surrogacy [*]. Many were drafted in the wake of the famous Baby M case in 1985, a traditional surrogacy that went sideways when the surrogate (Mary Beth Whitehead) found after delivery that she could not part with the child she conceived on behalf of the Sterns, with Mr. Sterns’s sperm, for an agreed upon fee and through a professional fertility clinic.
Fearing the despondent and unhinged Mrs. Whitehead would harm herself, the Sterns gave Baby M back to her for what was to be a short period that would allow her to settle her emotions. Instead, Mrs. Whitehead fled out of state with Baby M, the Sterns filed suit, and months of legal proceedings ensued in which Baby M’s best interests were considered alongside whether state laws prohibiting termination of parental rights and payment of money in connection with adoptions applied to surrogacy contracts.
Ultimately, a higher court found that these laws did apply and the surrogacy contract was thus unenforceable but that the baby’s interests were best served by granting custody to the Sterns while allowing Mrs. Whitehead visitation rights.
The Baby M legal conundrum has made traditional paid surrogacy risky and even illegal in some states and the laws continue to evolve. Some states prohibit paid surrogacy out of concern that vulnerable women, such as underage girls or intellectually disabled women, might be exploited for financial gain [*][*].
If the surrogate is the biological mother (traditional surrogacy) she will have parental rights when the baby is born. That means additional legal procedures will be necessary to terminate her parental rights and legally adopt the baby. Because of the legal and emotional complexities involved in traditional surrogacy situations, many professional agencies only offer assistance with gestational surrogacy.
So the first part of the journey to parenthood via surrogacy is working with an agency or lawyer who specializes in fertility law and surrogacy issues to understand what options are available to you in your state that meet your needs and means [*].
First, know that in the U.S., the average cost of surrogacy is $150,000 - $200,000 [*].
When you add up the agency fees, surrogate compensation and expenses, medical expenses including fertility treatments, legal fees, and egg or donor sperm, the costs can really mount.
The insurance question can be complicated. Insurers usually regard surrogacy as a choice made by the intended parents rather than a medical necessity and further, since the surrogate is not a party to your policy, they will typically exclude her from coverage.
The surrogate may have her own insurance that could potentially cover or offset some of the costly medical or fertility treatment expenses, but a few insurers have clauses excluding coverage of medical or fertility costs associated with surrogacy [*][*].
On the positive side, there are specialty insurers such as Progyny and Carrot that provide fertility benefits for employers to offer their workers which may allow for reimbursement of out-of-pocket costs associated with surrogacy. It’s worth asking your employer if they have such plans or expect to in the near future.
For people who have medical conditions that preclude them from having children or otherwise cannot afford the costs of surrogacy, there are a number of nonprofit organizations that offer fertility treatment scholarships and grants [*][*].
Yes, you can bank cord blood with a surrogate but the surrogate does have to consent to the collection of these cells from the umbilical cord. This is true of gestational carriers as well as traditional surrogates. The intended parents will have exclusive rights to the stem cells after collection and pay for the services.
While all parents want their children to be safe and healthy should they face a life-threatening illness in the future, parents that may have already invested $150,000 or more to have a child via a surrogate may consider cord blood banking with MiracleCord another wise investment in their family’s future.
MiracleCord offers the industry’s most advanced stem cell processing and responsive service at affordable prices. Learn more by downloading our free Info Kit or call 888.743.2673 to speak with a representative who can answer all your questions.
Surrogacy can be an amazing way to build a family for people who cannot carry a child and want a biological connection to their child but it’s not for the faint of heart.
It can be legally complicated, emotionally fraught, and extremely expensive whether you use a traditional surrogate or gestational carrier.
DISCLAIMER: THE INFORMATION ON THIS WEBSITE IS NOT INTENDED TO BE USED AS MEDICAL ADVICE.The materials and information contained on the MiracleCord website is provided for educational and informational purposes only, and is not intended to, and does not constitute, medical or other health advice or diagnosis, and should not be used as such. You should not use this information to diagnose or treat a health problem or disease. If you are seeking personal medical advice, you should consult with a licensed physician. Always consult with a qualified health care provider regarding a medical condition.
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