Surrogacy refers to a “third-party” reproductive technique in which the woman who carries the pregnancy is not the Intended Mother but gives up the child(ren) to the Intended Parents at birth. There are two types of surrogacy depending on the source of the eggs: Gestational Surrogacy and “Traditional” Surrogacy. Gestational surrogate/carrier carries and delivers a pregnancy established with eggs either from the Intended Mother or from an egg donor with fertilization occurring in the laboratory (IVF Primer). Traditional surrogates become pregnant with their own egg and fertilization occurs in the surrogate’s body after intrauterine insemination (IUI).

Since common law presumes that the woman giving birth is the child(ren)’s mother, surrogacy requires extensive legal assistance so that the Intended Parents are recognized as such on the birth certificate and a drawn-out custody battle is avoided. Whereas the legal status of gestational surrogacy is well established in California and several other states, traditional surrogacy presents more legal pitfalls because the surrogate’s claim to the child(ren) is much stronger since it is based upon both a genetic and gestational link. Thus, for safety reasons alone, gestational surrogacy is generally preferable to traditional surrogacy.

The main reasons for using surrogacy are: 1. absence or dysfunction of the uterus (womb); 2. medical conditions in the Intended Mother which make pregnancy too risky for her. Gay couples and single men who desire children must perforce use a gestational surrogate. At the Alta Bates program we do not provide surrogacy to women who just want to avoid pregnancy because of lack of time, work commitments or cosmetic considerations. Surrogates come either from the Intended Parents’ family or friends or are recruited through an agency (Finding a Surrogate).

The most important pre-requisite for a surrogate is to have had child(ren) in uncomplicated pregnancies. Ideally, a surrogate has already completed her own family. Obviously, she must have a normal uterus and be free of medical illnesses likely to impact the pregnancy negatively. Unlike egg donors, the age of the surrogates is of less importance and women in their early to mid 40’s make excellent gestational carriers. The success rate of surrogacy is primarily determined by the age and ovarian reserve of the woman providing the eggs (What is Age Factor? How Do We Test Ovarian Reserve?).

The treatment schedule for a gestational surrogate is similar to that of a recipient of donor eggs: her ovarian function is first suppressed with leuprolide, she takes injections of natural estrogen and progesterone to prepare the uterine lining for implantation of the received embryos and these hormones are continued for 2-3 months until the placenta can support the pregnancy. The treatment schedule for the egg provider is similar to that of a woman undergoing IVF or an egg donor: ovarian stimulation and monitoring followed by egg retrieval. Needless to add, for successful implantation and pregnancy the surrogate’s endometrium and the egg provider’s ovaries need to be closely synchronized.

Currently, the compensation for surrogates is US$20-25,000 which, together with legal, medical and agency fees, makes surrogacy the most expensive family-building approach. For appropriate candidates, surrogacy offers an excellent, and oftentimes the only, medical family-building option.