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Many choose surrogacy for several reasons. With surrogacy, the intended parents can be involved with the baby’s conception and the pregnancy. Also, some would like to have a biological connection with their child if possible. For others, it may be the only option as they do not meet specific qualifications for adoption. Finally, some may decide on surrogacy simply because it can be faster than adoption. With a decline in the number of newborn infants available for adoption, surrogacy offers a childless couple/individual another alternative to having a baby. It’s also a wonderful option for those who are LGBTQIA+ who want to expand their family.

Traditional surrogacy is when the surrogate not only carries the child but also uses her eggs. This means she is the biological mother who carries the child with the intention of parentage placed to the intended parent(s) upon birth. Because of the traditional surrogate’s biological connection to the baby, traditional surrogacy raises many legal and medical concerns. If you are interested in this route, please proceed with tremendous caution.

Infertility affects 6.7 million women in the U.S., about 11% of the population’s reproductive-age population. It’s estimated that 1 in 8 couples (or 12% of married women) has trouble getting pregnant or sustaining a pregnancy.

According to CDC reports on ART (Assisted Reproductive Technology), between 1999 and 2013, about 2% (30,927) of all assisted reproductive technology cycles used a gestational carrier. Between 1999 and 2013, gestational carrier cycles resulted in 13,380 deliveries and the birth of 18,400 infants. The data shows 9,819 (53.4%) of these infants were twins, triplets, or higher-order multiples.

The first compensated surrogacy agreement occurred in 1980 and was arranged between a traditional surrogate and the intended parents. Elizabeth Kane (a pseudonym) received $10,000 to carry a baby for another couple.

In what would be a sensational case that gained worldwide attention around surrogacy, the “Baby M Case” took place between 1984 – 1986. Bill and Betsy Stern hired Mary Beth Whitehead to be their surrogate in 1984, agreeing to pay her $10,000. Whitehead’s eggs were used in the artificial insemination process, making her the child’s biological mother. However, when the baby was born, and it was time for Whitehead to sign over her parental rights, she refused and took custody of baby Melissa Stern (“Baby M.”) — starting a lengthy custody battle in 1986. This case put “traditional surrogacy” and the potential legal ramifications into question.

Between 2004–2008, it was reported that almost 5,000 children were born via surrogacy in the United States.

Today, we continue to make significant discoveries that have dramatically changed how we think about conception and family building.

Surrogacy has a tremendously high success rate. The CDC monitors ART using the National Assisted Reproductive Technology Surveillance System, or NASS 2.0, for every cycle performed in the U.S. IVF clinics in the U.S. have a surrogacy success rate of about 75%. Once the surrogate is pregnant, the success rate for a healthy birth is as high as 95%. Still, the Society for Assisted Reproductive Technology (SART) notes that “success varies with many factors.”

Traditional surrogacy is when the surrogate not only carries the child but also uses her eggs. This means she is the biological mother who carries the child with the intention of parentage placed to the intended parent(s) upon birth. Because of the traditional surrogate’s biological connection to the baby, traditional surrogacy raises many legal and medical concerns. If you are interested in this route, please proceed with tremendous caution.

Lack of a Uterus or a Uterine Concern

The intended mother may not have a uterus or might have an inherent condition of uterine defect that makes it difficult to carry a child to term.

A Medical Condition

Some medical conditions, while they don’t directly affect a woman’s physical ability to bear children, can have an impact on her to carry a child to term while simultaneously maintaining her health. Conditions such as a history of cancer, heart disease, kidney disease, or severe diabetes can make pregnancy a life-threatening concern for both the mother and child. In some cases, your age may be a factor. What’s important to remember is whatever physical reason may be preventing you from carrying a pregnancy to term, there are options like surrogacy to help!

Same-Sex Couples

Gay couples, most commonly men, will sometimes use donated eggs and the services of a surrogate mother to create a family.

Gestational Surrogates (Carriers) vs. Traditional Surrogates

Gestational Surrogates

Gestational carriers, also known as gestational surrogates, are by far the most popular option being used by couples. Gestational surrogates are not genetically related to the child that they carry. Instead, modern technology allows the gestational surrogate to carry a genetically unrelated fetus through donor eggs or using the intended mother’s eggs.

Gestational surrogates can work closely alongside mothers or egg donors to sync their cycles and prepare for the IVF process shortly after the egg retrieval procedure and embryo creation. They may also instead use an embryo that was frozen through an earlier IVF cycle. Again, they do not have the genetic linkage that might further complicate parentage issues and ethicality.

Traditional Surrogates

Traditional surrogacy is when the surrogate not only carries the child but also uses her eggs. This means she is the biological mother who carries the child with the intention of parentage placed to the intended parent(s) upon birth.

A traditional surrogate is often impregnated via IUI, using the intended father’s sperm or donor sperm. In the end, the child is half biologically related to the surrogate mother – who they will likely never know – and their intended father. Some prefer this as it can be less money.

There are concerns about this, however. First, even if the traditional surrogate is a close friend or relative, she is the genetic mother and could be seen as having a greater advantage in court should she ever change her mind about keeping the child.

Because of many of the potential concerns (genetic issues, the dangers that come along with home insemination in some cases, etc.), the majority of health professionals, surrogacy lawyers, judges, and clinics may refuse to be involved. In addition, some states have banned traditional surrogacy due to the possible ramifications so if you are interested in this route, proceed with tremendous caution.

Donor Egg or Donor Embryo

If you cannot conceive with your eggs or if you’re in a same-sex male relationship, you can pursue IVF treatment using donated eggs. First, the eggs are combined with a partner or donor sperm. Then, the resulting embryo(s) is transferred to the intended mother or gestational surrogate’s uterus.

Donor eggs can vary in cost depending on where you go, whether the donor eggs are fresh or frozen, or if the donor is someone you know as a friend or relative.

Some of the immediate questions when it comes to deciding between fresh versus frozen are success rates and costs. It’s worth noting that thanks to the somewhat recent technology of vitrification (which “flash freezes” eggs preserving their integrity), the success rates for frozen versus fresh are close to the same. With respect to cost, whether you pursue fresh or frozen egg donation, the cost of donor eggs is not inexpensive. Frozen donor eggs can cost less than fresh eggs, in general there are pros and cons to fresh versus frozen egg donation. Here are some advantages to each: