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What is Surrogacy?

Simply put, surrogacy is when a woman carries an embryo or donor embryo to term and gives birth to the baby.

Surrogacy in the U.S.

As you prepare for your surrogacy journey, there is a lot to consider. While some may look at International Surrogacy, there are often additional costs and concerns many might not be aware of. In terms of expenses, there is considerable back and forth travel costs as well as hotel expenses, food, and other incidentals, and many other unexpected costs that can be incurred. In addition, in some countries, surrogacy is banned for foreign intended parents. This means there is a high risk of ethics and questionable practices.

When it comes to surrogacy in the United States, there are significant factors to consider when deciding where to pursue your family-building journey. Some compelling aspects are:

Considering Surrogacy?

According to data from the Centers for Disease Control, 10,000 births took place with the help of a surrogate in the United States in 2018. Whether it’s a woman who is unable to carry a pregnancy due to a medical issue, a couple with infertility, or a same-sex relationship where a gestational carrier is essential.

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.

Gestational Surrogacy Agreement Terms

Just as there are different types of surrogacy arrangements, there are also two different agreement terms that identify how a surrogate is compensated. The impact a surrogate has on the lives of others goes far beyond money, however, it is a vital part of the agreement. When you move forward with choosing Fairfax as your agency, you are ensuring that our surrogates are generously compensated for their time, commitment, and emotional investment for such a compassionate cause.

In years prior the GSA terms were commonly referred to as “Altruistic and Commercial”. There was a movement to change these terms by many pro-family and advocacy organizations. The new and accepted terms are Compassionate Surrogacy – replacing Altruistic and Compensated – replacing the outdated term Commercial. One of the many reasons is that specific terms in use can be damaging to those fighting anti-family building legislation and anti-surrogacy organizations. The community at large is shifting or currently using these terms to identify the agreement (GSAs).

Here are how each is defined:

Compassionate Surrogacy

A woman carries a pregnancy for no compensation beyond her medical bills and direct costs associated with the pregnancy; Compassionate surrogacies can be gestational or traditional. Compassionate surrogacy seems to be more widely accepted as it is legal in many states and countries where compensated surrogacy is banned.

Compensated Surrogacy

A woman is paid a fee for carrying a pregnancy beyond covering her medical bills and expenses. Compensated surrogacies can be gestational or traditional.

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:

Using fresh donor eggs:

  • On fresh cycles, the egg donor typically helps just one family so the number of children genetically related to the donor is minimal
  • There’s a potential opportunity to speak with the egg donor to learn more about her
  • You will have a greater chance of being able to have biological siblings later should you choose to expand your family as you may be able to freeze extra embryos for later use
  • Fresh eggs have slightly higher improved fertilization rates


Using frozen donor eggs:

  • There will be no delays or waiting to start your cycle as the need for “cycle synchronization” would be eliminated as the eggs are available immediately
  • Your IVF treatment could be scheduled at your and your doctor’s convenience.
  • Frozen donor eggs tend to be more affordable
  • You greatly increase your chances of receiving mature eggs and decrease your chances of a canceled cycle


Using donor sperm:

This is an option for LGBTQIA+ couples, single women, or if a male partner has no sperm or a poor semen analysis (azoospermia, low count, poor motility), or genetic concern could be inherited from the male.

Understanding the lingo

Quite often, the family-building community uses acronyms as a shorthand for their journey. It can be overwhelming, we know. In fact, it can feel like a whole new language! Here we have broken down the most commonly used acronyms so you can help understand the lingo as you begin your surrogacy journey.

Below are the most commonly used acronyms that you may want to be aware of:

2WW: Two-week wait

AF:  Aunt Flo, After Flo, Period, or Menstrual Cycle

ART:  Assisted reproductive technology (e.g., in vitro fertilization)

BBT:  Basal Body Temperature

BCP:  Birth Control Pills

Beta:  HcG pregnancy test

BFN:  Big Fat Negative

BFP:  Big Fat Positive

CB:  Cycle Buddy

CD:  Cycle Day

DE:  Donor Eggs

DH:  Dear Husband

DI:  Donor Husband

DOR:  Diminished Ovarian Reserve

DPO:  Days Post-Ovulation

DPR:  Days Post-Retrieval

DPT:  Days Post-Transfer

DW:  Dear Wife

Dx:  Diagnosis

ENDO:  Endometriosis

EPT:  Early Pregnancy Test

ER:  Egg Retrieval

ET:  Embryo Transfer

FET:  Frozen Embryo Transfer

FF:  Fertility Friend

FHR:  Fetal Heart Rate

Frostie:  Frozen Embryo

FSH:  Follicle-Stimulating Hormone

FTTA:  Fertile Thoughts to All

GC:  Gestational Carrier

HcG: Human Chorionic Gonadotropin (hormone detected by pregnancy tests)

HPT:  Home Pregnancy Test

HSG:  Hysterosalpingogram

HX:  History

ICSI:  Intracytoplasmic Sperm Injection

IF:  Infertility

IP:  Intended Parent

IR:  Insulin Resistant

IVF:  In Vitro Fertilization

IUI:  Intrauterine Insemination

LAP:  Laparoscopy

LH:  Luteinizing Hormone

LMP:  Last Menstrual Period (start date)

LSP:  Low Sperm Count

MAI:  Miscarriage after Infertility

MC, m/c, misc.:  Miscarriage

MF:  Male factor

O, OV:  Ovulation

OB, OB/GYN:  Obstetrician/Gynecologist

OC:  Oral Contraceptives

OPK/OPT:  Ovulation Predictor Kit, Ovulation Predictor Test

OTC:  Over the Counter

PCOS:  Polycystic Ovarian Syndrome

PG:  Pregnant

PGD/PGS:  Pre-implantation Genetic Diagnosis, Pre-implantation Genetic Screening

PI:  Primary Infertility

PIO: Progesterone in Oil injection

PID:  Pelvic Inflammatory Disease

POAS:  Pee on a Stick

POF:  Premature Ovarian Failure

POI: Primary Ovarian Insufficiency

PUPO: Pregnant Until Proven Otherwise

RE:  Reproductive Endocrinologist

RPL:  Recurrent Pregnancy Loss

SA:  Semen Analysis

SART:  Society for Assisted Reproductive Technology

SI:  Secondary Infertility

STD:  Sexually Transmitted Disease

TL/TR:  Tubal Ligation, Tubal Reversal

TPR: Third-Party Reproduction

TTC:  Trying To Conceive

TTCAR:  Trying to Conceive After Reversal

TWW: Two-week wait

TX:  Treatment

US:  Ultrasound

V/VR:  Vasectomy, Vasectomy Reversal

Is your state surrogacy-friendly?

Be aware that there isn’t any federal law governing surrogacy. That means it’s up to each state to decide how to handle surrogacy, and almost all have them have a unique approach.

In general, forty-seven US states recognize gestational surrogacy. However, three US states do not recognize gestational surrogacy, and contracts are “illegal.” Those three states are Nebraska, Michigan, and Louisiana.

If you’re an intended parent, you can become a parent no matter where you live. So the laws in the state where your surrogate lives – and will give birth – are the surrogacy laws that matter.

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Surrogate Friendly States

This map is intended as a helpful guide. Every state must be evaluated by an attorney based upon the circumstances of the Intended Parents.

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Become a Parent

If you are a parent in the making, we want to be a part of building your future family. Having an experienced guide to help you walk through everything step by step, avoid pitfalls, and offer you the support you need can make a tremendous difference. Contact us so we can take that first step together. You don’t have to be alone!

Become a Surrogate

Are you interested in becoming a surrogate? YOU could be the answer to someone’s wish! While it is a big commitment, it’s also the most rewarding experience you may ever have. It doesn’t just change the lives of intended parents; it can transform YOUR life in the most beautiful way as well! Gestational Carriers are special women. If YOU think you are that special woman, contact us to learn more!

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Let’s Chat

We know your story is like no other, yet we understand so much of what you are going through. Our team members have walked through the challenging world of infertility, and we also have experienced surrogates on our team who can offer unique insight and support.

We see you, and we empathize with the multiple facets each family must consider. We are so honored to support and care for surrogates and intended parents as you navigate new waters both physically and emotionally. Be a part of something amazing, and trust in us to hope with you.

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