How Does Surrogate Pregnancy Work?

Types

• According to the American Society for Reproductive Medicine, there are two types of surrogacy: traditional and gestational. In traditional surrogacy, a woman is inseminated with sperm. In gestational surrogacy, an embryo created with the sperm and an egg of the intended parents is transferred to a third party surrogate. In the case of traditional surrogacy, the surrogate -- because she provides the egg -- has a greater biological tie to the child. It is for this reason that most surrogate pregnancies in the United States are gestational.

Legal Implications

• Surrogacy laws vary from state to state. It is very important to research the laws in your state to see what is covered. Some states prohibit surrogacy contracts. Others don̵7;t explicitly prohibit them but will not enforce them. The surrogate and the intended parents should seek their own legal counsel. Attorneys should draft a legal contract that discusses financial obligations and rights of the donors. Contracts might also discuss expected behavior from the carrier to ensure a healthy pregnancy, prenatal tests and agreements in the case of multiple fetuses.

Counseling

• Counseling is recommended for both the carrier and her partner, if there is one, as well as the intended parents. The surrogate, her partner and a counselor should discuss the psychological issues related to pregnancy, managing the relationship with the intended parents, dealing with attachment issues and the effect of the pregnancy and surrogate arrangement on any other children. Intended parents and a counselor should talk about maintaining a healthy relationship with the surrogate.

Finding a Carrier

• Most surrogates are relatives or friends who volunteer, according to the ASRM, but agencies that specialize in recruiting carriers are available if you choose an anonymous carrier. A surrogate should be a woman between the ages of 21 and 45 who has successfully delivered a baby. The ASRM also recommends the surrogate have no more than five previous vaginal births or no more than two previous cesarean deliveries.

Process

• The patient (egg donor) is stimulated for in vitro fertilization and the surrogate is placed on medications to suppress her menstrual cycle and make her uterus receptive. Eggs are removed from the patient and fertilized with sperm. Embryos develop in the lab for three to five days and then are transferred to the surrogate̵7;s uterus.

  The ASRM recommends intended parents undergo a complete physical examination, including semen analysis and evaluation of ovarian function. Once you choose a surrogate, that person should undergo a complete physical exam and a complete screening for infectious diseases, and should provide a detailed obstetric and lifestyle history.