[00:00:00] Speaker A: Hey, it's Eloise. Quick heads up before this episode starts, what you're about to hear is from the Fertility Cafe archive. We're bringing some of our past conversations back because new listeners find this show every week, and these stories deserve to keep finding the people who need them. If you've heard this one before, give it another listen. Something always lands differently the second time. And if it's your first time, you're in the right place.
Okay, let's get into it.
[00:00:29] Speaker B: Whoever thought making a baby could be so hard? Luckily, the fertility journey isn't meant to be traveled alone. Eloise Drain has helped hundreds of people build and grow their families over the last 15 years, and she's ready to share her insider knowledge and expertise with you. So grab a seat and let's talk fertility and alternative family building in the Fertility Cafe.
[00:00:51] Speaker A: Welcome to Fertility Cafe. Hi, I'm your host, Eloise Drain. We asked around, we asked our surrogates, we asked our staff, we asked our buddies in the field. What piece of information or strange fact do you wish you knew or feel like surrogates should know? And this episode is an accumulation of all the responses we received. They may at first appear a bit random, but if you're looking to increase your understanding of gestational surrogacy, the process, the field, and even the professional aspect of the undertaking, listen on. You may just learn a few dozen things. Let's start by talking about the surrogate application process.
First off is the reality. Qualified surrogates are in a very empowered position. I am not certain if many surrogates really realized this until recently. If you're a woman who meets the qualifications of most surrogacy agencies in the United States, you are very much in demand. We'll talk about how big the market is, but for right now, you should know that women who qualify are in a very nice position.
There are a lot of agencies and a lot of intended parents who want to work with them. So really, there is no reason not to feel empowered as a surrogate and to go with any agency that makes you feel comfortable. Okay, next. I was speaking with the surrogate intake specialist recently and she had noticed that a lot of surrogate applicants abandon the application around the same questions. Questions about abortions, weight and state support programs seem to really scare off applicants.
It is such a shame too, because she felt like a lot of applicants were making incorrect assumptions about right answers just by seeing questions about these topics.
It's true that some questions are disqualifying, but not every question is. Some Application questions are asked to help the professionals gain a better understanding of the applicant. My advice is if you are interested in becoming a surrogate, don't let any questions on the application scare you off.
Answer everything truthfully and don't overthink it. Don't self eliminate by just assuming that you'll be disqualified based on one or two factors. If you don't qualify, the agency will let you know. I would also say that if you are not accepted and you feel there must have been a mistake, follow up with the agency. Make certain that there was not a mistake. Becoming a surrogate is important enough to double check and it's always possible that something was overlooked or a clerical error confused the issue.
Now, you may have noticed that agencies mid size and up usually don't give too much information about why you were denied or why they cannot accept you. This can be frustrating, but there is actually a pretty good reason. Some agencies worry that if you tell an applicant exactly why they can't be accepted, they will simply move on to another agency and lie about that thing. So the vagueness is not personal. It's an agency's attempt to try and safeguard other agencies and other intended parents from those who rare but existing women who are trying to game the system. Next is the issue of proving claims. We heard from many folks that they wish applicants realized that almost everything they submit on their application will be followed up on. Surrogacy is a big deal and surrogates must be trustworthy people. Reputable agencies who prioritize the safety and well being of their surrogates and intended parents don't just take an applicant's word for it when it comes to qualifying factors. They're going to do some deep dives on most, if not all the information provided as an applicant. And it's not that they don't believe you. It's just so worth it to make certain. And yes, even though it sounds crazy, there are a lot of women out there who try to present themselves in a less than honest fashion. I don't recommend trying this. Fibs, omissions and outright lies are almost always found out by agencies. Take weight for example. I know really small, but we all know that BMI is important to the gestational carrier standards. Women are not able to simply report their weight or even submit a photo of them standing on a scale. Most agencies are going to require a validation of her weight, among other health indicators in a relatively early phase of the process from a licensed physician. Next we have the realities of the screening process, specifically how long the screening process would take. Filling out an application to become a surrogate may take up to an hour of your time, sometimes even longer. If you think that's long, you should hear about the screening portion of the journey. The screening portion is a bit different at every agency, but often it involves collecting records from multiple doctor's offices, getting a letter of approval from the applicant's obstetrician, and submission of a lot of paperwork. There's also evaluation by a licensed mental health professional and often a home visit. It can take time. It is certainly not an immediate start sort of thing. This is why we encourage women who are thinking about becoming surrogates to start sooner rather than later. Get that ball rolling. The intake staff you work with will help you guide you through the process, and if you change your mind or something comes up, you can always ask for your application to be put on hold.
Most gestational carrier applicants are inspired by a personal connection with fertility. Agencies don't generally share the patterns that they see in their applicants, but it's becoming even more clear that the vast majority of women who consider becoming a surrogate are at least in part inspired to do so because of a person's connection to someone who has struggled with infertility or family building. Perhaps it takes considering what you would do to help someone close to you to really open one's mind to the concept. Or maybe it's just that one in eight Americans struggle to become pregnant. But the vast majority of applicants include a mention of a personal tie to infertility, friends or family, and their applications.
You'll likely have to answer the question, am I done with building my own family? With any pregnancy, surrogacy pregnancies have risk. Some agencies ask if you are done having your own children before acting to help another family build theirs. If you're not sure, be honest about it in your application, but be aware it might disqualify you from certain agencies. Maybe you already know this one, but you would be surprised how often this distinction is misunderstood. It's all about where the surrogate lives. There are no federal laws governing surrogacy. The federal government has left the regulation of the practice of surrogacy up to the states. The state that matters most isn't the one where the agency is headquartered or where the intended parents live. It's the state in which the gestational carrier lives and presumably plans to deliver. It will be her state that dictates the choice of law that will be applied for the surrogacy journey following off of that, a surrogate can work with any agency in close proximity to her or an agency in a different state. It doesn't really matter. We know that a lot of women begin searching for agencies near them, but in truth, the physical location of the agency you work with may not have much of an effect on your journey. You're certainly allowed to prefer an agency near you, but most established agencies are capable of supporting surrogates who are not local. The closeness of the intended parent she's eventually matched with and her proximity to the fertility clinic often have a larger impact on her journey than the agency's offices. Okay, those are the items we had related to the surrogacy application and screening process. Moving on, we have the reality that surrogacy is a long road. Surrogacy is a process that can't really be rushed. It's a lengthy commitment for all parties involved. Of course, the last portion is almost always close to nine months long. But the screening, matching legal transfer preparation and achievement of pregnancy can take time. On average, that process can take 15 to 24 months.
Question we most often receive is how involved does my husband or partner have to be? Sometimes surrogates don't realize all the ways in which their husbands or partners are going to have to be involved. First, this is going to be a pregnancy. You have to think of all the ways in which your partner helped out when you were pregnant before you needed assistance to get through those last few months. And you certainly need the support in the delivery room. But even before all of that, your partner will need to be fully involved.
To start, he or she will likely need to complete a background and credit check. He'll have to take part in a mental health evaluation and be present for the home check. He'll also attend the medical workup at the fertility clinic. If she's not required to attend the medical workup, she'll have to submit to medical screening, including a drug test and STD screening. Your spouse or partner will be involved in the legal contract phase and is required at the very least to sign his or her name to the contract.
Most spouses act as medication administrator, helping the surrogate with fertility drug injections. If you're in a heterosexual relationship, you'll be likely asked to abstain from sex during certain periods of the journey. Your partner may also prefer to attend the embryo transfer with you, but it's not required. Presumably be there when you hear the good or bad news about the result of the transfer. And of course, is support throughout the entire pregnancy and in the delivery room with you as you recover. So yeah, your partner is in. This side note about husbands that comes as a surprise to crying husbands. Your husband might make a friend. This may sound like a long shot, but some women are surprised by how affected their husbands or partners are emotionally by the experience. A surrogate we spoke with said that her husband did not cry when their own children were born. But for him, seeing another man, the intended father, become a father and seeing that man cry inspired the surrogate's husband to break into tears. You just never know. That said, you do not have to be married. There are a lot of single women who become surrogates. Single surrogates are mothers who already have a stable community around them. They have a tribe of people supporting them and are well practiced at taking the world on.
This next surprising bit of information came from a staff member who has been in the industry for some time. She noticed at the start of her career that a lot of the women who were first time surrogates were experiencing difficulty in their marriage. She began to wonder if the women had become surrogates in part as a way to earn for themselves and give themselves a way to leave their partner. Uh, totally not recommended. You really need to be in a stable place with your partner to become a surrogate. It's okay if you're single, it's okay if you're married. Anything less certain or subject to change is not a good idea. This can lead to some needless complication from your intended parents. This is not a task to undertake if your marriage is falling apart or you anticipate any relationship turmoil.
The next topic is surrogacy agencies. I'm not certain if folks realize this, but there are over 120 businesses in the United States that identify as surrogacy or egg donation agencies. The vast majority of these businesses have been open for less than 10 years, have one or two employees, and are often started by women who are inspired after their own surrogacy journeys. Certainly there is no harm in that. There are also some mid sized agencies such as my own which have been around longer, have larger staff, and have helped more folks become parents over a longer period of and of course there are very few larger agencies. There is a wide variety among all of these agencies in the service levels that they provide. As you may imagine, surrogacy agency professionals and third party reproduction generally are a small world and many of the agency owners and executives talk among themselves. There are some unifying organizations that most of us work with and we even have A few Facebook groups where we collaborate and share ideas.
A few of our surrogates tell us that they were surprised to learn that they have the ability to work with an agency or be independent. It's true that you do have the ability to work with an agency, but independently matching with intended parents is also possible. This happens most commonly when you know the intended parents already. Maybe you hear of a couple in your church community who is seeking a surrogate or you step up to help a family member or friend. If you match with strangers through the Internet, for example, be sure to be very careful and skeptical at first. Make sure they are who they say they are and that your personalities vibe okay. Many of the surrogacy gone wrong cases you hear about in the news come from independent journeys where one or both of the parties either misrepresented themselves or didn't do their due diligence. Both types of journeys can be successful. You're just taking on a bit more risk when matching with an unknown intended parent on your own.
It's important to know that many surrogacy agencies tend to be intended parent centric. This may be because some of the agencies in the United States were created by folks who were themselves intended parents. We've had many surrogates tell us. I was surprised that I get a say in the sort of journey I have. Know that this is your journey too. You get a say in what you want it to be like. If you want to carry for an LGBTQ couple or to honor your cousin, tell your agency. If you want to carry for a woman who has breast cancer to help support cancer survivors, tell your agency you don't get to control everything in your journey, but a good agency will do their very best to honor the vision you have for this adventure. It's important to know each agency has their own way of making matches. Some agencies match intended parents and surrogates based on a first come first served basis. I don't care for this type of matching. Just because an intended parent is next in line doesn't mean they are the best fit for the surrogate who has recently accepted into the program.
I would be a little wary of a program who matches primarily this way. You want to make certain that the priorities that are important to you will be considered during the matching process.
A mismatched intended parent surrogate relationship can be miserable and 15 to 24 months is a long time to ride it out. How can you tell if your priorities will be considered? Well, you can ask an agency what their matching protocol is like and if they're asking you questions about what you value and what is important to you, that is certainly a good sign. Know that some intended parents may prefer secrecy. Even if you're open about your journey and excited to tell the whole world about what you're doing, your intended parent may prefer you to be incredibly secretive about the entire process.
There are many different reasons. They could simply be private people. They may be in a high profile situation or in an extreme example, if they are from another country where surrogacy is not legal, they may be trying to avoid legal consequences. If this is a deal breaker for you, let your agency know before they begin the matching process. You may find yourself working with international intended parents. Surrogacy is illegal in many countries and so nearly half of the American surrogate population found themselves working with international intended parents. This can make for some challenging time difference considerations and potentially language barrier issues, but partnering with international parents can be a wonderful experience.
That said, if this is a deal breaker for you, let your agency know.
Okay, let's Talk about Money One response we received was the statement I wish surrogate applicants knew that they can totally care about getting paid, but that it truly cannot be all just about the money.
If you truly just need the money, I recommend getting a part time job or looking into a gig economy.
Becoming a surrogate is not something you want to undertake just for the money. Surrogacy is not a get rich quick scheme. A surrogate applicant can totally be inspired in part by the income she would receive, but there has to be an additional drive to want to do something for another family or to create big change in the world. There has to be some altruistic aspect in her motivation because it is not an easy undertaking and there are certainly easier, more efficient ways to make money. You have to have something else to motivate you during the process because when the hard parts of surrogacy comes, and it often does, you need to have something that will motivate and push you through. Fertility is a multi billion dollar industry.
Piper Sandler research puts the US fertility market at $15.4 billion by 2023. And yes, of course the vast majority of that number is not egg donation or surrogacy specifically, but they are in there. Helping to build families is big money for some. And while there are smaller actors who are very much connected to the cause and invested in the outcomes, there are also a lot of business people who see the entire endeavor as the next big business.
When you're thinking about becoming a surrogate you might be looking at just the base, but there is so much more to be considered. Some agencies have a fixed rate and others have flexible rates. This is to say, some agencies offer you a set amount of compensation and that is the most you will get no matter the circumstance. Others allow for flexible payments. When does this come into play? Doctor ordered bedrest is one possibility. If you're put on mandatory bed rest and you can't work and you can't earn an income, you will either be compensated for a flat rate which has previously been agreed upon, or your actual costs. Now, this may not seem like a huge deal, but it's worth knowing about. Compensation and base pay can be fixed or flexible depending on your agreement and agency. Your intended parents will not have to compensate you for lost wages if you get a new job. If you get higher paid job but have already agreed to your previous salary, you need to understand if the increase rate would be honored. Another thing to note is that compensation payments are not immediate. Your contract will outline when you receive base compensation, but generally payments don't begin until confirmation of heartbeat. You'll of course have all pre pregnancy expenses reimbursed and receive compensation for certain milestones like the start of medications or the embryo transfer. But you need to know that there are things more important than compensation. Location, the right intended parents, the right clinic, the right agency. How long it will take to match you. There are so many more things that are equally as important, if not more important than the base compensation that will have a huge impact on your overall experience.
It's hard to see that when you're looking at what may appear to be a significantly higher compensation by going one route over another.
A big misconception when someone begins to think about surrogacy is that it's only done by the rich and famous. Most of the general public's experience with surrogacy is by reading about celebrities who have worked with surrogates. Now, it's not to say that as a surrogate you won't be matched with a celebrity. It's possible there are newscasters, famous writers, niche comedy actors and athletes who might be in the pool of intended parents at your agency, but it's far more common for your intended parents to be hardworking individuals who are using various means to financially take on a surrogacy journey.
Let's talk health insurance billing next.
I know no one likes to talk about health insurance, but it's a hot topic in the surrogacy world. Most intended parents dream of finding a surrogate who is not only qualified but who has private insurance that doesn't exclude surrogacy. This type of scenario is goals, but the reality is that most surrogates will still need their intended parents to purchase a policy for the pregnancy, even if they have their own health insurance. Most policies specifically exclude surrogacy. Now, there are certain states that have moved to disallow these exclusions, but intended parents who are thinking about this issue should be braced for having to purchase a temporary policy to cover the pregnancy health costs for their surrogate. Just a quick note on medical billing. Some insurance companies will have claims processed and paid within two to three weeks of receiving a bill, but some may take months. That said, most escrow companies suggest keeping the account open for at least six months after delivery, as bills can be delayed with the added element of the woman who gives birth not being the payer. Sometimes surrogacy delivery bills can be even more delayed, with a wayward bill arriving as late as a year later. If you're vetting surrogacy agencies or escrow companies, ask them what their protocol is for assuring that the surrogate's good name and her credit are not negatively affected by overdue bills that she's not responsible for in the first place.
Okay, so what about taxes? How does the IRS view surrogacy? Well, it's complicated. There's not a lot of clear information out there about taxation and surrogacy, specifically whether surrogate compensation and payments are taxable. For a while, agencies were encouraging the concept of the compensation falling under an exemption. But that line of thinking is not really subscribed to by tax attorneys or certified accountants. If you speak to those who know and understand the Internal Revenue Code, they see the compensation and payment surrogates earn as income, which is not in any section of the code specifically exempted. I plan on having another episode on taxes where I'll go more into it, but to be on the safe side, most qualified professionals suggest surrogates plan on paying taxes on the income they earn.
Now, it's worth noting that the vast majority of surrogacy agencies do not 1099 their surrogates, but to my understanding, not receiving a 1099 does not excuse tax liability. I would suggest you speak with your trusted tax professional about how to proceed, but just putting it out there that some cautious surrogates plan on paying as much as 30% taxes on the compensation they earn in the early stages. Your intended parents fertility clinic is very important.
Each clinic's protocol may be different. One clinic may have you do a mock cycle. Another may not have you do it at all. With some clinics, you can drink your morning coffee. With others, caffeine is off the table. If your intended parents are working with a world class clinic, you may be dealing with a doctor who is a wizard at achieving success, but who has a less than warm bedside manner. You'll be interacting with the clinic staff very frequently, so your experience can vary a lot from clinic to clinic. We had one surrogate say, I had no idea I would become so well versed in biology. End quote. One of our intended parents said this to us and we agree. Many people are surprised at how much they end up learning about biology. Becoming a surrogate is like taking a crash course in biology in modern fertility. You're going to have a few take home tests and lots of prep work. Pretty soon though, terms like gametes and oocytes and blastocysts will become everyday language around your house.
Next up, you should know that multiples are a thing. The ASRM suggests the transfer of only one embryo at a time, and most fertility clinics are certainly moving towards this standard. But not all are. Even when one embryo is transferred, multiples are still possible. The process of IVF in and of itself doesn't necessarily give you a higher risk of multiples, but statistically, women who undergo IVF have multiples more often than women who conceive naturally. According to statistics from 2013, around 40% of all IVF pregnancies resulted in multiple births. That's a concerning percentage, especially when compared to the natural occurrence rate of 2% in the general population. The main reason for that, though, is the practice of transferring more than one embryo. The reason clinics do this is to increase the chance that at least one of the embryos will take and result in a successful pregnancy. But if you really aren't willing to carry multiples, you need to insist on only one embryo being transferred, and you need to let your agency know that up front.
Okay, let's talk about the one part of surrogacy. I Shots I hope you're ready for some shots. There may be exceptions to this, as all clinics are different, but as a surrogate you need to accept that shots come with a territory. Clinics usually have surrogates. Start with Lupron, a subcutaneous injection that suppresses the ovulation cycle before transfer. Lupron is administered with a small needle and pretty easy to do since your body has lots of subcutaneous injection sites.
The time frame for these shots is typically fairly short too. The other injection Progesterone in oil is an intramuscular shot that is used to thicken the lining of the uterus and prepare it for embryo implantation. This shot is definitely more difficult and can hurt more because it's an intramuscular and there are only a few places this can be administered. This is the shot that is scariest to most. Still, most people tell us the anticipation was worse than the actual injection.
Besides, you've given birth to an entire human, maybe more than one, so you can do this. Many surrogates tell us their surrogacy pregnancy is so unlike their own that it's hardly believable. Every pregnancy is different, but surrogacy pregnancies are an entirely different biology. Different cravings, different symptoms. After a certain point, though, when you're released to your own obstetrician, it can feel a lot like regular pregnancy. The start of surrogacy is going to feel very unusual, or at least your first time around. But by the time you are approved by your intended parents clinic to be released to your doctor for care, then the surrogacy pregnancy can start to feel like a normal old pregnancy. Except for that whole it not being your baby thing. What about how other people view your role as a surrogate? First, get comfortable with the fact that not everyone is going to understand this.
Yeah, surrogacy has an overwhelmingly positive reception and most people get what a cool undertaking it is. But there are always going to be these folks who just don't get it. It surprises a lot of us in the field, and it surprises a lot of surrogates and tended parents when they realize there is still a ton of misconceptions out there about surrogacy. You probably have to field questions like did the baby look like you? There must be at least 300 blog articles out there outlining the difference between traditional surrogacy and gestational surrogacy. In traditional surrogacy, the woman who carries the child is biologically related to the child as her own egg is used. With gestational surrogacy, the surrogate has no genetic relationship to the child she carries, as her egg is not used in the creation of the embryo. Traditional surrogacy has really fallen out of favor in the past two decades. A very slim number of individuals partake in the practice, so almost always when someone identifies themselves as a surrogate, what they usually mean is that they are a gestational carrier. They have no genetic link to the child they are carrying. The general public seems to be so close, yet so far away from grasping the important message that surrogates don't have any genetic link to the baby. I know of a lovely woman who served as a gestational carrier who who had lovely curls. After she gave birth, her own best friend asked her if the baby had gotten her curls. This really took the surrogate aback. She was shocked that her own best friend thought she was genetically related to the baby she had carried and thus could have passed on her curls. When she asked her friend if she was joking, the friend realized her silly question and they both laughed a bit. Best friend's momentary lapse in her understanding of gestational surrogacy is actually a really great example of the general public's understanding surrogacy. They almost get it, but not quite.
The next major topic that came up was all about the surrogate's own children.
Here are a few things people have been surprised by. First, the kids get it more than a lot of adults. A lot of surrogates worry about how their kids are going to handle mommy being pregnant with a baby who won't be their sibling. Funny thing is, most children do better with the concept than adults. Kids are usually very receptive to the idea.
You'll have to have a broader answer to the question where do babies come from? As one surrogate shared, I have a friend who carried for intended parents when her old children were five and seven. When her eldest child got older, she and her husband had the birds and the bees talk with him. The first thing he said when they were done explaining the whole process was is that what you did with the two daddies to make the baby you carried for them Mommy? Of course the friend was so embarrassed she immediately posted to her surrogate forum with the suggestion that the birds and bees talking with an addendum that not all babies are made that way anymore. Finally, rest assured that agency staff are used to speaking to women who have young children. It can be nerve wracking hopping onto phone calls when you have little ones at home. And many women who perhaps have been considering surrogacy find themselves delaying their first interview call because of this. Trust me, we get it and we will never bat an eye at a screaming toddler in the background. Completely normal. Our last little tidbit for you. Repeat and or sibling journeys are a thing. Acting as a surrogate is an incredibly fulfilling experience and the numbers prove it. Close to 20% of the women who become surrogates have second or subsequent journeys. They may carry for the same intended parents for what is often referred to as a sibling journey or they carry for new intended parents. Most stay with their same agency, but some will shop around for additional perks or program features at other agencies.
So there you have it. I hope you've enjoyed today's episode and that you've learned a thing or two about surrogacy that you didn't know before.
Visit
[email protected] familyinceptions to share with us what you are most surprised about. We'd love to hear from you. I hope you found this discussion helpful as you weigh your next steps. You can follow Fertility Cafe on its new Instagram and Facebook page under Family Inceptions.
If you haven't yet, go to your listening platform of choice and subscribe, rate and review this podcast. We'd also love you to share Fertility Cafe with friends and family members who would benefit from the information shared. Join us next week for another conversation on modern family building. Thank you so much for joining me today. Until next time, remember, love has no limits.
Neither should parenthood.
[00:31:11] Speaker B: Thank you for joining us in the Fertility Cafe. Whether you're a if you're an intended parent, a woman considering egg donation, thinking of becoming a surrogate yourself, or a friend or family member of someone dealing with infertility, we're here to help. Visit our website, thefertilitycafe.com for resources on fertility, alternative, family building, and making this journey your.
