The Surrogacy Blueprint for Intended Parents
We know that as Intended Parents that this process of surrogacy is not your first choice or what you expected for your path to parenthood.
At Bright Futures Families, as well as with our local support branches, our goal is to provide clarity to the process so you know what to expect and provide support that goes above and beyond your needs so that you can have the best possible experience. In that vein, we have created the following blueprint so you can educate yourself on the process, set milestones, and celebrate accomplishments along the way.
*The below steps cover what intended parents can expect during their journey with a gestational carrier. We recognize that each specific journey is unique and multiple steps may occur simultaneously.
Finding a Clinic
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Wondering where to start? – This is it! Every step of the process before the surrogacy pregnancy is based on your IVF Clinic. The IVF clinic will help you with testing of gametes, finding/testing donors, retrieval of gametes, creating embryos, testing embryos and getting all the pieces ready to start your surrogacy journey. Bright Futures Families works with any clinic the intended parents choose – we don’t require a specific clinic in our program. This enables our intended parents to choose a clinic that is specifically suited to their unique needs. A few things to think about when selecting a clinic are location, success rates, communication, and cost. We would suggest checking out several different clinics and choose the one you are most comfortable working with.
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We start off the process by getting to know you via a free initial consultation. The first consultation is scheduled for 30 minutes, but don’t feel rushed as we can always schedule an additional consultation to continue the conversation; you’ll typically meet with a member of our team via telephone, but don’t be afraid to request videoconference or in person, depending on where you live, if those options are preferable to you. During this consultation you will learn about our program, options available, the process of matching with a surrogate, general overview of your state’s surrogacy laws, insurance issues, financial implications such as gestational surrogate cost and medical cost, basic medical information and, of course, you tell us what you are looking for in a surrogate! It can be a difficult and emotional conversation and we want to take our time to make sure we truly understand your history, desires and needs!
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Once you have decided that Bright Futures Families is the Agency for you, you’ll sign a contract with us called an Agency Agreement. You will also fill out an Intended Parent Application to help us get to know you better as well as provide photos and permission to complete a background check. We do not take any agency fees until you have been matched with a gestational carrier, although we do take a $100 application fee to offset the cost of background checks.
Agency Onboarding
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Background checks are required for intended parents in a surrogacy agreement to ensure the safety and well-being of the surrogate and the child to be born. Surrogacy is a complex process that involves many legal and ethical considerations, and background checks are an important step in protecting all parties involved. The background check will look at criminal history and make sure there is no history of child abuse or neglect. Completing a background check is simple. The intended parents simply need to provide their full legal name, date of birth and social security number, as well as sign a consent form. With that information the agency can then have the background check completed by a reputable third party company. This process generally can be completed in a matter of a couple of days.
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Each clinic (and sometimes each doctor within a specific clinic) has their own criteria for gestational carriers. We start with our general selection criteria based on the American Society of Reproductive Medicine (between ages 21-42, good physical and mental health, previous successful pregnancy and delivery, healthy BMI of 20-32, non-smoker, no drugs, good support system), and then specifically we look at your clinics requirements. Your clinic may be more or less strict. This can include differences in items such as vaccine requirements, limits on age or BMI, stricter or unique medical history requirements, double embryo transfer policy/requirements (if this is requested by IP’s).
Our agency has close working relationships with many clinics and has a clear understanding of what the clinics expect in a surrogate candidate. This is important in ensuring clinic approval of your surrogate on first attempt, thus saving time and heartache with multiple matches.
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There are many things our team considers in the matching process before ever presenting a profile to either the intended parents or the gestational carrier. The first thing we consider is clinic criteria and who they are likely to approve to move forward according to medical records. Then we consider vaccination status, termination beliefs, number of embryos being transferred, location of the surrogate relative to intended parents, communication style, how much involvement each party wants, and so much more. This relationship lasts for at least a year, so it is best to be on a similar page! The items that we consider should be things you consider as well; think about your expectations for the journey and choose someone you feel is similar to what you are expecting. Typically, our agency presents gestational carrier profiles to the intended parents first. If they say yes, then we present the intended parents’ profile to the gestational carrier. If both say yes to being interested in each others’ profile then we schedule a match meeting. It is important to know that each person always has a chance to say yes or no to moving forward with the other party. We want the right match, not the match right now!
Match Meeting
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The match meeting is like a blind date, with a third wheel, as the meeting is facilitated by a Bright Futures Families team member. The meeting can be conducted in person or via video conference. We want everyone to get to know each other, confirm all parties have similar expectations and make certain it is a good match. It is meant to be a conversation, frequently in depth, about vaccination status, termination, location of the surrogate to intended parents, consideration of how much involvement each party wants, communication style, delivery room desires, pumping, and so much more. After this meeting each party has the choice to move forward or not. If everyone says yes, it’s a match!
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Escrow is initially used as a surrogate expense account while she is going through the clinic screening process before legal agreements are completed. Promptly after the legal contract is completed, escrow will be more fully funded to cover expenses reasonably anticipated through the surrogacy contract, generally $75,000 to $90,000.
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There are several pieces to the clinic screening and clearance process. First the potential gestational carrier’s medical records are sent to the intended parents’ clinic to be reviewed and approved by their doctors. This process can take anywhere from 1-6 weeks, depending on the clinic, before we hear whether your gestational carrier is approved to proceed. Once records are approved, depending on cycle timing and the clinics procedures, she will go in for in person medical testing by the clinic. This testing typically happens in one or two appointments, and usually is scheduled between days 6 and 12 of her cycle. The clinic testing can consist of a hysteroscopy or saline infused sonogram, blood draws for sexually transmitted diseases, thyroid, vitamins, plus other clinic specifics, and meeting with the doctor or the clinic psychologist. The appointments all combined can be several hours long and some clinics’ screening timing/window may vary. As part of the screening process the gestational carrier’s spouse/partner, or any sexually intimate partner, will also need to be tested. Depending on the clinic her spouse/partner may need to attend the same workup appointment too. Other clinics will send a lab slip home with the gestational carrier and allow the partner to be tested at a separate time, but this is a decision that varies between clinics. After all testing is complete, it usually takes approximately 10 to 14 days for all test results to come back to the clinic before full medical clearance can be granted. The clinic may also require additional items as part of their screening as well as retests. It is not unusual at this point in the process for the clinic to request that the gestational carrier complete a mammogram or take vitamin D supplements, vaccines, or thyroid medications.
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Once full medical clearance is granted, the intended parents will work with their lawyer and the gestational carrier (and her spouse/partner) will work with their own separate lawyer to establish the Gestational Carrier Agreement. We are happy to help recommend attorneys for this part of the process, but our agency does not require that either side use any specific attorney. The only requirement from us is that the attorneys must specialize in Assisted Reproductive Technology (ART) law and that at least one attorney practices in the state where the gestational carrier intends to give birth (in some states both attorneys must be licensed in the state, though). Typically, the intended parents choose their attorney first, who is typically the drafting attorney, and then the gestational carrier will choose her attorney as the reviewing attorney. Occasionally there are situations where the agency may suggest a legal agreement be put in place before full medical clearance is granted. If you fall under that situation, we will let you know!
*(The legal agreement must be in place before any invasive procedures are done or any cycle related medication, beyond birth control, is started.) The Gestational Carrier Agreement, in general terms, is meant to talk about what everyone’s responsibilities are, plans if any issues arise, and, of course, compensation. It’s typically a very long document and a process that we never want anyone to feel rushed through as it is very important.
Embryo Transfer Cycle
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Once legal is complete the IVF clinic will issue a calendar for the embryo transfer cycle. This calendar includes the gestational carrier medication protocol and appointments. Every clinic has a unique transfer medication calendar and protocol. In simplest terms, the IVF clinic is trying to prepare her body for embryo transfer. They are trying to limit the gestational carrier’s ovulation while building a lining in the uterus that will hopefully accept the embryo. Typically, the gestational carrier will start taking medications anywhere from 30 days to 2 weeks before the embryo transfer (on rare occasions this may begin more than 30 days in advance). As part of medication and transfer protocol, blood draws are done frequently to check the gestational carrier’s hormone levels, both before and after transfer, as are uterine lining checks via ultrasound. The number of blood draws and ultrasounds varies between clinics but typically between 1 and 3 checks are conducted between medication start and transfer and 3-6 appointments after transfer. And while not all clinics require shots, most do, and all will involve at least some medications.
We’re here - the reason for all the previous steps – Transfer Day! The gestational carrier will travel to the clinic, and they will transfer an embryo to her uterus. Post transfer rest guidelines vary widely from clinic to clinic. Feel free to ask your clinic what theirs are for the gestational carrier. We have seen as lenient as “take it easy the day of transfer” up to as strict as full bed rest for two full days post transfer and lift nothing over 10 pounds for 10 weeks following. Congratulations! On transfer day the gestational carrier is already considered 2 weeks and 5 days pregnant!
Once the embryo transfer is completed medications continue, according to clinic guidelines, typically for up to 12 weeks. Clinic restrictions may also continue. There will be at least 2 blood draws, testing HCG to confirm pregnancy (10-14 days after transfer and usually within 48 hours of each other) Additional blood draws are conducted to continually monitor hormone levels in the gestational carrier’s blood. If HCG is positive, the clinic will request 2 ultrasounds around 6 and 8 weeks along for fetal heartbeat confirmation. If your gestational carrier is not local to the IVF clinic, we can assist with finding a monitoring clinic closer to her home. The clinic will continue to monitor your gestational carrier and give a medication weaning schedule. Then, once the clinic gives you all the go ahead, the gestational carrier will be released to see her own OB/Midwife to be seen just like any other pregnant person.
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Once she is released to her OB, she will follow their guidelines to have a happy and healthy pregnancy. This is the point where it starts feeling more like a “typical” pregnancy now that she is under OB care and following the routine pregnancy appointments. It is not uncommon for your OB/midwife have the gestational carrier see an MFM (Maternal Fetal Medicine Specialist Doctor) because this is an IVF pregnancy, so please don’t be concerned if yours makes that request. As intended parents, you may want to be involved in appointments, especially any ultrasounds. There should always be a release on file that allows the intended parents to talk to the OB directly about the baby and its care. This is a team effort, and you should be included in all testing and other decisions throughout the pregnancy.
Bright Futures Families remains a supportive presence as you prepare for the birth. We ensure that you and your gestational carrier are prepared as you count down to welcome baby. This is a quieter stage and it is meant for the intended parent and gestational carrier relationship to grow, and you may experience less interaction with the agency (but we are always available and doing things in the background, such as making sure financial matters are handled!). -
Establishing parentage is what the pre or post birth orders are for. This process is usually started at 14-20 weeks gestation, depending on the state. Your legal team will file the appropriate documents with the court to establish your parental rights and have your names listed on the birth certificate from the start.
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Our case management team is excited to help in any way possible during and after the birth. We work with you, your gestational carrier, and the hospital to make sure that everything is in order before the birth by sending a letter with contact information of all parties that explains the situation. We also typically include a copy of the Pre Birth Order and insurance information that will be used for the baby. We tailor our services to each match and what is needed during this exciting time.
Post-Partum
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You are home snuggling your sweet baby! While that is the goal of this process, there are still pieces that need to happen after the birth. Psychological support for up to 2 months after the birth can be part of the post-partum process. Escrow wraps up paying fees, lost wages, the gestational carrier’s medical bills and breastmilk pumping fees, if any. We’re still here helping with that process so you can be doing what you should truly be doing during this time: Enjoying new parenthood! The escrow account closes approximately 6 months after the birth. While escrow closing ends our formal process with you as intended parents, we’re always happy to stay in touch as long as you would like (and we LOVE to get pictures!!)
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