The road to surrogacy

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  • November 2, 2016
The road to surrogacy

*Photo courtesy of Maya Ellsworth, a 14 year old aspiring artist from Hawaii. For more information about Maya’s artwork email

When I was 12 years old my mother’s best friend (and my favorite person to babysit for) became pregnant. At the time, she was a single mother and I was curious how this happened. This was the first time I heard the word “surrogate”. She was already a loving mother of two and wanted to gift a couple she didn’t know but was “matched” with the opportunity to become parents. Her words took years to sink in and for me to realize how truly remarkable Carolyn was.

When future gestational carrier, Carrie, was 12 she read an article in People magazine about surrogacy. She told her mom, right then and there she would one day carry for another couple. She never forgot that conversation and nearly 24 years later she took the necessary steps to make her statement true.

Carrie, now a mother of two, brought the subject up to her husband. It took very little time to convince him this was her lifelong dream.

The road to surrogacy

Finding an Agency

How do you find an agency?

  • Look for an agency with a maximum number of pregnancies you can have. Reputable agencies phase out surrogates after 6-7 pregnancies. This includes gestational carrier (GC) pregnancies and traditional surrogate’s own children. For more information check out surrogacy advisor.

What to Know

  • The GC is required to undergo rigorous mental and physical testing, interviews with social workers and a review of family history.
  • Strong support system and strong mindset necessary.
  • Partners are interviewed.
  • Background checks are conducted
  • Intended parent’s undergo similar tests
  • Gestational carriers have the option of approaching as a business relationship or more of an open adoption type relationship.

The Terminology

It is important to know the correct terminology during your surrogacy process.

  • Surrogates are “gestational carrier’s” or “GCs”
  • Parents are “intended parent’s” or “IPs”

The Process

The interview with a social worker creates a profile about the surrogate. Next, the intended parents select a gestational carrier.

  • The process is sort of like a dating website. Questions, answers, interviews, matching.
  • Parents review profiles, including pictures of prospective GC’s, and make their selection.
  • GC’s review profiles of the IP’s who selected them.
  • The gestational carrier selects the intended parents.
  • If the gestational carrier agrees with the parent profile match then the prospective parents meet over skype. They then proceed to next steps.

Surrogacy is in essence the same process as In vitro fertilization. IVF treatments include medications and ovulation manipulation. Drugs like lupron suppress the ovaries, whereas estrogen builds up uterine lining and progesterone injections “hold” the pregnancy. Some surrogates opt for a “natural” cycle (temperature, cervical mucus). For more information see citing below1

Carrie matched with a same-sex couple last year and after the third transfer she became pregnant! She delivered a healthy baby boy in 2014.

Initially the IPs didn’t want to be in the room during sonogram, the birth or cord cutting. But then one parent changed their mind. Both attended several ultrasounds, and were in the hospital for the birth (although didn’t quite make it in the room the whole time).

As IPs you want to feel happy and connected right away but there is a fear, similar to standard adoption, something will go wrong, something will fall through. The process is almost unreal until the child is in your arms. You are so busy filling out forms, and looking at profiles.  If you are supplying the sperm or egg you undergo medical procedures and medication, traveling (we’ll review that part further down) and anticipation.

It is understandable and normal to have a delay in happiness. The extra steps you have to take to become, what seems effortless for everyone around you, a parent. There can be disappointment, apprehension, and overall fear along the way.

The pregnancy process is viewed as sort of a business relationship, but after birth there is a little more of a connection. The gestational carrier typically has no biological relationship to the child, and has the ability to detach herself. She may form a friendship with the parents in the future. They may exchange emails, receive periodic photos, or not. This is entirely up to the IPs and GCs. No one surrogacy relationship is the same.

Loss and Surrogacy

As with any pregnancy, notably A.R.T. (assisted reproductive technology), there is a risk of miscarriage and loss. The dynamics of being a gestational carrier are an interesting dichotomy. Since typically there is no physical tie to the child, a pregnancy loss is almost more scientific to the GCs whereas it is an emotional roller coaster to the parents. Depending on how many viable embryos are available, emotions can increase significantly.

Carrie describes her chemical pregnancy as “a bit of an out of body experience”. Many surrogates feel if the child is not their child then the loss is not their loss.

Postpartum and Surrogacy

As part of the screening process, agencies go over the surrogate’s postpartum history.  Did you suffer with ‘baby blues”? For how long?  Was postpartum depression diagnosed, which needed medication for treatment? Medication would not necessarily disqualify a surrogate, most agencies will take into account any extenuating circumstances.  Part of the support a surrogate receives from the agency is a  social worker, who is available to the surrogate after delivery, specifically to help with postpartum issues.  For more information on mood disorders associated with pregnancy and postpartum visit: Postpartum Support International (PSI).

The Laws and Surrogacy

There are surrogacy agencies scattered throughout the world. India’s controversial surrogacy policy is under scrutiny.  Baby brokers exploit poverty stricken women, promising them large (to them) sums of cash and room and board. There are literally hundreds of Indian women housed together, being pumped full of drugs and embryos, and used as gestational carriers for wealthy people all over the globe. There should always be a limit to how many embryos are implanted. An investigative report on HBO (Outsourcing embryos) shows black market babies in essence being sold (human trafficking) with unsuspecting IPs & GCs unknowingly participating in the process.

It is important you research agencies and gestational carriers, and view them as the people they are. They are selfless people wanting to make your dreams of parenthood come true. Yes, there is a monetary exchange, as any service would charge you a fee.

In 1991 Germany passed a law “in protection of embryos” and the implantation of an embryo, not biologically related to the carrier, is a crime. In 2014, a same-sex German couple selected a California woman as a gestational carrier and took the case all the way to the Federal Supreme Court in Germany. Both petitioned to be listed as the child’s legal parents/guardians as the GC was not recognized as legal or fit to parent. Intended parents still have no legal rights but this case may change the future of surrogacy rights in Germany.

Many GCs and IPs are matched out of town or out of state.  Each country and each state has their own laws. The agencies figure out what state or country where you can legally participate. The carrier has the option of single cell transfer or, if they want to, carry multiples.  Since you are often matched out of state or country, it is important to factor in travel expense as well. Surrogacy rates, medical costs, travel and procedures make this an expensive journey.

Carrie is now working with her second, and final family overseas. The intended parents and gestational carrier both decided, this time around, they would like more of a friendship out of the process. She noted this is such a good pairing, if they lived closer, she envisions they would be best friends. It is a very big deal to become a surrogate, just as it is a big deal to dream of being an intended parent. To transition the two roles – to drop the carrier and add “friend” and to drop the “intended” and just be “parent”. Forever grateful to one another for the gift of life and parenthood and the gift of giving life and parenthood.


Jake McKenna IbarraJennifer “Jake” McKenna Ibarra is a mother, writer and 4th generation San Francisco native. She studied early childhood education at S.F.C.C. and is a certified SBD doula, focusing in postpartum, certified in perinatal mood and anxiety disorders through Postpartum Support international and is also a P.S.I. member. In her spare time you might find her walking around San Francisco.  




  • Just because there isn’t a biological connection between the GC and the child, doesn’t mean the separation experienced at birth is easy. This was perhaps the case for Carolyn…but to make that generalization for all women who serve as surrogates seems dismissive.

    • doulaspot says:

      Thank you for raising that point but Carolyn was the focus of this article. Every surrogate may have a different experience and we acknowledge this and we honor the special gift surrogacy provides for families.

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