Getting pregnant isn’t always easy. About one in eight American couples suffer from infertility, or the inability to conceive despite having regular unprotected intercourse. Several methods exist to overcome fertility issues, ranging from medications to intrauterine insemination (IUI) and in vitro fertilization (IVF). But there’s another, lesser-known option for those struggling to have a baby: hiring a surrogate.

What is Surrogacy?

With surrogacy, one woman – called a gestational carrier or gestational surrogate – carries and delivers a baby for someone else. She undergoes IVF to become inseminated with the father’s sperm and mother’s egg (or the egg of a donor). After delivery, the surrogate gives the baby to his intended parents, who act as legal guardians.

Surrogacy has become a household term, since celebrities like Kim Kardashian and Neil Patrick Harris had children through a gestational carrier. Even so, “its makes up a very small percentage of the overall number of IVF cycles” done each year, says Timothy Hickman, M.D., the medical director of CCRM Houston and director of the Division of Reproductive Endocrinology and Infertility at Houston Methodist Hospital. He elaborates that 208,000 IVF cycles were performed in 2015, and only 5,452 involved surrogacy.

Types of Surrogacy

According to Dr. Hickman, there are two types of surrogacy: traditional and gestational.

Traditional Surrogacy: “In traditional surrogacy, the surrogate uses her own egg,” says Dr. Hickman. In other words, the surrogate is the biological mother of the child. Traditional surrogacy comes with a host of legal and emotional issues, so it’s illegal in some states. Dr. Hickman adds that most IVF clinic refuse to perform traditional surrogacy.

Gestational Surrogacy: In gestational surrogacy, the egg is extracted from the intended mother of the child, then inserted into the surrogate’s uterus. The baby is biologically related to both intended parents, and the surrogate simply acts as an “oven.” The egg can also come from a donor.

Why Choose Surrogacy?

Couples may decide to hire a surrogate for several reasons, including:

  • The woman doesn’t have a uterus, or her uterus is damaged.
  • The embryos won’t plant, despite several attempts at IVF – although Dr. Hickman says this has a low probability of occurring.
  • A medical condition, such as heart disease, makes pregnancy unsafe for the mother.
  • The couple is homosexual, making it physically impossible for them to conceive a child.

The Surrogacy Process

Surrogacy relies on a fertility treatment known as in vitro fertilization (IVF). Eggs are extracted from the ovary of the intended mother (or egg donor) using a needle, a suction device, and ultrasound imaging. These eggs are inseminated with the father’s sperm in a Petri dish. After three to seven days, the fertilized egg (embryo) is inserted into the gestational surrogate’s uterus with a catheter; the surrogate prepares by taking injectable fertility medicine for about 10 days prior to the procedure. Implantation should take place one or two weeks later.

IVF success rates vary by egg quantity and quality, among other factors. But a 2015 study by the Society for Assisted Reproductive Technology (SART) predicts that IVF is about 50.2% successful when using fresh donor eggs, and 38.3% successful when using frozen donor egg

Finding a Surrogate Mother

In an ideal world, a friend or relative will offer to be a surrogate; this saves money and makes the experience more personal. As it happens, however, Dr. Hickman says most couples hire a surrogate through a gestational carrier agency. These surrogates go through medical and psychological examinations, and they’re also paid for their services – usually around $30,000 – $50,000.

While surrogates don’t need to meet legal criteria, the American Society for Reproductive Medicine gives some recommendations. The surrogate should:

  • Be healthy
  • Be between the ages of 21 to 45
  • Have experienced at least one successful full-term pregnancy (and all of her subsequent pregnancies were also successful)
  • Have had two or fewer C-sections, and five or fewer vaginal births
  • Live in a stable and supportive home environment

The intended parents also need psychological and medical evaluations before hiring a surrogate. Blood tests and physical exams check for diseases that can be passed onto the carrier.

Gestational Surrogacy Cost

Surrogacy costs vary by region and circumstance, but Dr. Hickman estimates the price as between $70,000 and $150,000 for an entire cycle. This includes:

  • IVF: about $12,000
  • IVF-related medications: $3,000-$5,000
  • Egg donation, if necessary: usually $5,000 – $10,000
  • Payment to surrogate: usually $30,000 – $50,000, but can be higher for twins and triplets
  • Legal costs: varies depending on state
  • Agency fees, including background checks, matching, screening, and support
  • Healthcare for gestational carrier, if her insurance doesn’t cover everything

By Nicole Harris