Surrogate mothers in different countries

There's still some controversy about using a surrogate mother to have a baby. The legal process is also tricky because it varies from state to state. Even so, whether it's because of fertility problems or other reasons, surrogacy is an option for you and your partner. Find out how it works and see if it's right for you.

What Is a Surrogate Mother?

There are two kinds:

Traditional surrogate. It's a woman who gets artificially inseminated with the father's sperm. She then carries the baby and delivers it for you and your partner to raise.

A traditional surrogate is the baby's biological mother. That's because it was her egg that was fertilized by the father's sperm. Donor sperm can also be used.

Gestational surrogates. A technique called "in vitro fertilization" (IVF) now makes it possible to gather eggs from the mother, fertilize them with sperm from the father, and place the embryo into the uterus of a gestational surrogate.

The surrogate then carries the baby until birth. She doesn't have any genetic ties to the child because it wasn't her egg that was used.

A gestational surrogate is called the "birth mother." The biological mother, though, is still the woman whose egg was fertilized.

In the U.S., gestational surrogacy is less complex legally. That's because both intended parents have genetic ties to the baby. As a result, gestational surrogacy has become more common than a traditional surrogate. About 750 babies are born each year using gestational surrogacy.

Who Uses Surrogates?

If you're a woman, you may consider a surrogate for several reasons:

• Medical problems with your uterus
• You had a hysterectomy that removed your uterus
• Conditions that make pregnancy impossible or risky for you, such as severe heart disease

You may want to think about surrogacy if you tried but couldn't get pregnant with a variety of assisted-reproduction techniques, such as IVF.

Surrogates have also made parenthood an option for people who might not be able to adopt a child, perhaps because of their age or marital status.

If gay men decide to use a traditional surrogate, one of them uses his sperm to fertilize the surrogate's egg through artificial insemination. The surrogate then carries the baby and gives birth.

A gay couple might also choose an egg donor, fertilize that donated egg, and then have the embryo implanted in a gestational surrogate to carry until birth.

There are several ways you can find a surrogate mother:

Friends or family. Sometimes you can ask a friend or relative to be a surrogate for you. It's somewhat controversial. But because of the high cost of surrogacy and the complex legal issues it raises about parental rights, a tried-and-tested family relationship can be simpler to manage.

The American Society for Reproductive Medicine accepts certain family ties as acceptable for surrogates. It generally discourages surrogacy, though, if the child would carry the same genes as a child born of incest between close relatives.

A surrogacy agency. Most people use one to arrange a gestational surrogate. There are about 100 agencies now operating in the U.S. They act as go-betweens.

An agency helps you find a surrogate and make arrangements. It also collects any fees that get passed between you and the surrogate, such as paying for her medical expenses.

How to Choose a Surrogate

Right now there aren't any regulations about who can be a surrogate mother. But experts agree on a few points about how to select one.

You should choose a surrogate who:

• Is at least 21 years old
• Has already given birth to at least one healthy baby so she understands firsthand the medical risks of pregnancy and childbirth and the emotional issues of bonding with a newborn
• Has passed a psychological screening by a mental health professional to uncover any issues with giving up the baby after birth
• Signs a contract about her role and responsibilities in the pregnancy, such as prenatal care and agreeing to give you the baby after birth

Using a Surrogate

The American Society for Reproductive Medicine says a surrogate should get a medical exam to check that she's likely to have a healthy, full-term pregnancy. The organization suggests she gets tests that check for infectious diseases such as syphilis, gonorrhea, chlamydia, HIV, cytomegalovirus, and hepatitis B and C.

Surrogates should get tests to make sure they have immunity to measles, rubella (German measles), and chickenpox. Also, you may want to ask that she get a medical procedure to visually "map" the uterus, which can help the doctor check her potential to carry a pregnancy. A surrogate mother should have her own doctor during pregnancy rather than use yours.

The cost of surrogacy can range from $80,000 to $120,000. A lot of different things go into the price, such as whether the surrogate has her own medical insurance or whether you need to buy a surrogacy-pregnancy policy for her.

Legal Issues With Surrogates

Parental rights aren't guaranteed after a surrogate pregnancy. The law continues to change as reproductive technology and the very definition of a "parent" changes.

There isn't a federal law on surrogacy and state laws vary. After a surrogate pregnancy in some states, you may still have to pass adoption proceedings to gain legal custody of the child. In other states, a "declaration of parentage" before birth lets you avoid having to "adopt" the baby.

To protect your rights as parents-to-be -- and the rights of the child you're hoping to have -- hire an attorney who specializes in reproductive law in your state. He can write a surrogacy contract that clearly spells out what everyone needs to do.

A contract like that may help if legal issues come up after birth. It can also outline agreements about a variety of possible scenarios with the pregnancy, such as what happens if there are twins or triplets.

What is a Surrogate Mother?

A surrogate mother is the hero of the surrogacy process. She will carry the baby on behalf of the Intended Parents, which itself is challenging. She will undergo a variety of invasive fertility procedures. Plus she must agree to strict personal and medical restrictions to ensure the success of the pregnancy and the health of the developing baby.

In This Article:

The Journey Starts Here

The surrogate mother is neither an employee nor a servant. A surrogate is more than just an incubator to carry a fetus. She is the primary caregiver to the Intended Parents’ nascent family. For nine months the surrogate will carry the pregnancy and take care of the developing baby. Starting with an array of medical and psychological evaluations, followed by weeks of fertility treatments, the surrogate mother’s role will take a full year to complete.
Whether your surrogate is from Kiev or California, Intended Parents should remember that the surrogate mother is an equal participant in their surrogacy journey. The Surrogacy Contract is a partnership agreement, with each person having obligations toward the other.
The surrogacy contract is a two-way agreement in which the surrogate mother agrees to care for the pregnancy, but also in which the Intended Parents agree to care for the surrogate. That means treating her ethically, respectfully, and with an appreciation for the service she is performing.
The surrogacy contract is a two-way agreement in which the surrogate agrees to care for the pregnancy, but also in which the Intended Parents agree to care for the surrogate.
Surrogate mothers in many overseas countries are pre-evaluated and readily available with no waiting period. In the United States, the process to recruit and evaluate a surrogate mother requires a six to eight week screening process (a service called “Surrogate Matching”).
Once the surrogate mother has passed her initial evaluation and been “matched” to an Intended Parent, it is often another 2 months before she is fully prepared for her embryo transfer (called “Surrogate Preparation”). While these two processes are underway, parents often work with the clinic to complete their own donations and IVF cycle.
The initial matching stage requires a series of blood tests and ultrasound scans, as well as a litany of personal evaluations (including criminal and psychological evaluations). The Preparation stage includes fertility boosting hormone injections to thicken the surrogate’s endometrium and make her more receptive to the intended parents’ transplanted embryo.
Surrogate mothers overseas are often not as thoroughly screened as in Western countries. Even in the United States some agencies perform far more rigorous evaluations of their surrogate candidates than others. The disparity in surrogate evaluation may be one reason for the differences in pregnancy rates between countries and between clinics within the same country. if you worry about the health of your surrogate, you may ask her agency to perform additional medical tests, although you likely will need to pay extra for this.
Although the depth of her initial evaluation and medical screening is often quite different, the preparation and fertility treatments for your surrogate mother are basically the same from country to country.

The Journey Starts Here

How much do Surrogate Mothers earn?

Surrogate mothers overseas are typically paid the same as their US counterparts, but differences in cost of living, costs of medical care, and legal expenses, make surrogacy costs much more affordable for Western couples.
A surrogate mother in the United States may earn about $40,000 USD for her 9-month effort. In comparison a new elementary teacher can expect to earn just $41,000 USD per year, according to PayScale.com. Dental technicians make $31,000 USD annually, and a sales associate makes $21,000 USD. (About the equivalent of a minimum wage paycheck, 24-hours a day, for the full term of a pregnancy! Surrogates also demand a lot of extras, including clothes, transportation, lost wages, household expenses, and more.
Plus many women experience great satisfaction from being pregnant. That makes being a surrogate mother a meaningful alternative to other forms of less-skilled or part-time work.

Calculating Surrogate Compensation

Surrogate compensation overseas is the equivalent of about $45,000 USD in the United States when adjusted for the local cost of living. According to the Consumer Prices Index, $10,000 USD is the equivalent of $25,000 in local currency in Kiev. So a surrogate earning only $10,000 overseas would receive pay similar to her US counterpart when adjusted for cost of living.
According the United States Consumer Prices Index (Including Rent)…

• Consumer Prices in Phnom Penh 50% lower than in Los Angeles
• Consumer Prices Including Rent in Kiev are 70% lower than those in Los Angeles
• Rent Prices in Kiev are just 20% of those in Los Angeles
• Restaurant Prices in Phnom Pehn are 70% less than in Los Angeles
• Groceries Prices in Kiev are 60% lower than in Los Angeles

Similar figures are available for all our overseas destinations, where cost of living is much lower than in the US.
In addition, a surrogate mother overseas receives a housing stipend, medical care, food, transportation expenses, and other benefits as part of her agreement. In a typical US program, surrogates would pay those costs either themselves, or they would be additional expenses charged to the Intended Parents. So in all, the surrogate may be better compensated than US surrogates.
Make the cost of living comparison yourself, and you can see that finding a surrogate mother overseas not only can make it affordable to start your family abroad, but also often provides an excellent opportunity for your surrogate.

What is the Ethical Treatment of a Surrogate Mother?

Surrogate Mothers provide a tangible service that requires significant effort. Their service adds clear value to our lives and society, and their work has a clear altruistic component as well. This is why Sensible Surrogacy (and our international partners) advocate ‘Ethical Surrogacy.’
Ethical Surrogacy is focused on the health of the surrogate mother and egg donor, who will be so vital to every Intended Parent’s new family. Advocates of Ethical Surrogacy take special effort to ensure the complete physical and emotional well being of these important women.
We insist that every surrogate mother and donor receive excellent compensation. For many surrogates the experience is life-altering. We offer financial benefits and opportunities that many of these women could never realize otherwise.
Ethical Surrogacy also provides the surrogate mother with the best medical care during and after her pregnancy through our associated IVF clinic. When necessary, surrogates and their children are housed in a dedicated apartment complex with an on-premise caretaker and a nearby doctor on call 24×7. Of course the surrogates’ privacy must be totally protected according to her own wishes.
By choosing Ethical Surrogacy, our partners have the satisfaction of knowing that they have made a choice not just to serve their Intended Parent clients, but also help their donors and the surrogates improve their own lives.
For more on Ethical Surrogacy and what it means, check out this interview with Sensible Surrogacy founder.

Ethical Guidelines for Surrogate Mothers

We’ve read the reports of unscrupulous profiteers who exploit surrogate mothers. Such practices are a threat to women and to our practice, which is why we are committed to the Ethical Treatment of our surrogates and donors.
Sensible Surrogacy (and our affiliated partners) are proud to take a leading role in establishing Ethical Surrogacy Guidelines to ensure the well-being of your surrogate mother and donors.
‘Ethical Surrogacy’ includes a set of guidelines that ensure that the welfare of the surrogate mother is given fundamental importance. Among the components of Ethical Surrogacy:

• Providing the surrogate mother with 24/7 medical care
• Providing clean and safe housing for the surrogate
• Continuing medical care and housing even after the delivery
• Providing emotional and psychological support
• Respecting the surrogates’ rights to privacy
• Offering the excellent compensation, including non-cash options.

Where agencies provide housing, they should provide private, clean and safe apartments. The apartment facility should have a 24/7 caregiver living on the premises, and offers assistance with cleaning and cooking. A doctor should be on call 24X7 in close proximity to the surrogate housing.
We believe in the philosophy that ‘money is not everything in life’. Parents often find that Ethical Surrogacy options give them the satisfaction of knowing that they are able to bring a positive change in the lives of their Egg Donor and their Surrogate Mother.

How to become a surrogate mother.

To become a surrogate mother women must meet strict medical, emotional, and personal criteria. Here is a short list of the minimum that every surrogate mother should meet.

Have at least one successful, natural pregnancy

The first requirement is the most obvious… all surrogate mother candidates must demonstrate they are fertile and capable of maintaining a healthy pregnancy by having their own successful pregnancy. In addition having gone through pregnancy gives an important understanding of what is involved and the physical and emotional toll that pregnancy may bring. Raising a child is also a sign of emotional stability and responsibility.

Be generally healthy and take good care of themselves

We all know that it’s important to eat healthy and exercise regularly, and even more so during a pregnancy. All surrogates must be able to demonstrate that they live a healthy lifestyle, including regular exercise and personal wellness habits. Surrogates must also live in a well-maintained home unless they will be offered housing by their agency.

Healthy body weight

Women who are overweight are at a greater risk of developing gestational diabetes, which can be a risk not only to the surrogate but also to the pregnancy. IVF clinics have become very strict regarding the body mass index (BMI) a surrogate mother must maintain, and may accept a possible surrogate only if she can modify her lifestyle to meet this criteria.

Be between 21-40 years old

Different clinics have different requirements regarding the age of a surrogate. In general surrogates need to be at least 21 years to have the emotional stability needed to be a surrogate. Meanwhile, while there are instances of women successfully serving as surrogates into their 50s, most clinics will only accept surrogate mothers up to the age of 35.

No drugs. Limited alcohol.

A woman must live a stable lifestyle to qualify to become a surrogate mother. This means no drugs of any kind, whether it is street or prescription pills without a doctor’s prescription. While an occasional drink is normal and acceptable, heavy or regular use of alcohol is also a reason for exclusion. The surrogate also must agree to regular drug screenings throughout the pregnancy.

Be a non-smoker

Smoking during pregnancy can cause a stillbirth, premature delivery, and low birth weight. It will also cut the oxygen off to the baby by narrowing blood vessels throughout your body, including the ones in the umbilical cord.

No criminal history.

All surrogate candidates go through an extensive criminal background check.

Have a stable relationship or support network

Being pregnant is often hard work, and most women will need some form of emotional or physical support during their pregnancy. A good surrogate should have either a husband/partner able to assist her throughout the pregnancy. If not a spouse, then an available network of family and friends can often provide the needed support.

Emotionally stable

Every surrogate mother candidate must pass a psychological review to ensure she is emotionally capable of fulfilling the requirements of being a surrogate. Surrogates must be able to schedule appointments, remember to attend them and follow doctor’s orders. They have to also be able to read and understand the legal Surrogacy Contract with the help of an independent lawyer. Most importantly, a surrogate mother must be able to care for the growing baby responsibly throughout the pregnancy, and then she must relinquish her parental rights when the baby is delivered.

Positive outlook on life

Intended Parents should look for a surrogate who is generally positive and optimistic. This type of attitude is important as she goes through the pregnancy (which can sometimes include physically and emotionally challenging days.). A good attitude will help her stay focused on the important work that she is doing, and the joy that she is bringing to a childless couple.

Be able to handle the logistics of the surrogacy process

This includes and ability to Take time away from your employer and family for surrogacy (appointments, bedrest, birth, post partum) It also means the surrogate must often we willing to travel to fertility clinics, lawyers, doctor’s/ultrasound appointments.

Didn’t find what you need? Search our for all the answers…

Who is a Surrogate Mother?

Daisy, one of our Surrogate Mothers at 36 weeks pregnant.
A surrogate mother is a woman who carries a child or children for another person. The surrogate mother may carry for an individual or a couple that they have met through the help of a third party surrogate agency, an online forum or a personal friend or family member. Many surrogate mothers are compensated for their personal time and sacrifice during the surrogate arrangement, this is referred to as compensated surrogacy. Here at SAI we provide guidance, support and assistance to our surrogate mothers, through a legally compensated surrogate arrangement.
There are two types of surrogate mothers; traditional and gestational. A traditional surrogate mother is biologically related to the child that she carries and a gestational surrogate mother is not. Due to medical advances, gestational surrogate arrangements are preferred and are more common today. For over a decade, SAI has proudly assisted intended parents, surrogate mothers and egg donors through gestational surrogate and egg donation arrangements.
In the late 1700’s, a Scottish-born surgeon named, John Hunter impregnated a woman during her natural ovulation cycle using her husband’s sperm; resulting in a successful pregnancy. This technique is now known as Artificial Insemination.
A traditional surrogate is a woman who agrees to become pregnant using her own ovum/eggs for another person through a medical procedure known as Artificial Insemination (AI or IUI). The sperm is provided by either the intended father or a sperm donor and is safely inserted into the traditional surrogate mother’s uterus during either her natural or medically enhanced ovulation cycle with the assistance of a physician. A traditional surrogate mother is biologically related to the child she carries and gives birth to.
In 1978, a hospital in Great Britain welcomed the birth of Louise Brown, the world’s first “test tube” baby born through a medical process known today as In-Vitro Fertilization (IVF).
A gestational surrogate is a woman who agrees to become pregnant for another person through a process called In-Vitro Fertilization. A gestational surrogate mother is not biologically related to the child. Embryos are created within a laboratory using the ovum/eggs of either the intended mother or an egg donor and the sperm of either the intended father or a sperm donor. The ovum/eggs are retrieved from the woman’s body through a medical procedure called an egg retrieval. The mature eggs are then fertilized with the sperm provider’s sperm, creating an embryo. Afterward the embryos are then safely transferred into the uterus of a gestational surrogate mother with the assistance of an IVF Physician.
In other countries and within the United States, many states do not recognize traditional or gestational surrogate arrangements and will recognize the surrogate mother as the legal parent until a full adoption is completed after the surrogate mother gives birth to the child. However, in the State of California, a woman who enters into a proper legally represented traditional or gestational surrogate mother arrangement and gives birth within the State of California, can relinquish her biological and legal rights to the child or children and appoint the intended parent or intended parents as the rightful and legal parents before the child or children are born. For this reason, California is often referred to as the most “surrogate friendly” State. Prior to the surrogate mother becoming pregnant a legal surrogate agreement between the intended parents and the surrogate mother will be signed, reflecting the surrogate mother’s intent to become pregnant for the intended parent or intended parents. During the surrogate pregnancy, a third party reproduction attorney will complete a legal process referred to as the “parental establishment process”. Once this process is completed, the intended parent will be provided a certified Pre-Birth Order (PBO) approved by the State of California which will allow them to be listed on the US birth certificate as the rightful and legal parent once the child or children are born; an adoption will not be necessary.
Although California recognizes both traditional and gestational surrogate mother arrangements, many intended parents prefer gestational surrogate arrangements to assist them in creating or enhancing their families. Gestational surrogate arrangements allow intended parents the opportunity to have a child that is biologically related to them and take full advantage of numerous IVF medical advances. Over the years, SAI has proudly seen these medical advances help people from all over the world who have struggled with infertility for many years or been led to choose third party reproduction assistance in order to achieve their dream of having a family.

How can our agency help you?

Surrogate Alternatives, Inc. (SAI) has been in business since 1998 and is proud to have assisted people from all over the world through third party surrogate mother and egg donation arrangements. Our agency has successfully helped create thousands of happy families over the years, resulting in the birth of more than 1,000 children through our surrogate mother program alone; and that number continues to grow each day as we continue to help others through their personal journeys. We can help you too! With our agency you can expect a reputable, reliable, knowledgeable, supportive and caring staff to guide you step-by-step throughout your entire journey. Many of our staff members, have personally been surrogate mothers themselves, which allows us to provide you with a more personable experience. Having been surrogate mothers ourselves, we are able to recognize the emotional and physical commitment necessary in potential surrogate mother candidates and provide you with quality surrogates to choose from. Once matched, you can expect our efficient staff to assist you throughout the screening and legal process. The time frame for each journey will vary depending on various factors such as availability of all parties involved, however a typical outline is shown below.

• Retain agency for surrogate match services (1-5 days to complete)
• Psychological and medical screening process (1-2 weeks from a confirmed match)
• Legal process (2-4 weeks from a completed psychological and medical screening)
• IVF stimulation medication start date (0-4 weeks from legal contract signing)
• First embryo transfer/pregnancy attempt (4-6 weeks from IVF medication start date)
• Pregnancy blood test results (10-14 days from embryo transfer date)
• Confirmation of pregnancy ultrasound (2-3 weeks from positive pregnancy blood test date)
• Average singleton pregnancy term (36-40 gestational weeks)
• Average twin pregnancy term (32-38 gestational weeks)
• Parental establishment legal process (begin process between 15-18 gestational weeks of pregnancy; completed prior to birth)
• Post-birth support and responsibility (12 weeks)
• Case finalization and escrow account closure (1 year post-birth)

A surrogate arrangement which successfully achieves a viable pregnancy with the first attempt typically will be completed within 1 year. However, should any unforeseen delays arise; intended parents can rest assured they are in good hands with our reputable and experienced agency.
When is the assistance of a Surrogate Mother needed?
An individual or a couple may choose a surrogate mother to assist them in building or expanding their family for various reasons such as:

• Diagnosed or unexplained infertility (see common terms below)
• Medical conditions preventing a woman from carrying a pregnancy without risking her own life
• Loss or absence of reproductive organ
• Hysterectomy (uterine loss)
• Antibodies
• Repeat miscarriages
• Failed own IVF and IUI cycles
• Age
• Sexual orientation
• Sterility
• Tubal Ligation or Vasectomy
• Blood disorders
• Heart conditions
• Genetics (choosing to avoid passing genetic traits/conditions to their child)
• Gender selection preferences
• Failed or denied adoption