Things to consider when thinking about Surrogacy

There is a lot to work out when embarking on your surrogacy journey – including which country, whether to use an agency and what level of service to opt for. Your decision will be influenced by your budget, your risk appetite, who you know and the advice you’re given.

Countries such as France, Germany, Italy, Spain, Portugal and Bulgaria prohibit all forms of surrogacy.

In countries including the UK, Ireland, Denmark and Belgium, surrogacy is allowed where the surrogate mother is not paid, or only paid for reasonable expenses. Paying the mother a fee (known as commercial surrogacy) is prohibited (in theory – see below).

Commercial surrogacy is legal in some US states, and countries including India, Russia and Ukraine.

People who want to be parents may go abroad if their home country does not allow surrogacy, or if they cannot find a surrogate. However, even in this situation, the laws may vary. For example, some Australian states have criminalised going to another country for commercial surrogacy, while others permit it.

1.    How it works in the UK

It is illegal for an organisation to profit from matching a surrogate with intended parents.

Intended parents cannot advertise to help find a surrogate.

The surrogate is deemed to be the legal mother and her spouse as the second legal parent before the parental order is made. Where she is single the biological father will usually be the child’s legal father.

There is therefore a shortage of surrogates – you will need to be patient.

The options for finding a surrogate are:

1. A non-profit surrogacy organisation or agency – the main four in the UK are Brilliant Beginnings, COTS, Surrogacy UK and www.mysurrogacyjourney.com
2. A friend or family member
3. An independent surrogate found via social media or the internet. NGA Law: “There are many websites and closed Facebook groups where intended parents and UK surrogates find each other. Independent surrogacy arrangements can be successful but there is much less screening and support than if you work with an organisation. We would always advise that you get to know your surrogate before moving forward, follow all the same steps you would follow if working with an organisation and seek legal advice before progressing your plans.”
4. International surrogacy.

Whilst surrogacy agreements are not enforceable, they are a great way of talking through the potential pitfalls and making all arrangements, including financial compensation, very clear.

The surrogate and her spouse (if relevant) will be named on the original birth certificate. When the child is 18, they have access to this.

The costs you can expect are as follows:

Paying your surrogate – It is not illegal for a surrogate to receive more than expenses. Most surrogates typically receive £12,000 to £20,000 as expenses, though some are paid as little as £500 and 10% of surrogates are paid more than £20,000. As part of the parental order process, the family court is supposed to check that no more than ‘reasonable expenses’ have been paid; though no parental order has ever been refused because too much was paid.

Agency or organisation fees – UK surrogacy organisations are all non-profit and the fees reflect the costs of the service. Expect costs of £4,000 if you are working with a surrogate who is friend or family member or £15,300 for a full agency service. The community support organisations charge lower membership fees for access to their community and peer support. You do not have to work with an organisation and matching independently (for example on Facebook) will save organisation fees, but it is very important to take care and not to cut any corners in your preparation.

Legal fees – Most fertility clinics require intended parents (and in some cases surrogates) to have legal advice before proceeding with surrogacy. The costs will vary depending on the lawyer you choose, the surrogacy organisation you are working with and the level of service you require.  At a minimum, and if you represent yourselves in the parental order application, you can expect to pay around £1,200 which includes the costs to update your wills and the court fee. However, if you opt for a full service from a prestigious legal firm – including helping you plan for surrogacy in the UK or overseas, the parental order application, applying for UK passports and British nationality if your child is born through surrogacy overseas, specialist wills, legal advice on fertility treatment and moving embryos, legal help with any surrogacy disputes that arise – you can expect costs to be in the region of £20,000.

Fertility treatments costs – There is very little NHS funding for fertility treatment involving surrogacy, so most IVF treatment for gestational surrogacy is funded privately. The costs will depend on how many cycles of treatment you need, the fee scale of the clinic you use and whether you are conceiving with an egg donor or your own eggs/embryos. You can expect to pay £5,000 to £10,000 per treatment cycle, and it is always sensible to budget for 2-3 cycles (although you may need more or less). If you conceive with a traditional surrogate, you may not need to pay for fertility treatment.

International surrogacy - costs vary considerably from country to country, with a range of £40,000 to £220,000 depending on where you go.

2.     How it works in the US

There are 5 ways to find your surrogate:

1. Surrogacy agencies and matching professionals – They take care of most of the process including:
   • -  Sourcing and screening surrogates (medical, legal, psychological clearance)
   • -  Managing the surrogate’s fertility treatments, prenatal care and oversight during the pregnancy
   • -  Managing the matching process
   • -  Acting as liaison with the clinic, donor agency, lawyers, and other service providers
   • -  Managing the surrogate’s compensation, as well as the escrow account and journey finances
   • -  Educating the Intended Parents, and keeping them informed throughout the journey
2. Surrogacy Clinics – They usually cover screening and matching, but involvement usually ceases after the medical process is complete.
3. Surrogacy Attorney – They usually work in conjunction with other organizations or support an independent arrangement.
4. A friend or family member.
5. Online support groups and classifieds – Finding a surrogate online is one of the most popular methods.

Fees vary depending on the service, the location and how much you pay your surrogate. Full agency fees usually amount to between $110,000 and $170,000, payable over the period of the pregnancy.  

Paying your surrogate – most surrogates get paid between $35,000 and $55,000. The full surrogate compensation is paid up-front into an escrow account. Payments take the form of a monthly salary over the pregnancy, various benefits, compensation for costs and fees e.g., invasive procedure fee. Experienced surrogates with a successful journey can add another $10,000. Some geographic areas are more expensive.

Agency or organisation fees including legal fees – These vary between $30,000 to $50,000 plus around $10,000 in legal fees.

Fertility treatment costs amount to $25,000 - $35,000.

Medical costs – prenatal care and delivery related expenses around $10,000 to $20,000. Though according to www.sensiblesurrogacy.com “Babies conceived via IVF have a higher likelihood of premature birth (about 1 in 10 will arrive early) and dramatically higher for twins’ pregnancies. Premature birth has the greatest effect on medical costs. Average healthcare for premature/low birth weight infants is nearly 11 times more costly than that for newborns without complications”.

3.     What to think about when choosing a surrogacy agency?

Nancy Block, @privatelabelsurrogacy: “You want to investigate their experience and medical knowledge. Ensure they cover all the services you require e.g., liaising with attorneys, escrow arrangements, sorting a fertility clinic with satisfactory recent live birth rate etc. Choose an agency that is responsive – it’s really important they keep in regular contact and are open and transparent. Look at their testimonials and customer feedback.”

Sali: “I would strongly recommend using an escrow arrangement for all surrogacy payments even if one isn’t a requirement in your case. I found ours made such a difference, freeing our relationship with our wonderful surrogate from all awkward financial conversations about money.”

4.    Should I be considering Epigenetics?

Your behaviors and environment can actually cause changes that affect the way your genes work – the study of this is Epigenetics. A cell’s DNA is made up of genes. Epigenetic information gets laid down on our chromatin during our embryonic development. As the cells begin to divide and receive signals and information from surrounding cells the Epigenetic marks begin to accumulate and then the genes begin to get turned on or off.

In the world of assisted reproduction this timing of the Epigenetic effects is of real interest – both to families that used a surrogate (how much influence does the surrogate have) and to mothers that carry a baby conceived by donor egg (how much impact does the ‘actual carrying’ have?).

Epigenetic marks can be influenced by the environment – not just from the surrounding cells, but the food the carrying person eats, the vitamins she takes or the stresses she encounters can all be transmitted as chemical signals though her bloodstream to her developing fetus where they can get laid down as Epigenetic marks that affect the fetus’ own genes and long-term health.

We know our surrogate shouldn’t smoke or drink alcohol, we want her to eat the right foods and exercise, we might even encourage her to play classical music; but should we be asking her to do anything else to ensure the best outcome for our baby?

The study of Epigenetics, especially as pertains to assisted reproduction, is still in its infancy. If you want to know more about this, talk to your physician.

5.    Communicating with your surrogate

Nancy: “Parents and surrogates work out the best frequency and method for them. Texting or WhatsApp work well particularly in international situations with time zone differences. Facetime is common – especially during appointments (with the doctor’s permission) or straight afterwards. One of our requirements is our surrogates already have children, and some work – so bear this in mind.”

Sali: “We connected all the time. It is such a bizarre relationship; you feel so much love and gratitude to this person that in many ways is a virtual stranger. Yet you both know some incredibly intimate things about each other. And sharing the birth is such a monumental event in both of your lives.”