What You Should Know About Surrogacy, According To Experts & People Who've Been There

When we hear the word “surrogate,” we tend to equate it with the rich and famous. Kim Kardashian, for example, used a surrogate to bring her third and forth children into the world. Because her first two pregnancies were less than easy, her doctors suggested she not conceive and try to carry a fetus to term again. For Kardashian, having a surrogate was the best way to do it.

But surrogacy isn't just for celebrities. Surrogacy can be a great option for people who struggle to conceive, for same-sex couples, or for anyone undergoing IVF. Granted, it's a very expensive and complicated process, but for those who want children and who can afford it, it's often a price worth paying. And if you're thinking about becoming a surrogate, there's a good chance that someone out there is willing to take you up on it.

Although there are a variety of reasons why someone would use a surrogate or become a surrogate, it’s definitely not something to enter into lightly — no matter what side of the surrogacy you’re on. “Becoming a surrogate is not for the faint of heart,” Heather Manojlovic, a person who has served as a surrogate, tells Bustle. “It’s a commitment not only for the surrogate, but for [their] entire family as well. There are injections, appointments, and a whole new world to experience once you decide to embark on this life-changing journey to help another family.”

In other words, being a surrogate is a lot more involved than donating your eggs, which is another process that allows people to offer the gift of life to couples who can't conceive with eggs of their own. Because of this, surrogates may be compensated quite a bit — but that's not all that goes into the process.

“Surrogates don’t just do it for the compensation,” Julia Alkire, the CEO of Family Creations, an egg donor and surrogate agency, tells Bustle. “While that is one of the reasons, most of the surrogates I have interviewed over the years have another driving force. Infertility affects one in six couples trying to conceive, and many of our surrogates have a loved one who struggled with infertility… this becomes a motivator for wanting to help. Another motivation is time. Surrogacy offers a compensation package that can range anywhere between $30,000-$75,000+, which allows parents to earn money while being able to stay home with their small children.”

Why might this be a decent option for people who have small children? Because one of the requirements of becoming a surrogate is already having had a child, to prove you can carry a fetus to term and because the hormones can possibly prevent a surrogate's ability to conceive later on. But it doesn’t stop there.

“When doing your research, you should see that there are basic requirements that need to be met before being considered by an agency or clinic,” Emily Westerfield, director of surrogacy engagement and matching at Gift of Life Surrogacy, tells Bustle. “You need to be at least 21 years of age, have had at least one child of your own with an uncomplicated pregnancy and delivery, not currently be taking any medication for mental health issues, not on any state or government assistance of any kind, be able to travel as needed for appointments, screening, transfer and monitoring, and have a solid support system.”

And that’s all before you sign up for being pregnant for nine months. With pregnancy comes its own set of requirements, limitations, and risks. But before conception is even achieved, there’s a whole other process leading up to it.

The Process

When someone decides they want to be a surrogate, they then need to decide which type of surrogate they will be. There isn't just one type of surrogacy.

“There are also two types of journeys one can take when choosing to become a surrogate,” Westerfield says. “You can do things independently, or work with an agency. If you choose to take an independent journey, you must locate the intended parents and match on your own, facilitate all of your own screening and medical appointments, hire your own attorney and understand all of the steps involved and complete them in the proper order at the proper time throughout the journey. Also, you’re in charge of coordinating the invoicing/payments throughout the journey.”

In other words, if you’re not a master at negotiation and would prefer someone else take charge of organizing all the details, financial and otherwise, working with agents who takes care of all the technicalities can be a real relief. When you choose an agency, you’re working with an experienced group of people who have been down the road many, many times.

“Your to-dos are being taken care of, so you can be the best as possible for your upcoming exciting experience,” Westerfield says, adding that it’s important to do your research when it comes to agencies. Not all are in it for the right reasons. From agencies trying to make a quick buck to crooked attorneys who prey on people who want be surrogates and families who want a child, you don’t want to be scammed because you chose the first agency that popped up in Google.

As Manojlovic explains, the intricacies of the surrogacy process definitely warrant having someone on your side. Not just to advocate for you, but to make the whole process as smooth as possible, so you can relax and focus on your task at hand: carrying a healthy fetus to term.

Once you’ve decided how you’re going to be a surrogate, the next step is deciding which surrogate you’re going to be: gestational or traditional? “A gestational carrier/gestational surrogate is a woman who agrees to have a couple’s fertilized embryos implanted in her uterus and carries the pregnancy for the intended parent,” Dr. Janelle Luk, a reproductive endocrinologist and medical director and founder of Generation Next Fertility, tells Bustle. “The gestational carrier does not provide the oocyte and is not biologically related to the child. The egg and sperm are derived from the ‘intended parents’ or possibly the egg or sperm donor through the process of in vitro fertilization (IVF). The egg is fertilized in the lab and then the embryo or embryos is transferred into the uterus of the gestational carrier.”

A traditional surrogate, on the other hand, is when the potential surrogate donates their egg and carries the fetus to term. In this scenario, the surrogate is biologically related to the child. But due to the legal ramifications and controversies (it's even prohibited in some places), Dr. Luk says that traditional surrogacy is less common.

Then, the body needs to be prepared for the pregnancy. “There is an extensive medication schedule that must be followed,” Westerfield says. “From birth control, to antibiotics, to steroids, to hormones — a surrogate’s body goes through a lot to prepare for a pregnancy. Medications come in the form of pills, patches, inserts, and injections. Some of these medications last from 12-14 weeks (outside of your prenatal vitamin, which is taken throughout the entire pregnancy). Carriers should understand that for at least 12 weeks, they’ll need an injection in their upper buttocks of a thick oil.” This "thick" oil is necessary to make the hormone progesterone injectable. The most common oils used to do this are ethyl oleate, olive oil, sesame oil, or peanut or cottonseed oils, as Growing Generations, a full-service surrogacy and egg donation agency, explains on their website.

As to how people with uteruses will respond to these injections, it varies. According to Westerfield, some people feel nothing, while others report feeling more emotional, or having night sweats or cold spells. But whether or not the surrogate experiences any side effects from the injection, it’s important that every carrier fully understands the amount of medication they'll be taking, as well as the time it entails.

“In an ideal world, everything would always go according to plan [in] life,” Manojlovic says. “The same can be said for a surrogacy journey. While there are many rainbow journeys without hiccups there are instances in a journey where things don’t always go as planned. Sometimes hormones may not be where they need to be and a transfer date can get moved. Other times a miscommunication can happen and feelings can end up hurt. Being flexible helps work through emotional upsets when things don’t always go as planned. Surrogacy isn’t always a linear process and acknowledging that a surrogacy journey is just that, a process, helps to keep things in perspective. As the old saying goes: adjust the sails, don’t change the destination. Being flexible can help with it all.”

Possible Side Effects

Not only are people with uteruses required to have had at least one successful pregnancy before (as proof that they’re able to have a successful pregnancy), but because of the possible impact the hormones can have on the body, there’s a chance that their own ability to conceive naturally could be affected. This side effect, in particular, can have further reaching impacts than just being a little extra emotional or having night sweats.

“While your generous heart is amazing for wanting to help others, you should also ensure before embarking on a surrogacy journey that your own family is complete, and you and your partner have discussed the possibilities of having or not having any more children,” Westerfield says. “Because of the hormone regimens surrogates are required to complete, it increases the chances of carriers having issues with their own fertility after a journey has been complete.”

The reason for this is because the science involved in the surrogate process literally “tricks” the body into thinking it’s already pregnant. With that trickery comes a rise in hormone levels, which is essential for the transfer of an embryo.

“While it is not impossible to conceive after surrogacy, there are so many cases of women who have had to turn to IVF themselves or even use a surrogate after being a surrogate themselves, so it’s vital you complete your own family first prior to wanting to help others," Westerfield says.

The Intended Parents

Unlike with egg donation, there is rarely anonymity involved in being a surrogate. While some intended parents prefer to treat it as a “business transaction,” according to Westerfield, some intended parents really want to be involved in the entire experience, getting to know the person carrying their fetus very intimately.

“Carriers and intended parents all go through an intake phase to understand the type of journey they’d hope for and the relationship with the intended parents,” Westerfield says. “Most intended parents and carriers want a close relationship, want to get updates about the pregnancy, and be a part of all the appointments and milestones throughout. Thinking about the before, during, and after of the journey is important for all parties to determine the best match for their surrogacy.”

Compensation and Legalities

Although being a surrogate can involve a pretty hefty financial compensation, depending on where you live, that’s not always a guarantee. In New York, Michigan, Nebraska, and Louisiana, it’s illegal to compensate anyone for being a surrogate. Laws also vary depending on what “type” of couple the intended parents are, meaning are they same-sex, single, different sex, married, or unmarried couples. These technicalities mean that working with an agency maybe be easier and les stressful than going about the process solo.

What To Expect

It’s important to remember just how huge it is to carry a fetus for another person. It’s also important to understand that there’s a potential to get attached to the infant once born, and the potential that the fetus may not make it to term. These two factors make having a support network absolutely paramount before you even consider becoming a surrogate.

“Support is a huge factor throughout a surrogacy journey,” Westerfield says. “Your number one support person should be your spouse/partner if applicable. Otherwise, family, friends, co-workers, or a support group is essential. Carriers should fully understand the process and make sure things are being done at the right time throughout the process. Feeling supported and encouraged throughout anything in life is important, but something as dedicated as this, it’s imperative.”

It’s also something that’s life-changing. You carry a fetus for nine months; you become part of another couple’s family and you’re forever linked, even if you decide to go your separate ways after the birth.

“I went into my surrogacy journey uncertain of what would come of it,” Manojlovic says. “I came out of my first and second journey with my life and family dynamic forever altered. Not only was I able to have an experience my family benefitted from, we helped another family that wouldn’t be complete without our help and with that, they became an extension of our family.”

Ultimately, being a surrogate isn’t for everybody. It’s a very complicated process that requires time, effort, mental stability, and the ability to let go. While the financial end of things can seem tempting, because it is such a major undertaking, it’s not something that should be treated lightly. Instead, it’s something you need to think long and hard about before showing up at a surrogate agency.