Working with a surrogate to help start a family has long been a complicated process. With the costs, the legalities and all the waiting. But the pandemic has made things even more difficult, as it tends to do. Enter: the shortage of substitutes, whose outlets, including The New York Times and Fortune have reported.
We called Dr. Natalie Crawford and Dr Lucky Sekhon, certified fertility doctors and OB-GYNs, to help Skimm why it’s so hard to find a surrogate right now. (They also spoke to us for an episode of Skimm This.)
Remind me: what is surrogacy?
It is when someone bears (gestates) a baby for someone else. But people tend to say “surrogate” when they usually mean “gestational carrier,” Crawford explained. A gestational carrier is a person who becomes pregnant with another person’s embryo through IVF. (The egg used for the embryo would come from either the parent or a donor. But not from the person carrying the baby.) Gestational surrogacy is illegal in some countries. And while Arizona outright prohibits surrogacy, there are other states that declare surrogacy contracts void and unenforceable. Thing to know: New York was one of those states until last year.
“Traditional surrogacy,” on the other hand, is when the carrier’s egg is used. These are less common in part because there are even more legal hurdles to overcome.
Why do people work with a surrogate?
There are many reasons. But one of the most common, Dr. Crawford said, is failure or inability to get pregnant. Maybe because they’ve experienced infertility, had recurrent pregnancy losses, or can’t safely carry a baby to term (which was the case with Kim Kardashian). And there are other reasons too: like if you’re single, in an LGBTQ+ couple, or don’t have a uterus.
Having a baby via surrogate has become more common — there were nearly five times more surrogacy cycles in 2013 than in 1999, according to the latest CDC data. But he is still stigmatized by society. “There’s this automatic assumption that using a gestational carrier might be ‘an easy street,'” Dr. Sekhon said. “There are a lot of misconceptions [around]…the real medical reasons people go to a gestational carrier.
Why is there a shortage of substitutes?
Before the pandemic, it could take months to connect with a surrogate. Part of the reason: That person, according to the agency, would meet certain criteria “based on what we know about optimizing the health of pregnancy,” Dr. Sekhon said. Think: a non-smoker who has carried a pregnancy to term at least once before.
But these days, there seem to be even fewer qualified carriers. Ten agencies across the United States have seen about a 60% drop in potential surrogates, according to The New York Times. The main problem: carriers face more potential health risks and legal limitations due to the pandemic. For example: being pregnant puts a person at increased risk of becoming seriously ill or dying from COVID-19.
“Pregnancy is not a benign condition. There are risks that come with pregnancy,” Dr. Crawford said. “So I think the pandemic, as it has done for everyone, has shifted priorities a bit. And in those circumstances, that made that risk a little too risky.
Also: A potential surrogate might not want to accept a contract that requires getting vaccinated and limiting her exposure, which some expectant parents might demand due to the pandemic, doctors told us.
And then the potential substitutes have to take care of their own lives. They could be facing burnout (who isn’t?) as they manage their own jobs, household chores and families – the same factors that have led to the continued decline in the national birth rate during the pandemic.
Dr Sekhon said agencies tell intended parents to mentally prepare to wait six to 12 months – or more – before they can connect with a potential surrogate. And for people with very specific ideas about who they want their surrogate to be, Dr. Crawford says it can be “almost impossible” to find those people.
What else can make it difficult to connect with a surrogate?
We have to talk about cost. They vary by agency and specific needs. But just getting an embryo tested and ready to be transferred to a gestational carrier could cost around $25,000, Dr. Crawford said. And if you’re working with a surrogacy agency, she said the basic cost to hire a carrier could be between $30,000 and $70,000, depending on the carrier’s experience with surrogacy, location, and any additional costs that the intended parents agree to cover. Think about medical expenses, maternity clothes, travel, monthly allowances, etc.
And remember: there is no guarantee that an embryo transfer or a pregnancy will be successful. More pregnancy attempts will cost you dearly.
While working with an international gestational carrier may be less expensive, a number of US fertility clinics won’t because it’s “too risky and less regulated,” Dr. Crawford said. See: Surrogates and Newborns trapped in Ukrainewith biological parents unable to attend.
Aside from the costs, it can be difficult to find a surrogate mother who matches the requirements of the intended parents and passes all the medical examinations. Working with a surrogate takes “a lot of legwork,” Dr. Sekhon said. And it could mean more work for LGBTQ+ couples, who can face discrimination and complicated rules around insurance, adoption and custody.
If I am looking for a surrogate, what are my options?
Before doing anything else, see a fertility doctor as soon as possible. “If you have a medical complication and you’re going to need a carrier, make an appointment early to give yourself plenty of time,” Dr. Crawford said. You can discuss the IVF and embryo transfer process and learn more about recommended transport agencies. Dr. Crawford said that in his clinic, about 75% of people who opt for surrogacy end up using a carrier from an agency.
After that, she recommends being open about your situation with your loved ones. Because although people “often assume it would be too much” for a friend or relative to carry their baby, “often there is someone who might be ready.” See: Phoebe on ‘Friends’ serving as a gestational carrier for her brother’s triplets – but IRL. Working with someone you know could put a lot of stress on your relationship. But according to Dr. Crawford, it will likely be “easier and cheaper” than working with an agency. Still, Dr. Sekhon points out that there is hope in connecting with a surrogate through an agency.
“If you just arm yourself with information and support and talk to your fertility clinic… there’s enough agencies and advocacy around that,” she said. “When we want we can.”
Working with a surrogate – that is, a gestational carrier – is a complex and expensive process. And the pandemic has made it even more difficult. But it’s an option that a number of expectant parents choose because they want to have biological children and can’t carry a baby on their own.
Skimmed by Carly Mallenbaum, Anthony Rivas, Eleanor Goldberg and Sagine Corrielus