Statistics from the Centers for Disease Control indicate there are approximately 8,000 cases of gestational surrogacy per year (2024) in the United States. These take place in most states with the exception of those few states that prohibit surrogacy or severely restrict the practice (Nebraska, Louisiana, Kentucky, Arizona, Michigan and Indiana). Surrogacy also takes place outside the United States for largely those who cannot afford the price of $150,000 plus dollars.
Those people seeking and using surrogacy include single males, single females, heterosexual couples and same sex couples. These people, termed Intended Parents (IPs) are not just from the United States. They essentially come from all countries of the world. Some notable exceptions are Greece, Georgia, and Ukraine where surrogacy is legally permitted for heterosexual couples with a medical need. To many having a baby being a USA citizen by birth is attractive to the IPs.
Several professional components need to converge and interact to complete a proper surrogacy journey (the term of art). These are: a surrogacy agency, a fertility clinic, two law firms, a psychologist, an insurance broker, trust fund entity, and maybe an egg bank, sperm bank, and cryogenic shipping company.
Genetic Material
Because gametes (sperm, eggs) can come from any source some people will use an egg bank, and/or a sperm bank to complete the needed set of genetic material needed to create an embryo. In rare cases some IPs might use embryos created by others. A cryogenic shipping company will then ship the frozen gametes or embryos to their chosen fertility clinic.
Psychologist
A psychologist should always be employed to screen the potential gestational carrier (GC: surrogate), egg donor, and at times the IPs themselves. When properly screening a GC a clinical evaluation and a battery test should be employed.
Licensed Insurance Broker/Agent
These professionals are called upon to review an existing medical insurance the GC might have. They rule whether the insurance policy will cover surrogacy. If it does not, they can help source medical insurance to cover the pregnancy. They also might sell life insurance to the IPs covering the GC and a second policy for the family of the GC (common practice).
Law Firms
Both the IPs and the GC will need legal counsel. This representation has to be separate parties. Their main role is the construction of the Gestational Surrogacy Agreement (GSA) on the IP side and a review of the GSA on the side of the GC. Certain states permit pre-birth orders where the parentage of the IPs is filed with the court prior to the baby’s birth. Counsel of the IPs will be responsible for this in states that have such provisions.
Trust Fund Escrow Entity
These entities will hold the money placed up front by the IPs that is reserved for the GC and her expenses. The money is held in escrow and paid to the surrogate at milestones defined in the GSA agreement. The escrow company can be just that or can be a law firm able to hold money in trust.
Fertility Clinic
The role of the fertility clinic is to medically screen the GC and possibly the IPs. They are also the recipient of any frozen genetic materials from egg banks, sperm banks, or other facilities that might be shipping embryos. The larger role of the fertility clinic is to conduct the in vitro fertilization procedure whereby embryos are created.
Once IPs have embryos they will be transferred (normally only one) into the uterus of a hormonally prepared GC. In the United States there are about 450 registered fertility clinics and the vast majority practice surrogacy.
Surrogacy Agency
There are at least 150 to 200 plus surrogacy agencies in the United States. The vast majority of these are small “mom and pop” type of operations having fewer then 10 journeys (cases) per year. There are about 10 agencies that have journey volumes above 150 cases per year.
The role of the agency is to recruit, screen and manage the GC. Finding and screening GC candidates is their largest challenge as less than 2% of all applicants will quality to be a GC. Surrogacy agencies can also be a source for an egg donor and referrals to specialized law firms working in surrogacy.
Surrogacy is widely practiced in the USA with both domestic and foreign IPs. There are an adequate number of agencies, law firms, egg and sperm banks, and fertility clinics, etc., to meet the need. However, surrogacy is limited in the recruitment of proper GCs. The number of GCs available does not meet demand.For this reason, some IPs may have to wait a year or more to find a GC.
The process is not cheap and normally costs upward of $150,000 when using all these professional organizations.
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