About one in eight couples in the U.S. struggle with infertility,and many consider alternate methods of having a baby. NBC News' Kristen Welker and her husband, John Hughes, announced on TODAY that they are expecting their first child with the help of a surrogate. But the surrogate pregnancy process is still surrounded by mystery and confusion.
What is surrogacy?
Surrogacy is an arrangement between two parties, where a woman, the surrogate, agrees to carry a pregnancy for the child’s intended parents or parent. There are two different types of surrogacy: gestational and traditional.
Gestational surrogacy uses the egg of the mother and the sperm of the father or sperm donor to create an embryo, which is then transferred to the uterus of the surrogate via in vitro fertilization.
In traditional surrogacy, the surrogate’s own egg is used, making her the biological mother of the child. Sperm is implanted into the surrogate’s uterus through intrauterine insemination (IUI.)
Witt doesn’t recommend traditional surrogacy.
“The traditional method is rarely done because it’s legally and emotionally complex,” Witt explained. “In cases where someone needs a donor egg, they’ll use a donor egg and have that transferred into a gestational surrogate. That separates whose egg it is from the person who’s carrying the pregnancy.”
Why choose surrogacy?
There are a wide variety of reasons that a couple may decide to hire a surrogate.
“One of the most common would be that the woman has problems with her uterus or she doesn’t have a uterus," Witt said. “Surrogacy is also a good option for a woman with medical problems like cancer, severe heart disease or pulmonary hypertension.”
Same-sex couples who want to be genetically connected to their child are also drawn to surrogacy. Neil Patrick Harris and his husband, David Burtka, welcomed their twins with help from a surrogate in 2010.
How do you find a surrogate?
“Most people turn to agencies,” Witt said. “But some will ask someone they know like a sister. The advantage of doing that is that you can save a lot of money. Carriers get paid roughly $30,000 to carry a pregnancy.”
But there are also benefits to using agencies, which have a rigorous screening process to ensure that the surrogate is emotionally and physically prepared for the journey.
How do you become a surrogate?
The American Society for Reproductive Medicine (ASRM) recommends that the surrogate should be between the ages of 21 to 45 and should have carried at least one healthy pregnancy without complications. Ideally, she should have had no more than five prior pregnancies and no more than three C-sections. The ASRM also notes that many reproductive endocrinologists maintain that a carrier should have a body mass index of less than 30.
How many babies are born through surrogacy each year?
The number is roughly 3,000 to 4,000, according to Witt.
How much does surrogacy cost?
“It’s a very expensive process — I believe it costs people about $150,000 in total,” Witt noted.
Increasingly, employers are offering financial aid for couples struggling with infertility and for those who want to pursue surrogacy. Some surrogacy agencies also offer assistance through grants and loans.
Do you need a surrogacy attorney?
In surrogacy, it's crucial to have all legal paperwork in place, according to Jeffrey A. Kasky, a Florida surrogacy lawyer. It's definitely not the place to try to cut your expenses.
"That is what is going to determine who the actual legal parents are," Kasky told TODAY Parents. "Here's a child that's being created through alternative means that was not contemplated by common law. And in order to secure your rights, you need a legal contract."
When speaking with TODAY in 2019, Kasky stressed the importance of hiring a knowledgeable attorney.
"Like adoption, surrogacy is a specialized area within family law which requires a specific type of experience,” Kasky said. “When push comes to shove, there are eventualities in which the legal work can be what saves you from disaster and heartbreak. You don't want to trust that responsibility to just anyone."
Here are more resources:
Growing Generations: Full service surrogacy agency offering grants of up to $50,000 for qualified intended parents
Children's book about surrogacy: "You Began As a Wish"
Book for adults about assisted reproduction: "Your Future Family: The Essential Guide to Assisted Reproduction (What You Need to Know About Surrogacy, Egg Donation, and Sperm Donation"
American Society for Reproductive Medicine: Resources for prospective parents going through fertility care
Family Equality: Resources for LGBTQ families, parents and parents-to-be
Resolve: Resources for anyone challenged in their family building process
Society for Assisted Reproductive Technology: Organization for assisted reproductive technology professionals
Men Having Babies: Financial assistance and resources for gay men pursuing parenthood