egg donation, surrogacy

For Intended Parents

 

A Perfect Match (APM) has been in business since 1998 working with individual families who need the help of a surrogate and/or egg donor to achieve a pregnancy. APM is dedicated to helping all those who are truly committed to becoming parents regardless of their race, age, gender, marital status or sexual orientation.

Originally, the surrogacy and egg donation programs operated under the Law Office of Thomas Pinkerton, a foremost authority in the country in the area of Surrogacy Law. His experience in this area began in 1990 with the first gestational surrogate baby born in San Diego, his own child, Kaitlin. In this case, he obtained the first legal judgment for placing the natural mother on the birth certificate, which set the precedent for all subsequent cases in California. Tom’s wife, Darlene, began working under his office as the Contract Coordinator between Intended Parents (IPs) and egg donors/surrogates. Tom and Darlene’s combined personal knowledge and experience in the field made them “A Perfect Match” for assisting others with their dream of having a child through egg donation and surrogacy. Their first egg donor and surrogate match was made in 1998 when a family came to ask help in locating a donor who met a very specific criteria (this was the original $50,000 egg donor) as well as locating a surrogate. Once it was known that the law office would help with matching families with donors who met their needs, it didn't take long before other families also requested assistance. This was the beginning of what would eventually become A Perfect Match, Inc.

In December 2000, while Tom continued to pursue his Surrogacy Law Practice, A Perfect Match, Inc. (APM) was established and Darlene took over operations full-time as Executive Director of the surrogacy and egg donation programs. The program has grown in both reputation and size and now works with many local, national and international Intended Parents in order to help them become parents through surrogacy. Rose is APM's full-time Surrogate Coordinator and she has been a surrogate three times herself. Her first-hand knowledge and expertise makes her a wonderful resource for intended parents and surrogates alike. The combination of Darlene's experience of working in the law office, as well as her personal experience as a mother of a surrogate child, plus Rose's experience as a surrogate mother gives us the ability to understand all aspects of the surrogacy cycle. Our intended parents and surrogates are able to have confidence that we will not only handle their cycle with expertise, but that we also genuinely care for all parties involved and will do all we can to make sure the surrogacy journey will be a success . To date, more than 600 babies have been born through the combined surrogacy and egg donation programs.

Surrogacy Program Information

APM is not associated with any one IVF center or physician, so we are able to enjoy a positive working relationship with various IVF centers across the nation. APM does not choose the professionals involved with the surrogacy process - that is up to the intended parents. We will, however, provide contact information for IVF centers, as well as share our experiences with specific IVF centers, if the intended parents have not yet chosen a center and request that information from us. APM's role is to facilitate by acting as the liaison between the intended parents, the surrogate, and the professionals performing the procedures and screening. APM's job is to coordinate the surrogacy process, including the screening process, as directed by the primary physician chosen by the intended parents. The following information provides an overview of the surrogacy process through A Perfect Match, Inc., and is only designed to help intended parents understand the procedures generally involved with surrogacy. The intent of this document is not to provide any medical or legal advice.

Definitions of Surrogate Types

Traditional Surrogacy: Involves a surrogate mother who, using her own eggs, is artificially inseminated with the semen of the prospective father. She then carries and gives birth to the child. Some traditional surrogates may also go through the in vitro fertilization process as an egg donor then, after the eggs are harvested and fertilized, the embryos are transferred back into the surrogate’s uterus. She then carries and gives birth to the child. A Perfect Match does not utilize either of these forms of Traditional Surrogacy because we feel the laws are still too unsettled in this area and we have concerns that intended parents would not receive the same legal protection as they would through gestational surrogacy.

Gestational Surrogacy: Involves an intended mother /egg donor, the intended father/sperm donor, and a gestational surrogate. Through the process of in vitro fertilization, eggs provided by an intended mother or egg donor are fertilized with the sperm of the prospective father/sperm donor. The resulting embryos are then transferred to the gestational surrogate who carries the child to term. A Perfect Match, Inc. only works with surrogates in southern California so we are better able to oversee and be involved first hand with the surrogacy cycle from the match through the birth. On occasion we will work with an out of state surrogate, but only if she completed a cycle with us prior to the time she relocated. We never work with a surrogate who does not reside in a "surrogate friendly state" so intended parents do not have to worry about having legal issues at the time of birth.

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Matching Process

The first step in the surrogacy process is the recruitment of a surrogate who is between the ages of 21-39 who has previously given birth. (APM has an extensive list of qualifications which may be viewed on the surrogate overview page). Each potential candidate is asked to fill out a profile and to send photos. Our office will assign a number to her profile and until a match is made, the combination of her number and first name is the only way she will be identified to intended parents. At no time will any identifying information be given to either the surrogate or an Intended Parent without the permission of the other party until a legal contract is finalized.

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Screening

Surrogates will have full physical, psychological and infectious disease screening as well as a background check performed. As a part of APM’s program all or a part of the screening may be completed prior to presenting a surrogate to families. The costs for these screenings, however, will be paid by the Intended Parents once a match is made.

Potential surrogates are carefully screened and must pass a number of tests as required by our program and mandated by the State of California. These tests may be performed locally and will be arranged by the physician in charge of the cycle.

Background screening is required on all of our surrogates as well as her spouse/partner before she is accepted into APM's program. Background screening may also be conducted on the Intended Parents. You and your spouse/partner will be asked to provide information and sign an agreement which allows us to do the check.

The Home Visit is a unique part of our program, and to the best of our knowledge, A Perfect Match is the only agency that requires this as part of prescreening and accepting surrogates into a surrogacy program. As a condition of being accepted into APM's surrogacy program, each surrogate is required to have our surrogate coordinator visit her residence. This is also one of the reasons we choose to only work with surrogates in southern California - we are able to visit each and every one of our surrogates. We believe strongly that a visit to the home of the potential surrogate is a necessity in order to ensure that our surrogates live in a clean and safe environment and neighborhood. The home visit lasts for approximately one hour and is a very relaxed and positive time during which the coordinator is able to meet the surrogate and her family and any other people who will be part of the surrogate's support system throughout the pregnancy. It is also a time when the surrogate and her family are able to ask additional questions about our program (and show off their family albums!). We find the home visit provides us and our intended parents with an increased confidence that the surrogates will be able to provide a safe environment for the child/children they will carry throughout the pregnancy.

Psychological Screening is to ensure that a surrogate fully understands the emotional ramifications of surrogacy. An MMPI or other type of personality assessment will be administered, and a personal meeting with a psychologist will be arranged. The psychological screening and is completed and clearance is provided by the psychologist prior to the time a surrogate is fully accepted into APM's program.

Medical Screening is performed to ensure that the surrogate is physically capable of undergoing the surrogacy process. This is the last screening and is not completed before a surrogate is accepted into APM's program because the exact screening required is determined by the IVF center chosen by the intended parents. This screening will generally include an ultrasound, hysteroscopy and possibly a mock cycle. The screening will also include vaginal cultures, lab work, urine screening or hair follicle testing for drugs. She will also be tested for sexually transmitted or other transmissible diseases which will include: HIV, HTLV-1 & 2, and Hepatitis B & C. The sexual partner of the surrogate will also be screened for sexually transmitted diseases. If the surrogate is required to travel to the location of the clinic chosen by the intended parents, these costs will also be covered by the intended parents as part of the surrogate's benefit package. The travel expenses will include flights, hotel, meals, etc. Some IVF centers allow the medical screening to be performed by an IVF center local to the surrogate, then the results are forwarded to the primary physician responsible for the surrogacy cycle and embryo transfer.

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Retainer and other Documents required:Once an intended parent requests to meet a specific surrogate either by phone or a personal meeting, the intended parents will receive a retainer that sets the terms of the relationship between intended parent and APM. They will also receive an excel spreadsheet showing the costs expected to be incurred in the cycle with that exact surrogate as well as a Surrogate Benefit Package which describes all obligations, fees and schedules of payments which will be required for the entire process. APM requires a signed retainer prior to allowing a phone conference or personal meeting between the IPs with a surrogate. Once the signed APM retainer and Surrogate Benefit Package are received by APM, then a phone conference will be arranged by our office. After the intended parents and the surrogate confirm their desire to work together, a personal meeting will be arranged between the intended parent and surrogate. Phone conferences are mandatory in our program; however, personal meetings may not occur until embryo transfer if the intended parents are international. At this point, APM will begin the coordination of the surrogacy cycle with your IVF center and they will set the physical screening requirements.

A trust fund is set up through National Fertility Law Center to hold and distribute funds throughout the surrogacy cycle as agreed upon in APM's retainer and the legal contract. Funds will be placed in trust to cover the reimbursement costs to APM for the screenings to date. The balance of the funds are due once the legal contract between the surrogate and intended parent is finalize and must be deposited to the trust account prior to start of surrogate's first injectable medication can begin. Compensation to the surrogate is generally paid monthly throughout the pregnancy. The first installment of $500 is paid when a surrogate begins a medication called Lupron. This will be paid to the surrogate by our office through priority mail once we receive confirmation that she has begun the medication. The second installment of $500.00 is paid on the day of embryo transfer. The amount of the base compensation as agreed upon in your contract is usually paid in equal monthly installments beginning the first week of the month following confirmation of fetal heartbeat through ultrasound. Any remaining compensation balance due to the surrogate shall be paid within 14 days of birth or according to the terms of your contract.

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Legal Contract

Once the surrogate has been evaluated by your IVF center and all the screening is complete, both the IPs and the surrogate will be referred to attorneys who specialize in Surrogacy Law. The IPs pay for all legal fees, including the surrogate’s attorney. The surrogate and the Intended Parents will have the option to choose joint representation or separate legal counsel. You will enter into a contract with the Surrogate and this legally binding contract should not be entered into lightly. The signed Surrogate Benefit Package is sent to the law office drafting your legal agreement and all the terms of this package will be incorporated into the legal contract you enter into with the surrogate. The contract will cover issues such as compensation, legal obligations of the IPs and surrogate, surrender of the child/children, surrogate's conduct throughout the pregnancy, etc.

The Intended Parents’ attorney is called “the drafting attorney” and the surrogate’s attorney is called “the reviewing attorney” If you choose separate legal representation, the drafting attorney will send a contract to the reviewing attorney. The drafting attorney is responsible for getting a copy of the contract to the Intended Parent for their review prior to sending the agreement to the surrogate's attorney. Any requested changes by the surrogate will be relayed from her attorney to your attorney. All parties will be required to sign a legal contract. Medications cannot begin until all parties have signed the contract and a clearance letter has been sent to the IVF physician by the drafting attorney to notify them that the surrogate can begin medications and continue with the cycle.

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Medications

If the surrogate is not already taking oral contraceptives, she may receive a prescription for birth control. These are given to help regulate the surrogate’s cycle and will allow the physician to coordinate her cycle with that of the intended mother /egg donor. She may be asked to start birth control prior to having the contract signed. Note: Birth control is not considered a medication start with regard to compensation; therefore no fee is paid at this time.

On day 21 of her cycle a surrogate will begin a medication called Lupron, which is a daily subcutaneous injection. Lupron is not a fertility medication and is given to keep the ovaries from ovulating. The needle used is a tiny, 2 inch insulin type needle. A vaginal ultrasound will be performed to make sure the ovaries are quiet. The surrogate will start her flow within 7-10 days or soon after her last birth control pill should both these medications overlap.

Once the surrogate and intended mother /egg donor have their flows the next medication will be administered for endometrial stimulation. Estradiol/Delestrogen is a medication that is used to thicken the endometrial lining to prepare for the uterine lining for the implantation process. This medication is administered twice weekly at the start of endometrial stimulation and may continue through the 12th week of pregnancy depending on the physician’s protocol.

During the endometrial stimulation phase the surrogate will be required to have a blood test and ultrasound performed on day 7 or as directed by the physician. Some centers will require the surrogate to have their day 7 ultrasound at their center only. Other centers allow the surrogate to remain in her home area until the day of embryo transfer.

The blood tests and ultrasounds will help the physician determine the thickness of the surrogate’s endometrial lining. These tests are generally required between the hours of 7-9 am in order to receive lab results the same day. Once the endometrial lining is at the appropriate thickness and the intended mother/egg donor is ready to have the egg retrieval, the surrogate will be required to start some form of Progesterone to assist with and sustain implantation. The form of Progesterone may be in an intramuscular injection form, vaginal suppository, oral pill or patch per the physician’s orders. Progesterone may be continued thru the 12th-14th week of pregnancy as directed by the primary IVF physician.

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Procedure

The embryo transfer procedure will be performed 2-6 days after the intended mother’s /donor‘s eggs have been harvested and fertilized. The embryo transfer is performed with a very fine catheter that is inserted vaginally into the uterus through the cervix and the embryo transfers usually take approximately 30 minutes, but the surrogate will rest at the IVF center for an hour or so before being released to go home or to the hotel. The surrogate will be required to have a companion drive her either home or to her hotel, and she will be instructed to go on bedrest for a specified period of time by the primary IVF physician. Each IVF center has their own protocol, so some will require no bedrest at all, but most require between 24-72 hours.

If the surrogate is required to fly for the embryo transfer procedure, she may be required to stay in a nearby hotel throughout the period specified for bedrest. This decision will be made by the physician and Intended Parents. All expenses will be covered by the Intended Parents. Following the embryo transfer the surrogate’s activity may be restricted. These restrictions will be determined by the physician and Intended Parents.

Gestational Period

The surrogate will schedule an appointment for a blood draw to determine pregnancy on day 12-14 after the embryo transfer as dictated by the primary physician. A follow up pregnancy test will generally be ordered 48 hours after the initial test for any positive or borderline test results. Further blood draws to check HCG or Beta levels will be ordered under the direction of the primary fertility physician. Once a surrogate is confirmed to be pregnant, she will continue to be followed for approximately 10-12 weeks by either the primary IVF physician or by the physician who monitored her prior to embryo transfer.

The first ultrasound to determine if a fetal heartbeat is present will be performed approximately two weeks following the second confirming pregnancy test. Again, this time line may vary depending on the protocol of the primary IVF physician. The surrogate can expect to be scheduled for bi-weekly ultrasounds during the first 10-14 weeks of pregnancy. In some cases, the appointments may be more frequent depending on the status of the pregnancy.

The surrogate will remain on supplemental Estrogen and Progesterone as directed by the physician until 10-14 weeks gestation. She will be required to take Prenatal Vitamins on a daily basis throughout her pregnancy, and she may also be required to take a Baby Aspirin daily. Again, each IVF center will have its own protocol that the surrogate will be required to follow.

Between the 10th-14th weeks of gestation, the surrogate’s care will be transferred to an OB/GYN to follow her through to the birth. APM will give you a list of OB/GYNs who are "surrogate friendly" and are local to your surrogate. The surrogate will have some input regarding the OB/GYN, but ultimately it is the IPs who make the final decision and that choice will depend on the insurance plan, location and potential risk factors of the pregnancy. All deductibles or payments due to the OB/GYN are paid for by the Intended Parents. The surrogate will sign a release so the IPs can attend doctor appointments if desired, as well as have full access to the medical records and doctor to discuss the pregnancy and related issues.

Obstetrical appointments will be monthly, but may be more frequent depending on any risk factors, such as multiples, premature contractions, vaginal bleeding, hypertension, etc. During the last trimester, the appointments will become more frequent and will be determined by the OB/GYN.

The surrogate will be required to notify the surrogate coordinator of all appointments, all changes in medications, all changes in her health status and all potential complications throughout the cycle and pregnancy. She will report all these changes in a bi-weekly report to APM.

Support group meetings and individual counseling are available to the surrogate. The surrogate will receive approximately $100 for every meeting she attends.

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Restrictions

The IVF center will provide the surrogate with a complete list of restrictions she is to follow. These will generally include such items as a specific period of bed rest after embryo transfer, the use of hair dyes, nail treatments, etc. Traveling may be restricted as early as the confirmation of pregnancy through delivery. Restrictions will be as directed by the IVF center. The intended parents, however, may request additional but reasonable restrictions.

The surrogate will be required to eat healthy meals and get plenty of rest during the cycle and pregnancy. In some cases, the Intended Parents may request that the surrogate eat specific health foods, organic foods and drink specific brands of water. The cost of the specified items requested by the intended parents will also be paid for by the intended parents.

The surrogate will be restricted from the use of alcohol and tobacco products as well as any types of drugs including prescription and non-prescription drugs unless prescribed by of approved by your primary IVF physician or OB/GYN during the course of the cycle and pregnancy.

The surrogate is expected to do everything in her power to follow doctor’s orders in order to maintain the pregnancy, even if those orders are difficult to follow. The agency stresses to the surrogates how important it is that she follow doctor’s orders to the letter, as the safety of the surrogate and the safety of the fetus (es) are at issue.

Sexual Conduct

There will also be restrictions placed on the surrogate’s sexual activity as dictated by the contract and the physician. Surrogates must refrain from sexual intercourse once injectable medications begin in order to protect her from becoming pregnant prior to the embryo transfer. The surrogate will be asked to either abstain from sexual relations completely or to use a combination of effective barriers prior to starting any of the medications and to completely abstain from the beginning of medications until cleared by the primary IVF physician. This can be from three weeks to three months or to the end of the pregnancy depending on the status of the pregnancy and the orders of the physician. She will also be asked to curtail any heavy exercising during the medication stage and possibly throughout the pregnancy if the physician feels exercising could pose a threat to the child/children.

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Additional Testing

Once the surrogate is pregnant, there may be supplemental testing requested by the Intended Parents and/or the physician which may include the following:

High Resolution Ultrasound or Level II Ultrasound: Is performed between 14-20 weeks gestation and may be repeated periodically throughout the pregnancy depending on the physician and potential risk factors.

Fetal Monitoring: Fetal Monitoring may be performed at the physician’s office or hospital and in some cases, fetal monitoring may be ordered at home. This may be ordered by the physician as part of his/her normal protocol or in the case of premature contractions.

Amniocentesis: Amniocentesis is a procedure performed during pregnancy in which amniotic fluid is withdrawn from a woman's uterus to test for certain problems in the fetus, such as genetic defects, fetal infections, fetal lung immaturity, or Rh sensitization. The word "amniocentesis" literally means "puncture of the amnion," the fluid-filled sac that encloses the fetus during pregnancy.

During amniocentesis, a needle is inserted through a mother's belly into the sac of amniotic fluid, the watery fluid that surrounds the fetus, and a small amount of the fluid is removed. The fluid, which is produced by the fetal lungs and kidneys and the umbilical cord, contains skin cells the fetus has shed and biochemical substances that the fetus has produced. These cells can be sent to a laboratory, where they are isolated and grown so that their genetic material (chromosomes) can be tested, or so other laboratory tests can be done.

There are risks involved with amniocentesis and less invasive options are available. Amniocentesis should be discussed and agreed upon between the IPs and the surrogate prior to signing the contract. Unless otherwise agreed upon, the IPs will make the final decision.

Chorionic Villus Sampling: Chorionic villus sampling (CVS) is a procedure for taking a small piece of placental tissue (chorionic villi) from the uterus in the early stages of pregnancy to check for the presence of genetic defects in the fetus.

Depending on where the placenta is located, CVS can be performed through the cervix (transcervical) or through the abdomen (transabdominal). The techniques are thought to be equally safe and effective for obtaining samples. Both the transcervical and the transabdominal CVS are performed with ultrasound guidance.

An abdominal ultrasound is performed to determine the position of the uterus, the size of the gestational sac, and the position of the placenta within the uterus. the surrogate's vulva, vagina and cervix are cleansed with an antiseptic such as Betadine. For the transabdominal procedure, the abdomen is also cleansed.

The transcervical procedure is performed by inserting a thin plastic tube through the vagina and cervix to reach the placenta. Ultrasound is used to help guide the tube into the appropriate area and a small sample of chorionic villus tissue is withdrawn.

The transabdominal procedure is performed by inserting a needle through the abdomen and uterus then into the placenta. Ultrasound is used to help guide the needle, and a small amount of tissue is drawn into the syringe.

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Termination or Selective Reduction

It is possible that the physician may find it necessary to terminate the pregnancy or perform a selective reduction for the safety of the surrogate and/or fetus(es). Any termination or reduction will be for a medical reason or indication of a mental or physical defect. No pregnancy will be terminated for gender selection. The surrogate’s considerations regarding termination will be discussed and taken into account during the match process so that she and the IPs are in agreement prior to the transfer of any embryos.

Judgment

At approximately 20 weeks gestation, the IPs will retain their Surrogacy Attorney to obtain a judgment that places the IPs names on the birth certificate as the sole and legal parents of any child/children born to the surrogate. In all cases where a surrogate gives birth to a child for another couple or person, The California Office of Vital Records will only list the Intended Parents’ name(s) on the birth certificate if the certificate is accompanied by a Superior Court judgment naming the Intended Parent(s) as the legal parent(s) of the child. Without such a judgment, the surrogate’s name (and if she is married, her husband’s name) must go on the birth certificate. The birth certificate must be registered with the office of Vital Records within ten days of the birth; therefore, the judgment should be presented to the birth records department of the hospital at the time of birth. The practical reason for this judgment is that after twenty weeks Vital Records will require either a certificate of birth or fetal death, both of which require the Parent’s name(s). Once the judgment is obtained, one certified copy of the judgment is given to the IPs, one to the surrogate, and another is kept at the agency until the birth. This document must be presented to the hospital at the time of birth.

Birth

The IPs are expected to attend the birth if at all possible unless there is an unexpected and premature birth, in which case the parents are expected to arrive at the hospital as soon as possible. The parents should expect to take the baby home with them when it is released by the hospital. Final payments will be due to the surrogate within six weeks after the birth.

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Potential Pregnancy Risks and Long Term Effects

Physical: All of the participants in gestational surrogacy must realize that the establishment of a pregnancy cannot be predicted or controlled. In fact, pregnancy does not occur all the time in both natural and assisted reproduction. Furthermore, pregnancy entails risks to both the surrogate mother and baby. Even pregnancies which are progressing normally may encounter complications, some of them annoying or inconvenient, such as the need for bed rest, or something more serious or even life threatening. A woman who has had one or more uncomplicated births may not necessarily experience an easy uncomplicated pregnancy in later births.

Cesarean section (surgery to deliver the baby) may be required for the health of the mother or the baby and this is fairly routine for twins or triplets

Psychological: APM requires psychological screening on all surrogates in order to minimize any potential long-term psychological risks associated with the surrogacy process. The ability to transfer an embryo into the uterus of an unrelated mother is relatively new in terms of the human experience, so there is very little information about the long term psychological consequences of gestational carrying. There is also little information on the long term emotional effects on the surrogate, the Intended Parents or the child, though surrogacy appears to have a very positive impact on all parties involved.

While the surrogate has no genetic relationship to the child, she does have an intimate biological connection in other respects. The surrogate may not believe that it will be emotionally difficult for her to relinquish the child to the Intended Parents after birth, but there have been legal actions which allege that it has been difficult for certain women to sever their connection to the baby. APM has not experienced this issue with surrogacy, but the risk remains a possibility and IPs should make sure they only work with psychologically screened surrogates. If the surrogate is a close friend or relative of one or both of the Intended Parents, there may be an ongoing social connection between the surrogate, her partner, the parents and the child. The impact of this arrangement on any or all participants in gestational surrogacy has not been established, but Intended Parents should arrange for psychological counseling for any person who acts as their surrogate.

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Conclusion

The underlying principle throughout this process is to have a safe and successful surrogate pregnancy with a healthy child (or children!) safely delivered into the waiting arms of the Intended Parents. That is the reason we are all working together, and that is the goal we are all working towards. A Perfect Match enlists the help of its surrogates in achieving this goal and works closely with the surrogates to insure they understand their responsibilities. We will do everything in our power to make this a positive experience for all parties concerned and work to support all parties throughout the process.

Please contact our office either by phone or email to let us know if you are interested in continuing with the process and would like information about our gestational surrogacy and egg donation programs. We look forward to hearing from you soon.

  • Intended Parent through Egg Donation
  • Intended Parent through Gestational Surrogacy
  • For More Information about our Surrogacy Program, please contact Rose@aperfectmatch.com or Darlene@aperfectmatch.com 1-800-264-8828 or 619-464-1424. 

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