Surrogacy: For Intended Parents

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Intended Parent Information

It is a rare and wonderful opportunity when a person can freely give of herself in order to help a perfect stranger—which is exactly what gestational surrogates do. Surrogates offer their bodies and a year or more of their lives to help intended parents create something—some one—they deeply desire: a child. (Note: we use interchangeably intended parent and intended parents, because both of these parenting contexts are gladly served by APM.)

All information provided in the document is intended to only give a general overview of surrogacy and of the processes involved in a surrogacy. This information is not intended as medical or legal advice. Always check with your chosen professionals to understand exact processes within their area of expertise.

The Rewards

  • Experience
    A Perfect Match has been in business for 16+ years and more than 1000 babies have been born through our agency programs.
  • Location
    We recruit quality surrogates from California in order to provide the best protection of parental rights and to provide personal support for our surrogates..
  • Prescreened Candidates
    Criminal, Civil and DMV background checks completed. Psychological clearance completed. Previous birth records and OB clearance obtained. Insurance clearance provided.
  1. Types Of Surrogacy
  2. Process
  3. Screening & Legal
  4. Surrogacy Cycle
  5. Gestation
  6. Restrictions
  7. Testing & Risks

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Gestational Surrogacy

Begins with in vitro fertilization of the eggs of an intended mother (or egg donor) by the sperm of the intended father (or sperm donor) in order to create embryos that belong to the intended parents. This is the only form of surrogacy facilitated by A Perfect Match. Through the IVF process embryos are created and grown in a petri dish for three to six days. It is during this time that you can do PGD (preimplantation genetic diagnosis or PGS (preimplantation genetic screening) on your embryos. The current recommendation of the industry is that intended parents should consider single embryo transfers (SET) as the risk to both the fetuses and surrogate increases when there are multiples; however, many IVF centers will still transfer two embryos if all parties agree or if the quality of the embryos is less than optimal. If the surrogate becomes pregnant she will carry the child to term and at birth relinquish the child over to the intended parents.

A Perfect Match does not facilitate traditional surrogacy because the laws are ambiguous and may not protect intended parent’s rights to the child.

Traditional Surrogacy

Involves a woman who, using her own eggs, is artificially inseminated with the semen of the prospective father or sperm donor. Instead of artificial insemination, a traditional surrogate may instead go through the in vitro fertilization process as though she is an egg donor and after her eggs are harvested and fertilized with sperm of the intended father or a sperm donor, the embryos are grown for 3-6 days. One or two embryos are transferred to the surrogate’s uterus and, if successful, she will carry and give birth to the child and upon birth surrender the child to the intended parents.

Unlike gestational surrogacy, a traditional surrogate uses her own eggs to create embryos—and is consequently the genetic mother, who may potentially change her mind about relinquishing the child she carries.

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Agency Process

Unlike many agency programs, A Perfect Match only charges a first installment of our agency retainer fee once we present a surrogate who meets your needs and you choose to proceed with that surrogate. To be considered for a match with one of our surrogates we ask intended parents to sign a confidentiality agreement and we ask our intended parents to fill out a questionnaire to help us in the matching process. We provide individual matching services, not an online database of candidates. Intended parents will receive information regarding the surrogate we feel is the best match for their criteria; however,no intended parent is ever obligated to accept our choice of candidates, nor will we stop helping should you not feel we selected a good match for you. We will continue working together until you find the surrogate that is best for you. Once that match is made, intended parents receive an agency retainer that sets the contractual terms between intended parents and A Perfect Match. You will receive a Surrogate Benefit Package that describes all fees, and a schedule of when payments are due to trust and to your surrogate for the entire process. The terms of the Surrogate Benefit Package are submitted to the attorneys representing each party and the terms are incorporated into the legal contract you enter into with the surrogate.

We don’t like surprises and we are sure you don’t either. You will also receive an estimate of costs anticipated for the surrogate cycle. We provide a very detailed report of line items and a very accurate estimate. Of course, there may be circumstances that arise during the pregnancy (multiples, complications, bed rest, hospitalization) that could require additional funds, but those should be the only times. In fact, most clients receive a refund at the end of the cycle.

APM’s services do not stop after the match or confirmation of pregnancy. We continue to work closely with you and your surrogate through birth.


Intended Parent and Surrogate Matching Process

The first step in the gestational surrogacy process is the recruitment of a surrogate candidate who is 21-40 years old, who has previously given birth to at least one child, and who meets the other pre-qualifications of the agency and IVF centers. The surrogate candidate must submit a profile and photos and OB clearance, as well as submit to a psychological evaluation, background checks, and meet other agency requirements. We also ask our intended parents to complete an intended parent profile and send photos, so we have a better idea of how to best help match intended parents and a surrogate candidate. We never divulge any personal and confidential information during the match process—your confidentiality is critically important to us and you will be a part of the decision when to share names, contact information, etc.

APM staff works closely with intended parents in order to understand their preferences for a surrogate candidate and will present candidates who match their criteria for consideration. Once a candidate is selected, APM will arrange a conference call or Skype between the parties in order to assess the compatibility of the parties for a match and for the surrogacy journey.

We want our intended parents and surrogates to be a good match and to share a common goal for a safe and healthy pregnancy, so we want for there to be a meeting of minds between intended parents and surrogate as a part of a successful match. Some common factors our intended parents look at when choosing a surrogate candidate for a match:

  • Number of previous births and surrogacies and whether those births were vaginal or c-section. Generally IVF centers want to see no more than 5 births and no more than 3 c-sections; however, exceptions are made when a surrogate has had healthy pregnancies and she receives medical clearance from her OB.
  • Is the surrogate willing to work with your family type? Married, single male, single female, same sex couple, older intended parents, international parents, etc.
  • Is the surrogate married or single? All our surrogates must have a good support system in place; however, her marital status may be very important because some international countries only allow intended parents to use single surrogates. The reason is they consider the husband of the surrogate to be the father of any child the surrogate delivers regardless of genetics. This could negatively impact an intended father’s legal rights to his own child within his country.
  • Local or long distance location of surrogate to IVF center? A Perfect Match primarily recruits surrogates from within southern CA; however, we do accept surrogates from northern CA and on occasion we will accept previous surrogates who reside in surrogate friendly states. All our surrogates are willing to travel to your IVF center for the embryo transfer.
  • How many fetuses will the surrogate carry? Most doctors today encourage people to only do single embryo transfers for the health and safety of the fetus and the surrogate; however, transferring two embryos may still be recommended by the IVF physician.
  • Will surrogate reduce in the case there are more fetuses developing than the parties intended? It doesn’t happen often, but IVF is very successful now and sometimes embryos will split and produce identical twins increasing the number of fetuses you wanted or the surrogate was willing to carry. Will she reduce from three fetuses to two? From two fetuses to one?
  • Will surrogate terminate the pregnancy for any reason or only for a medical reason? For Down Syndrome? A Perfect Match does not support termination due to sex selection. Testing of embryos can provide the sex of the embryo before transferring the embryo to the surrogate, so there is no need to ever terminate for sex of child.
  • Will surrogate only do non-invasive prenatal testing? Nuchal Translucency, ultrasounds, blood work. Will surrogate also do invasive prenatal testing? CVS or amniocentesis? Will she do testing upon your request or only upon doctor recommendation? There are risks with any invasive testing and not all surrogates are willing to do it without having a recommendation from the doctor of only if there is a medical indication for invasive testing.

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Screening of Surrogate

Potential surrogates are carefully screened and must pass a number of tests as required by your IVF center, or required by state and federal regulations. Surrogates will have full medical screening by your IVF center and FDA regulated infectious disease screening performed by your IVF center.

As a part of our agency prescreening, surrogates submit to background checks and a professional psychological evaluation and clearance is submitted to your IVF center. These screenings are standard; however, A Perfect Match goes beyond the standard and we make sure we receive copies of the surrogate’s previous births, previous cycle records (if applicable), OB clearance for a pregnancy, and we visit the surrogate’s home in order to verify that the surrogate lives in a safe and clean environment.

  • Medical Screening - The IVF center is chosen by intended parents screen and it is the IVF center that will determine if the surrogate is physically capable of undergoing the surrogacy process and embryo transfer. An ultrasound, hysteroscopy, and vaginal cultures will be required. Drug, alcohol and tobacco product testing is a part of the screening. The surrogate will also be tested for sexually transmitted or other transmissible diseases, which includes: HIV, HTLV-I, HTLV-II, and Hepatitis B and C. The sexual partner of the surrogate will also be screened for sexually transmitted diseases. Only the IVF center can make the final determination of eligibility for the surrogate to cycle.
  • Psychological Screening - ensures that a surrogate fully understands the emotional ramifications of surrogacy. An MMPI (or other type of personality assessment) will be administered by a licensed psychologist. A personal meeting with the psychologist is mandatory for the surrogate and the surrogate’s spouse or partner. A Perfect Match has this screening completed prior to the medical screening of the surrogate.
  • Background Screening - for criminal, civil and DMV history is required of all of our surrogates as well as of their spouses or partners. Background screening for criminal history is also conducted on the intended parents. In many courts it is mandated and intended parents must provide information and to sign an agreement that allows APM to do this background check. All information is considered your confidential information and will not be disclosed except if required by the court during the parental establishment procedure naming you are legal parents.

Legal Contract

Once the surrogate has been evaluated by the IVF center, all screening is complete, and the cycle is ready to commence, both the intended parents and surrogate start their legal contracts. Each party will be referred to separate attorneys who specialize in surrogacy law. As an intended parent, you will enter into a contract with the surrogate. The contract is serious and weighty, covering issues such as compensation, legal obligations of both the intended parents and the surrogate, parental rights, termination and reduction. One of the things you can do is have language in the legal contract stating the surrogate agrees to contact the intended parent after each doctor appointment, to notify the intended parents of all future appointments, all changes in medications, all changes in her health status, all testing recommendations, all testing performed and all potential complications throughout the pregnancy. The terms of the Surrogate Benefit Package will be incorporated into this contract.

The intended parent’s attorney is the drafting attorney; the surrogate’s attorney is the reviewing attorney. The drafting attorney sends the contract to the intended parents for their initial review and approval. Once approved, the intended parent’s attorney sends the contract to the reviewing attorney. Any changes that are requested by the surrogate are relayed from her attorney to your attorney. When a final version of the contract is agreed upon, all parties sign the legal contract. Medications cannot begin until all parties have signed the contract and until the drafting attorney sends a clearance letter to the IVF physician to notify them that we can commence with the cycle.

Reproductive Law Center generally drafts all surrogate contracts for our program. You may choose a different attorney to represent you as long as that attorney has a minimum of 3 years experience in reproductive law, however, Reproductive Law Center will generally represent one of the parties in the negotiations of the agreement between you and the surrogate. A Perfect Match is not a party to your contract with the surrogate, so this ensures that the agency program remains consistent with the legal contract terms set forth in the surrogacy agreement.

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Surrogacy Cycle

If I could give intended parents just one bit of advice it would be this: BE VERY INVOLVED throughout the entire cycle and pregnancy! There are many times throughout the surrogacy that decisions need to be made and you need to be available to make those decisions. This is your child and you need to be very proactive in the care of that child. APM is not saying an intended parent needs to micromanage the cycle, the doctors or the surrogate, but you need to understand the processes, the timing of when things happen, the choices you have with prenatal testing and when those choices must be made. Speak to the IVF doctor and the OB who will take care of the surrogate. Understand your role and your rights as the parent of the child.

The IVF center requires legal and psychological clearance, and all medical and FDA screening results before they will commence the medical coordination of a cycle. The IVF center is the sole entity that can determine the final eligibility of a surrogate. The IVF center will set the timing and medical protocol for the cycle. The following is not a complete list; however, it contains many of the things you may want to discuss with your IVF center so you understand their requirements and protocols:

  • Screening - medical, psychological, FDA, drug and alcohol
  • Medications - birth control, Lupron, endometrial stimulation, progesterone. Testing of embryos: PGS (Preimplantation Genetic Screening) or PGD (Preimplantation Genetic Diagnosis) if desired
  • How many embryos to transfer (recommendation is now single embryo transfers; however many IVF centers still transfer two and may go to more depending on the quality of embryos and the age of the egg provider.)
  • Pregnancy testing and ultrasounds
  • What is the plan if a pregnancy is not achieved? What is the plan if one is achieved?
  • Timing for transfer of surrogate’s care from IVF center to OB (this is usually done around week 10 so the surrogate can have non-invasive testing that can only be provided by OB or maternal fetal medicine specialist)

Procedure

Embryo transfer is performed 2-6 days after the intended mother’s or donor‘s eggs have been harvested and fertilized, depending on which procedures are performed. If doing genetic testing of the embryos, however, this time could be extended to two weeks or longer. In this case, embryos are frozen until all test results are back and the healthiest embryos can be selected for transfer.

Embryo transfers usually take about 30 minutes. Embryo transfer is performed with a very fine catheter inserted vaginally, through the cervix, and into the uterus. The surrogate will be required to have a companion drive her home or to her hotel, and she may or may not be instructed by the physician to go on bedrest for a specified period of time, usually 24-72 hours is the time if bedrest is required. If the surrogate must fly for the procedure, she may be required to stay in a hotel for the duration of her bedrest. This decision will be made by the primary IVF physician, the surrogate, and intended parents. Following the embryo transfer, the surrogate’s activity may be subject to restrictions determined by the physician, and agreed upon by the surrogate and intended parents.

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Gestational Period

Ten to fourteen days after embryo transfer, the IVF center will have the surrogate schedule an appointment for a blood draw to determine if there is a pregnancy. In the case of positive Beta result or borderline test results, a follow up pregnancy test will be ordered 1-2 days later to confirm if the beta levels have increased. All testing is under the direction of the IVF center.

Once a surrogate is confirmed pregnant she will continue to be followed by the IVF center for 8-10 additional weeks. The surrogate will have her first ultrasound to confirm heartbeat at approximately 4 weeks post embryo transfer. The surrogate will remain on supplemental estrogen and progesterone as directed by the physician until 10-12 weeks gestation and she will then be weaned off of the medications. The surrogate will ‘graduate’ from the care of the IVF physician and care will be transferred by the IVF physician to the OB/GYN who will care for the surrogate for the remainder of the pregnancy.

The OB/GYN is chosen by the surrogate and approved by intended parents. The selection of the OB depends on several factors: the surrogate’s insurance plan, location of surrogate to OB, and the potential risk factors if there are multiples that may require the care of a perinatologist. The surrogate will sign a release so the intended parents can attend doctor in-office appointments with her and speak with the doctor to discuss the pregnancy and related issues. Not all parents can attend the monthly appointments with the surrogate, so they need to understand how they will access the doctor if they can’t. If you are unable to attend appointments some OBs charge an appointment fee to communicate with parents. It is a small price to pay to have access to the person overseeing the pregnancy.

Surrogates are obligated by legal contract to update parents after every OB appointment, and we do find most OBs will no longer speak directly with intended parents unless they are present at the appointment, so it is very important to go to the first OB appointment whenever possible so you can understand how the OB will handle communication with you for future appointments. We recommend you attend as many appointments as you can, but the first appointment is the most important. It is when you meet with the OB and surrogate to discuss the plan for the pregnancy and discuss all prenatal testing available for the fetus and surrogate during the pregnancy.

If possible, you should also attend the appointment during which they will do a full anatomical scan of the child (approx. 18 weeks) At this point, the physician will have the results of noninvasive testing completed and this is when an amnio testing would generally be recommended if there are any questionable results or if the scan shows any potential defects. During the last trimester of pregnancy the surrogate’s appointments will become more frequent, as determined by the OB/GYN.

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General Restrictions

The surrogate is expected to comply with a complete list of instructions and restrictions from the IVF center and/or the OB. The legal contract will have language that stresses the need of the surrogate to follow all doctor’s orders throughout the pregnancy. Such instructions may include the appointments a surrogate must attend, the testing they recommend and on a more personal side, sexual activity, the use of hair dyes, nail treatments, exercise, etc. Travel may be restricted from as early as the confirmation of pregnancy to as late as delivery—or there may be no restrictions at all until the last trimester of the pregnancy. Any other restrictions an intended parent might want would need to be agreed upon with the surrogate at the time of the legal contract negotiations.

The surrogate is required to eat healthy meals and get plenty of rest during the cycle and pregnancy. In some cases intended parents elect to have their surrogate eat specific health foods —organic fruits, vegetables, meat—if intended parents request the surrogate eat organic foods then an additional monthly stipend will be assessed to cover the difference in costs. This cost is covered by intended parents.

The use of alcohol and tobacco products by the surrogate is strictly prohibited throughout the pregnancy. Surrogates will also be restricted from the use of any types of drugs (including illegal substances, prescription or nonprescription drugs) throughout the entire pregnancy if they are not prescribed by or approved by the IVF physician or OB.

The surrogate is expected to follow doctor’s orders in order to maintain a healthy pregnancy, even if those orders are difficult to follow. The agency stresses to surrogates how important it is that they follow doctors’ orders to the letter, since the safety of the surrogate and the safety of the fetus(es) are at issue.

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Additional Testing

Once a surrogate is pregnant, there may be supplemental testing requested by the intended parents or the physician which may include the following:

  • Nuchal Translucency - is performed between weeks 11-12. This is always performed by an OB and not the IVF center. This test will measure the neck of the fetus to determine if they see any signs of Down Syndrome or other medical conditions. This ultrasound is usually in addition to first trimester blood screening.
  • High Resolution Ultrasound or Level II Ultrasound - is performed between weeks 14 and 20 weeks gestation. This test is a full anatomical scan of the child and the ultrasound is in addition to second trimester blood screening. Combined, the first and second trimester testing can give you valuable information regarding your child’s health.
  • Chorionic Villus Sampling (CVS) - is an early-pregnancy (before 12 weeks) procedure that removes a small piece of placental tissue (chorionic villi) from the uterus to check for the presence of genetic defects in the fetus. This test is considered more risky than amniocentesis but it provides information about the health of the fetus earlier, which may be very important to intended parents who would not want to terminate a pregnancy pas the first trimester. Depending on where in the uterus the placenta is located at that moment, 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 transcervical and transabdominal CVS are performed with ultrasound guidance by the OB or a maternal-fetal specialist.
  • Amniocentesis - is usually only performed when there is an indication of potential issues with the child; however, intended parents may also desire to have the surrogate undergo an amnio if they did genetic testing (PGD or PGS) of the embryos prior to implantation as there is a small error rate associated with embryo testing and IVF procedures. Always discuss your concerns or questions about PGD, PGS and amniocentesis with your IVF physician, the surrogate and the surrogate’s OB to understand the risks and benefits of performing amniocentesis vs. the risks or benefits to the fetus if you do not have an amniocentesis. Amniocentesis is the withdrawal of amniotic fluid from the 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—that is, of the fluid-filled sac that encloses the fetus during pregnancy. Amniocentesis is generally performed between 16-20 weeks gestation.

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

    Amniocentesis has some risks associated with the procedure,and less invasive options (1st and 2nd trimester testing) are available. Amniocentesis should be discussed and agreed upon between the intended parents and the surrogate prior to signing the contract. Unless otherwise agreed upon, the intended parents will make the final decision.

Termination

Although it is possible you may find it necessary to terminate the pregnancy, APM and our surrogates will not agree to termination for purposes of gender selection. Procedures such as preimplantation genetic diagnosis (PGD) can determine gender prior to embryo transfer and should be used by intended parents whose desire for a child is gender-specific. Any termination, therefore, must be for a medical reason—a mental or physical defect or the health and safety of the surrogate or other fetuses, etc. The surrogate’s and intended parent’s considerations regarding termination are expressed during the match process, so that you are matched only with a surrogate who is in agreement with your wishes in this regard.

Parental Establishment

This information is specific only to the state of California. Other states may have a different procedure and in some states it is not legal to do surrogacy at all, so you are advised to seek legal counsel before your surrogate has an embryo transfer. Do not enter into an agreement with any surrogate before you understand your parental rights.

At 18-20 weeks gestation, the intended parent(s) will retain their surrogacy attorney to obtain a court ordered judgment that places the intended parents’ names on the birth certificate as the sole and legal parents of any child born to the surrogate through the embryo transfer. In all cases where a surrogate gives birth to a child for another couple or person, the California Office of Vital Records lists only the intended parents’ names on the birth certificate—if the certificate is accompanied by a superior court judgment naming the intended parents as the legal parents of the child. Without this judgment the surrogate’s name (and, if she is married, her husband’s name) must go on the birth certificate.

Because the birth certificate must be registered with the Office of Vital Records within ten days of the birth, 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 20 weeks, Vital Records will require a certificate of birth or of fetal death, either of which require the parents’ names. Once the judgment is obtained, one certified copy of the judgment is given to the Intended Parent(s), one to the surrogate, and another is kept at the agency until the birth.

Birth

The intended parents are expected to attend the birth except in the case of an emergency and unscheduled delivery; otherwise, intended parents must name a guardian in order to keep Child Protective Services from becoming involved. Intended parents should expect to take the baby home with them once the baby is released by the hospital. International intended parents and those parents from other states within the U.S. should plan to arrive one to two weeks prior to due date unless a c-section is scheduled. Those who have a surrogate carrying multiples may need to come earlier than normal. With multiples the timing of the birth is often unpredictable and you could miss the birth of your children. If an emergency birth does happen you need to plan to arrive as quickly as you can to take responsibility for the children and all health decisions pertaining to the children.

Risks and Long-Term Effects

  • Physical - All participants in gestational surrogacy should realize that the establishment of a pregnancy cannot be predicted or controlled. In fact, pregnancy issues occur consistently in natural and assisted reproduction pregnancies. Furthermore, pregnancy entails risks to both the surrogate and the child. Even pregnancies that progress normally may encounter complications— some merely annoying or inconvenient (such as the need for bed rest), others more serious, even life threatening for the surrogate or the child. A surrogate with one or more earlier, uncomplicated births may not necessarily experience an easy or uncomplicated pregnancy in later births.
  • Cesarean Section - (surgery to deliver the baby) may be required for the health of the mother or the baby. In fact, a C-section is fairly routine for twins or triplets in order to provide a safe delivery of all children.
  • Psychological - APM requires psychological screening of all surrogates in order to minimize any mental health risks associated with the surrogacy process. The ability to transfer an embryo into the uterus of an unrelated mother is relatively new in human experience, and there is very little information about the long-term emotional effects on the surrogate, the intended parents, or the child; although, surrogacy appears to have a very positive impact on all parties involved.

    While the surrogate has no genetic relationship to the child, she nevertheless has an intimate biological connection in other respects. Although the surrogate may be confident about her willingness and ability to relinquish the child to the intended parents after birth, there have been legal actions that allege the difficulty for certain women to sever their connection to the newborns. In most of these cases when a surrogate did not want to give up a child, however, the surrogate was the genetic mother of the child and it was a traditional surrogacy. This is why we do not engage in these types of arrangements.

    A Perfect Match has never experienced such a legal issue where a surrogate wanted to keep a child, yet the risk remains as a possibility—which is why the intended parents should ensure they work only with psychologically screened surrogates. If the surrogate is a close friend or relative of an intended parent, there is the likelihood of 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 and surrogate should undergo psychological counseling before entering into an agreement and doing an embryo transfer. Surrogacy remains a safe and exciting option, but it must be done in the most responsible way. When there is a mutual agreement on the issues discussed throughout this document, the surrogacy experience should be enjoyable for all participants.

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