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The Issues
Meg Lambrych, RN

LGBTQ+ Surrogacy: What Queer Parents Need to Know

With improvements in fertility medicine and positive changes to family law, surrogacy is an increasingly popular family creation path for LGBTQ+ families. But the surrogacy process has risks — some unique to queer families.

That’s why we’re here to break down the surrogacy process in an easy-to-understand way. Once you know the process, navigating the medical, financial, legal and emotional risks you might face during surrogacy is easier. And from there, you can chart a path toward the family you envision — and even be a helpful voice to friends considering surrogacy for their families.

What is surrogacy?

Surrogacy is when a person with a uterus becomes pregnant and carries the baby to term for someone else. 

Today, third-party surrogacy — also called gestational surrogacy — is the most popular. Unlike traditional surrogacy, where the surrogate contributes an egg, a gestational surrogate is unrelated to the baby they carry. Instead, the surrogate becomes pregnant through in-vitro fertilization (IVF).

How does the surrogacy process work?

Surrogacy can be a lengthy process, but it really comes down to eight straightforward steps.

1. Choose a gestational surrogate. Today,  there’s a veritable bounty of agencies specializing in helping queer families navigate surrogacy. These agencies will help you find a suitable surrogate, a sperm or egg donor (depending on your needs), and help with all the necessary paperwork and legal steps that protect your parental rights. However, you can also choose a private surrogate, as many families opt to have a friend or loved one carry their baby for them.

2. Choose your donors. You may need a sperm donor, egg donor, or both. Again, you can rely on an agency or your doctor to connect you with suitable donors, or you may have someone in your life willing to donate. Sperm donors are pre-screened before they donate, but egg donors undergo medical, genetic and psychological screening to determine their eligibility after intended parents select them. Your surrogate typically goes through medical screening at the same time. Once your donor(s) and surrogate clear screening, your doctor will coordinate the IVF cycle. 

3. Complete legal steps. You’ll have legal steps to protect your investment and parental rights throughout your surrogacy. That’s why you’ll need to work with an attorney specializing in surrogacy for queer families, as they have the experience you need to protect your parental rights after the birth. If you’re worried about finding an attorney, that’s where a surrogacy or donor agency can help, as they all have attorneys they regularly work with. 

4. IVF cycle. In-vitro fertilization (IVF) is the joining of the egg and sperm to create embryos in a laboratory setting. During this stage, egg donors and surrogates go through a medication phase to encourage egg production and prep the uterus for the embryo. Next, eggs (even your own) are retrieved during a simple medical procedure and combined with sperm in the lab so that embryos can develop.

5. Embryo transfer. Once the embryos are ready, your doctor will transplant one or more into your surrogate’s uterus. 

6. Pregnancy. Once the embryo successfully implants and the pregnancy is confirmed — generally two weeks after implant — your pregnancy is on its way. You’ll receive ongoing medical updates, perhaps more, from your surrogate throughout the pregnancy. It all depends on how you and your surrogate have chosen to stay in touch.

7. Delivery day. You’ll create a birth plan with your surrogate toward the end of the pregnancy. Your plan includes details about where the birth will occur, who will be in the delivery room and if additional support like a doula will attend. Then on delivery day, you can support your surrogate and welcome your baby into the world. 

8. Adoption. In some states, the non-related parent must sign adoption papers, which formally terminate the parental rights of donors and your surrogate and protects your rights as a parent.

LGBTQ+ surrogacy costs and timelines

To say the least, having a baby through surrogacy is an investment. The total cost of a gestational surrogate pregnancy can range from $64,000 to $205,000 and takes an average of 12 to 24 months, start to finish. And yes, that’s quite a wide range.

Timelines and costs can vary for several reasons, including:

• Donor costs. Costs tend to be higher for donors with highly desirable traits (hair/eye color, height, educational achievements) and a history of successful pregnancies from their donations.

• Number of IVF cycles. Sometimes it takes more than one IVF and donor cycle to achieve a pregnancy.

• Surrogate history. Surrogates with a history of successful, full-term pregnancies may have higher compensation requirements.

• Travel costs. You may need to travel to seek specialists and meet your surrogate. 

• Legal Costs. The complexity of your surrogacy contract and the number of donors required can all increase your legal fees.

As you go through the surrogacy process, you can work with your doctor, attorney and agencies to help manage costs where possible.

LGBTQ+ surrogacy risks

Like any pregnancy, surrogacy has medical risks, but there are also financial, legal, and emotional risks as well. 

Medical risks

• Fertilization complications. The embryo can fail to form for various reasons, including low-quality eggs/sperm or lab errors.

• Embryo implantation failure. The embryo could fail to implant properly, preventing pregnancy. 

• Pregnancy complications. The most common pregnancy complications include preeclampsia, gestational diabetes, miscarriage, preterm labor, depression and anxiety.

• Multiple pregnancy. More than one embryo can implant at once. Multiple pregnancies (think twins, triplets, and even quadruplets) are significantly higher risk than single pregnancies. This is only a risk if your physician transfers more than one embryo to your surrogate.

Financial Risks

• Total cost. The cost of surrogacy can be prohibitive, and if multiple rounds of IVF are needed or your surrogate experiences serious complications, the costs quickly skyrocket.

• Legal challenges. Improper or inadequate legal advice can lead to costly — headaches down the road.

• Failed surrogacies. Sadly, there are no refunds if your surrogacy doesn’t result in a pregnancy or birth

 Legal Risks

• The surrogate could change their mind. It’s true: Surrogates have changed their mind, but only in traditional surrogacy where the surrogate shares DNA with the baby. 

• State-specific laws. Depending on where you live, you may have significant legal barriers to surrogacy, so it’s important to plan for it in a queer-friendly state. 

• DIY Contracts. It may seem tempting to draw up your own surrogacy contract to save money, but doing so could put your parental rights at risk during and after the surrogacy.

Emotional risks

• Surrogacy is a long road. With an average timeline of 1 to 2 years, building a family through surrogacy can be exhausting on the best of days. 

• Surrogate attachment. Your surrogate may grow attached to the baby they’re carrying, placing them at higher risk for depression and anxiety after delivery.

• Disappointment. Though difficult to admit, surrogacy won’t always be successful, which can feel incredibly disappointing.

What’s next?

With the basics of surrogacy on board, you have one more potential tool for your family creation path. To keep learning about queer family building, you can:

• Take an IVF deep dive. Use our guide to IVF for an in-depth look at this common fertility process.

• Explore LGBTQ+ adoption. Our queer adoption primer lays out what you most need to know.

• Learn about donors. We demystify the donor egg and donor sperm process in easy-to-read guides.