Gestational Surrogacy for Gay Men

The Gestational Surrogacy Program at RMA of NY

The search for a gestational surrogate can take up to 6 months. Choosing a surrogate is a very personal decision and there are many factors that should be considered. It is important to identify the right agency and legal representation at the beginning of your family-building process. RMA of New York’s Third Party Team will work closely with you to assist in this process.

• Agency Selection

  To find a surrogate, the Third Party Team at RMA of New York provides patients with a list of surrogacy agencies. Contacting these agencies and learning about their programs is the first step in this journey. The agencies help guide patients as they view surrogate profiles and aid in finding lawyers for ongoing representation. The agencies review the details of each case and develop a unique contract for each patient that outlines different scenarios. Additionally, the agencies give a breakdown of the different programs they offer and the financial aspects of the entire process. The chosen agency will be responsible for identifying potential surrogates and for performing the in-depth investigation of the surrogate. This includes background checks for the surrogate and any partner/spouse, home visits, criminal checks, and financial checks.

• Surrogate Selection

  A gestational surrogate candidate is an individual who has given birth to at least one child of their own without complication. Gestational surrogates must live in a stable home environment and have a good health history. They must be within the ages of 21-45 years old and not have a body mass index (BMI) greater than 35 kg/m2. Gestational surrogates can be known (family member or friend) or compensated (paid through an agency).

  It is important to identify a surrogate that will be aligned with the intended parent(s) views on pregnancy. The surrogate will carry the child as it grows and the surrogate’s decisions can impact the intended child’s development. It is helpful to consider the following questions, therefore, when choosing a surrogate:

  • Where does the gestational surrogate live and where would she deliver?
  • Is attending prenatal obstetrician (OB) visits during the pregnancy important to you and will the surrogate be accommodating?
  • Will the surrogate allow you to be in the room for the delivery of the baby?
  • Does the surrogate have a healthy diet?
  • Does the surrogate have the same lifestyle values as you?
  • Does the surrogate have a support system in place?

• Surrogate Contract and Legal Documents

  Before the start of any medical procedures, both the intended parents and the surrogate must work with their legal representation to write, review, and sign a surrogacy agreement. This agreement is legally binding and enforceable in order to best protect the interests and rights of all parties involved.

  The surrogacy agreement is a comprehensive document that describes the rights and responsibilities of the surrogate and the intended parent(s). While every surrogacy agreement is different based on state surrogacy laws and each party’s individual needs and circumstances, in general it should include the following elements:

  • The surrogate’s financial compensation
  • The risks and liabilities associated with pregnancy
  • The surrogate’s responsibilities to take care of herself and the baby throughout the pregnancy
  • An agreement on sensitive issues, such as termination, should they become necessary
  • List of individuals permitted at prenatal appointments and the birth

• Surrogate Medical and Psychological Screening

  Once the intended parent(s) choose a surrogate and all legal contracts are in place, the surrogate will begin a screening process to ensure that she is able to move forward with an embryo transfer. Both the surrogate and their intimate partner (if applicable) will undergo specific screening as directed by the Food and Drug Administration (FDA) and the American Society for Reproductive Medicine (ASRM). Screening includes:

  • Infectious disease testing for the surrogate and partner (if applicable)
  • Urine drug screening for the surrogate and partner (if applicable)
  • Physical exam of the surrogate
  • Saline Sonogram to assess the uterine cavity
  • General blood work
  • Psychological screening with Dr. Georgia Witkin for the surrogate, partner (if applicable), and the intended parent(s)

• Identifying Egg and Sperm Sources

  Because a gestational surrogate cannot donate their own eggs as part of the surrogacy agreement, the intended parent(s) must identify a sperm and egg source. If needed, the intended parent(s) may choose to use donor sperm and/or eggs from a bank.

  Individuals who may be unable to conceive due to azoospermia (the absence of sperm), severe male-factor infertility, or a lack of sperm source may consider using donor sperm from a licensed sperm bank or a known donor. Donor eggs can come from a variety of sources, including non-identified (anonymous) egg donors from RMA of New York’s Egg Donation Program, an agency egg donor, a donor egg bank, or an identified or directed (known) donor.

  FDA screening of individuals will occur prior to the creation of the embryos based on the egg and sperm source. This will include infectious disease and genetics screenings in addition to a physical exam for both the egg and sperm donor sources.

• Preimplantation Genetic Testing of Embryos

  RMA of New York highly recommends Preimplantation Genetic Testing (PGT) on embryos intended for transfer into a surrogate. PGT can be used to evaluate embryos for genetic abnormalities before they are transferred into the uterus to attempt pregnancy. This allows for the selection of the healthiest embryo for transfer.

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• Embryo Transfer

  Once the previous steps are complete, the surrogate is cleared to begin an embryo transfer cycle. The surrogate undergoes additional infectious disease testing, bloodwork, and a transvaginal pelvic ultrasound just prior to the start of the embryo transfer cycle. After these results are collected and reviewed, the Third Party Team advises the surrogate on medications to take in order to prepare their body for the embryo transfer cycle. The surrogate comes in for morning monitoring appointments that involve blood work and transvaginal pelvic ultrasound about once a week. The fertility physicians review the surrogate's progress based on results and medications are adjusted, as needed, in order to increase the thickness of the surrogate’s uterine lining prior to embryo transfer. After approximately two and a half weeks, and after adding progesterone to the treatment regimen, the surrogate’s uterine lining should be ready to accept an embryo. At that time, an embryo from the intended parents (previously created using donor eggs and the sperm from one or both partners, or from a sperm donor) is transferred into the surrogate’s uterus. The embryo that is transferred may be fresh or thawed after being frozen in a previous cycle.

• Confirming Pregnancy and Post-RMA

  Two weeks after the embryo has been transferred, the surrogate will take a pregnancy test to confirm a pregnancy. If they receive a positive result and have achieved a successful pregnancy, RMA of New York will continue to follow the surrogate until about 9 weeks of gestation when a heartbeat can be identified on ultrasound. At that time, RMA of New York will recommend that the surrogate continue to receive care through her OB-GYN.

  Understandably, the intended parent(s) may want to be involved in the pregnancy as much as possible. A common example of this is attending regular pregnancy check-ups. Terms of the level of involvement should be predetermined prior to the embryo transfer and a mutual agreement should be reached before a pregnancy is achieved. Oftentimes, the gestational surrogate is located in another state and in-person visits are not feasible. However, telemedicine now offers more opportunities to be involved despite distance.