Some women hate being pregnant, but it's those who love the journey that make up the vast majority of gestational carriers.
Jodie Hayes had something on her mind. For four years, it tugged. For four years, she let it simmer.
Finally, the time was right – or at least as right as it ever would be – to bring it up with her husband, a U.S. Army soldier who was training in another state.
“Do you remember when you were a kid getting asked what you wanted to be when you grew-up?” Hayes, a 38-year-old who lives near Savannah, Georgia, wrote to him in an email during the summer of 2013. “I really wanted to be a mom. I didn’t care about a fancy career or getting rich. I just wanted to be the best mom I could be."
“Fortunately, you and I were able to conceive and become parents pretty easy,” continued Hayes, whose daughters are now 14 and 17. “I can’t imagine how it would feel to not be able to do the most natural thing in the world, experience pregnancy and having a child. Can you imagine life without our girls?"
Then Hayes cut to the chase: "This is why I want to become a surrogate."
Hayes was talking about becoming a gestational carrier, or woman who carries another couple's embryo to term. The process involves using assisted reproductive technology to fertilize a woman’s egg with a man’s sperm in a lab and then transferring the resulting embryo into the carrier's uterus. (In the other type of surrogacy, called traditional surrogacy, the woman is the child's biological mother but became pregnant via artificial insemination.) In a sense, Hayes was telling her husband she wanted to rent out her uterus to another family.
“I wanted to be the answer to someone’s pain or frustration [by helping them] get the family that they wanted,” Hayes said in an interview with U.S. News. “I wanted the pride of being able to do that – being able to get them to smile again – and be able to hold the child that they wanted to hold.”
The Goal: A Healthy Baby
Some women hate – they get , feel sluggish and tired and wish they could fast-forward to the good part: a baby. Other women love being pregnant – they glow, feel energized and at peace, and enjoy the journey and the destination. It’s the latter group that makes up the vast majority of gestational carriers, says Michele Purcell, a registered nurse who directs the , donor egg and gestational carrier programs at Shady Grove Fertility Center in Rockville, Maryland.
“Most women have good pregnancies, but I would say [gestational carriers] have exceptional pregnancies, where they really just feel great the whole time,” she says. “And if they don’t at the beginning, it’s so worth it at the end that they don’t mind it.”
There are other, less altruistic reasons, why a woman might want to become a gestational carrier. Namely, the money. Surrogate anywhere from $15,000 to $60,000, depending on various factors such as the agency, location, agreement between the parents and the surrogate and how many babies the woman carries. (All medical care, travel and other costs related to the pregnancy and birth are reimbursed as well.)
For Hayes, the prospect of paying off debt had an undeniable draw. “The money is about 40 percent of the reason I’d do this,” she wrote in another email to her husband. “The other 60 percent is split between wanting to be pregnant one more time and helping a couple become parents.”
On the other side, couples seek out women like Hayes because they the traditional way for all kinds of reasons. A woman, for example, might have a medical condition that makes pregnancy and childbirth life-threatening. She may have an abnormal or absent uterus due to a congenital condition or .
Breast taking tamoxifen – which is prescribed after treatment ends to keep estrogen levels down – are frequently in the market for gestational carriers, since the drug isn’t safe during pregnancy and women are taking it longer than they used to, Purcell says. Gay couples are also seeking gestational carriers more, whether they use the carrier's egg or another.
For Dr. Angeline Beltsos, the medical director of Fertility Centers of Illinois-Highland Park IVF, a surrogate was the safest way to complete her family. Her first three children were born via cesarean;, the fourth baby was born prematurely and did not survive. Although she and her husband continued to try for a fourth, the complications of the last delivery and prior C-sections made it difficult. That’s when they turned to something Beltsos knew well from her work: surrogacy.
“If you have the ability and you cannot carry a pregnancy yourself or you shouldn’t carry the baby yourself, using a gestational carrier is a means to an end,” she says. “Make sure there are people guiding you medically, emotionally and legally, and you will find success ultimately having a healthy baby in your arms – and that’s the whole point.”
Who Makes an Ideal Surrogate?
Once Hayes garnered support from her husband and children, she sought a surrogacy agency to act as the middleman between her, the parents and a fertility clinic. Reputable agencies screen gestational carriers and their partners for diseases, perform psychological assessments on surrogates, tell them what to expect and provide support throughout the pregnancy, says Dr. Richard Paulson, director of USC Fertility in Los Angeles.
At Shady Grove Fertility Center, the team partners with agencies that do thorough background checks, including pulling credit reports and driving records and evaluating the gestational carrier’s home environment, Purcell says.
Outside of their credit score and mental health, there are characteristics that make women ideal gestational carriers: They’re between 21 and 40 years old, , don’t smoke, have a support system and don’t want to have any more children of their own, Purcell says. “You would hate to see someone have a complication if they haven’t finished their own family building,” she says.
Almost all gestational carriers also have a track record of uncomplicated pregnancies and . Not only do those experiences often drive their desire become a surrogate in the first place, but they assure the intended parents that, essentially, the parts work.
“There’s always unknown things that can go on, and wouldn’t you want to minimize those risks?” Paulson says. “And what better way to do that than to make sure that this uterus has already been around the block?”
Eventually, surrogates are matched to intended parents based on factors such as location, their expectations during the pregnancy and childbirth, and views about how to handle complications and legal issues.
For example, will the intended parents accompany the gestational carrier to all medical appointments? What if she ends up carrying twins? What if the baby has a genetic abnormality? What will the relationship be like between the baby and the gestational carrier once the baby is born?
Things can get particularly complicated when gestational parents and surrogates live in states with different laws. In New York, for example, it's illegal to use a gestational carrier, while California is so "surrogate friendly" that hospitals put the intended mother's name on the birth certificate when the baby is born, Paulson says. Most gestational carriers and intended parents hire lawyers and write up a contract before beginning the process, but ultimately, it comes down to trust.
As Hayes wrote in her follow-up email to her husband, "the intended parents have to choose to trust me with their unborn child for nine months. To keep it healthy, safe and hand it over to them at the end … not flee the state."