A Step by Step Guide – What to Expect
Whether just beginning to research, to being a step away from starting your journey, a 1-2 hour free consult with our agency owner will address all of your questions about surrogacy!
Whether you were referred by your fertility specialist, a friend, or found us on the internet, the first step is to reach out by phone or email. You will receive a prompt reply by our Agency Owner, who will offer to schedule a video call that is convenient for you. This allows you to “meet” us face to face from the comfort of your home or office.
Our in-depth discussion with you will include the following topics, in addition to others depending on several factors and personalized to your specific situation:
– A Welcome from Family Makers by our Agency Owner
– Review of your personal history and need for a gestational surrogate
– Estimated timeline for your journey
– Fertility clinic and/or egg donation agency considerations and referrals
– Budget: the expected and unexpected costs related to surrogacy
– State laws specific to surrogacy and how you are protected
– Health insurance in the U.S., and its impact on your journey
– What are you looking for in a surrogate mother?
– What kind of involvement would you like to have during pregnancy?
We understand that there is a lot to consider, which is why we understand that additional information may be needed before committing to the process. You will never feel pressured to begin until every question has been answered and you are sure you are ready.
When you are prepared to begin, you will then sign our Family Makers Agency Agreement, which is a contract outlining all of the ways we support you and your surrogate throughout the process. Once a signed agreement has been received, your with us journey begins!
Creating a Profile
One of the most important roles an agency has is finding an ideal match for Intended Parents and Surrogates. Each agency has it’s own process of doing this, and our approach is based on getting to know you as much as possible.
In addition to several interviews and calls with you, we will ask that you complete our Family Makers Relationship Planner. This important document gives us detailed information and feedback from you, including social and medical history and your expectations for the surrogate you will ultimately be matched with. We will ask for photos and a letter to share with possible matches, so that you can describe your story and dreams for a child in your own words.
After gathering enough information from you, we will create an amazing profile to share with potential surrogates. In the same way you choose a surrogate to match with, the amazing women who serve as surrogates in our program choose their Intended Parents based on the Intended Parents profiles they review. You are provided with a final draft for approval before it is shared with any possible matches.
Background Checks & Medical History
At the same time as we are working on your profile, we will be conducting background checks conducted by a licensed investigator to ensure there is no history of criminal activity or legal concerns we should be aware of that could affect your journey. We will also reach out to your fertility clinic, if one has been chosen, to request any pertinent information needed to match you with a fantastic gestational surrogate.
Reviewing Your First Prospective Candidate
Unlike some agencies, we do not match Intended Parents based on who has been waiting the longest. Instead, much consideration goes into presenting a profile to Intended Parents since we understand the stress of waiting, or the heartache of a disappointing match. We do not want that for any of our Intended Parents, and strive to provide as much relevant information as possible to make your decision. That is why more than 95% of Intended Parents and Surrogates who work with Family Makers agree to the first match they are presented with. We do everything possible to get it right the first time. Check out some of our former and current Surrogates with Family Makers who have helped our Intended Parents here.
Meeting Your Prospective Surrogate
Many Intended Parents have described meeting their a prospective surrogate to be very much like a first date. You have seen one another’s profile and like what you see. Still, it can be a little nerve wracking when you have so much invested in the process, while trying to create a conversation out of thin air. Rest assured that we will prepare you so that you know exactly what to discuss, and a member of our staff will help guide the conversation to ensure that all major topics are covered. If you forget to ask a question, or you think of one after your call, no worries! We can clarify anything you need to know before making the decision to match. It’s a Match! At Family Makers, our matching process means that both the Intended Parents and Surrogate agrees to the match and general terms that both parties have agreed upon. We believe that communication is the foundation for a healthy journey, and so we encourage you to begin building your relationship with your match immediately. Once a match is official, we will provide email and phone contact information so that you can begin getting to know one another.
Medical Record Review & Screening
When a prospective Surrogate applies to Family Makers, one of the first things we do is a thorough medical record review. Records pertaining to previous obstetric and gynecological history, pregnancy and delivery of previous babies are reviewed for any issues that could cause possible issues for future pregnancies. Once they have passed Family Makers’ approval process, they are then sent to your fertility specialist for final review and approval. Intended Parents can choose to have records sent to their clinic prior to meeting their Surrogate, or after their first match meeting.
Medical and Psychological Screening
Once your fertility clinic has confirmed that your prospective Surrogate’s medical records are acceptable, a psychological evaluation is performed by a licensed mental health professional. This lengthy interview is an opportunity for the psychologist or social worker to go over the risks and responsibilities of surrogacy, social history of the surrogate and her significant other, and to assess a number of things to determine if your prospective surrogate is an appropriate candidate. This evaluation also typically includes a group consultation with the Intended Parents review and clarify sensitive and important topics known to come up in surrogacy arrangements as a group. Lastly, your match may be required to complete a standardized personality assessment called a MMPI-2 or PAI, an additional tool used to assist the mental health professional in the overall evaluation.
Psychological assessment may be completed prior to or during her physical medical screening at your fertility clinic. This one to two day appointment with your RE will include an interview, pelvic exam, ultrasound and blood work. Additional tests may be performed at your physician’s discretion.
In addition to a mental health evaluation, your Surrogate will be required to travel to your fertility clinic for a day of testing and appointments. There will be extensive blood tests taken from her and her partner to look for infectious diseases, common health problems, and drug use. An ultrasound will be performed to evaluate her uterus for any scar tissue, fibroids, polyps or anatomical malformations that could interfere with becoming a Surrogate.
Once the medical approval process is complete, she will return home. She should receive final confirmation of approval in 1-2 weeks once blood tests and the psychological evaluation have been reported.
Legal Process – Choosing Your Attorney
Once clear blood results and psychological reports have been received in 8-10 days after her visit to the fertility clinic, your prospective Surrogate is then be officially “approved” by your clinic. All that’s left before you can begin your journey is contracts
One of the most important steps you can do to protect yourself and your Surrogate is to select a qualified attorney experienced in surrogacy. Family Makers is privileged to partner with legal experts throughout the United States and abroad who will prepare and negotiate your surrogacy agreement. In most cases, you will use this same legal expert once your Surrogate becomes pregnant to ensure you are acknowledged as the baby’s legal parents by obtaining a Pre-Birth Order.
Contracts can be a bit stressful, even for matches who believe they are on the same page about everything. As part of preparing for this stage of the process, Family Makers supplies a detailed list of match terms outlining all of the things you and your Surrogate have already agreed on, including compensation and delivery location. Surrogacy contracts, some as lengthy as forty pages, cover anything and everything that could arise during your journey and can provide you with piece of mind that both parties are as protected as possible throughout the process. Once contracts have been approved by you and by your Surrogate, you will visit a notary to sign. It’s now official and now the exciting part begins!
Preparing for Embryo Transfer
Once your attorney has provided a legal clearance letter to your clinic stating that contracts have been finalized and executed, a number of things start happening! n addition to the administrative side of things that we will be handling for you, such as setting up your escrow account and activating any required insurance policies, your Surrogate will finally begin preparing her body for embryo transfer. During this time, your clinic will also create a medication calendar and protocol for your Surrogate to follow. Your Surrogate’s Case Manager will review her shipment of medications and instructions just to confirm that there are no outstanding questions or concerns she should address with the clinic before beginning.
Many Surrogates do not live physically close to their Intended Parents’ fertility clinic, which means that a clinic located near her home is utilized. This is what we call a “monitoring clinic,” and is the place she will be receiving 2-3 ultrasounds and blood work in preparation for transfer.
This is a big day, and one you’ve been waiting for! Some Intended Parents and their Surrogates come dressed in matching pineapple socks, transfer shirts, lucky green polish, or other ways symbolizing the day. Just as common are those that are more reserved and do not do anything. Whatever your preference, many Intended Parents are present for embryo transfer and are allowed in the procedure room to witness the big moment. Most procedures occur mid-day, so your Surrogate will usually be asked to arrive the day before or the morning of the transfer. The procedure itself lasts a few moments, and then the 10-day countdown begins to find out if your Surrogate is pregnant.
Positive Pregnancy Test!
Ten days after transfer, a blood test is performed to determine if there is a specific hormone present to indicate pregnancy. This is commonly called “beta,” and should increase steadily over time. Your fertility specialist will order a second, and sometimes third, blood text to ensure that these levels are rising appropriately…indicating a viable pregnancy.
Approximately 3 weeks after your Surrogate’s last blood test, she will be scheduled for her first ultrasound to look for baby’s heartbeat! This appointment usually takes place at her monitoring clinic or OB’s office.
We Have a Heartbeat! – First Trimester of Pregnancy
You’ve heard the most precious sound in the world – your baby’s heartbeat! Because this is a surrogacy pregnancy created through IVF, this pregnancy will be treated a bit differently than others. Instead of an OB appointment, your Surrogate will continue being monitored by your fertility specialist for another 4-6 weeks after heartbeat is confirmed to ensure there are no complications or concerns prior to being released to a general obstetrician or midwife. Your Surrogate will also stay on hormonal medications to support the pregnancy for several more weeks.
Once released out of the care of your fertility specialist between 9-12 weeks, your Surrogate will begin attending regular prenatal appointments at her own provider’s office that will be managing the remainder of the pregnancy. Intended Parents are many times able to join one of these first appointments in person, over video call, or by phone to “meet” the staff or ask questions as a new Parent.
One of the first tests many Parents learn about during pregnancy is prenatal testing (also called NIPT), a simple blood test that can identify possible genetic abnormalities. An ultrasound-guided test called a nuchal translucency test can also be performed to check for early signs of physical birth defects as well. We encourage Parents and their Surrogates to discuss these optional tests with the provider during their first visit since it can only be done before 14 weeks gestation. Billing, insurance, and HIPAA releases can also be addressed during one of these first trimester visits.
Your Legal Rights
Second Trimester of Pregnancy
We hope that the second trimester of pregnancy is a relatively quiet and enjoyable time for both you and your Surrogate. At the 18-20 week mark, an anatomy scan will be performed to evaluate growth and to ensure everything is as it should be. Many Intended Parents attend this milestone appointment for a chance to see their baby and visit with their Surrogate. If you have not already discovered your baby’s gender and want to, you can find out now. Some Parents want to be the first to know and keep the secret to themselves, others like to plan a party and make an announcement.
Establishing Your Parental Rights
Once your Surrogate has reached the middle of her pregnancy, we will initiate a vital part of the legal process in order to establish your rights as your baby’s Parent between 18-24 weeks of pregnancy. A Pre-Birth Order (commonly referred to as the PBO) is used in all but a handful of states to assign parentage prior to the baby’s birth. Once the baby is born, the document goes into effect and protects your parental rights. These rights allow you to make medical decisions regarding care of your baby, ensures that your name goes on your baby’s birth certificate, can assist in resolving insurance claim issues, and allows the baby to be discharged home in your care.
While more uncommon, a few states do not utilize a Pre-Birth Order process, but uses a similar document called a Post-Birth Order instead. Rather than the order being prepared prior to baby’s birth, paperwork is filed after the baby’s birth sometimes with or without a hearing. If a great potential Surrogate is in a state that does not utilize Pre-Birth Orders, Family Makers will discuss that with you prior to matching to ensure you understand the process completely.
Setting Expectations for Delivery
During the third trimester, we recommend touring the hospital where your baby will be born if you haven’t already during a previous visit. From assisting with travel for our Intended Parents who aren’t local to their Surrogate, to ensuring the hospital is provided with all the insurance and legal paperwork needed, Family Makers does everything needed for a positive experience during this exciting time.
Many Intended Parents have questions about how exactly the delivery will go. Can you be in the delivery room? Will you get your own room after the baby is born? What if you miss the birth due to travel delays? What happens in case of a c-section or complications? Should a pediatrician be selected? Is it possible to fly home with a newborn? Should you bring a gift for your Surrogate? Can your Surrogate provide breastmilk? What should you pack and bring with you?
All of these questions, we can help answer to ensure you feel as prepared as possible when the big day arrives!
Whether delivery is planned, or you receive a phone call saying your Surrogate is in labor, delivery day can be extremely stressful and exciting all at the same time. Many of the women who have completed journeys with us say one of the most special moments of their entire experience is witnessing their Intended Parents meeting their baby for the first time. In most cases, Parents are allowed to attend delivery, or shortly after if a cesarean is performed. Once your baby has arrived, we will request that you are provided with your own private area or room in the hospital to bond and enjoy one-on-one time with your child.
If a Post-Birth Order or hearing is required to finalize your parental rights or to have your name on the birth certificate, Family Makers will initiate that process upon notification that your baby has been delivered. In most cases, you will receive a copy of your child’s birth certificate in 1-3 weeks after birth with your name as the baby’s parent.
Supporting Your Surrogate after Delivery
Understandably, a lot of energy and activity went into bringing your baby into the world. The end of a journey can create some unexpected feelings and emotions as a Surrogate recovers physically and emotionally from the birthing experience. Many are excited to get back to their normal lives and schedules, while others struggle to refocus their energy and emotions after so much has been put into the last year or two. Postpartum hormones can play a big part in how a Surrogate feels emotionally weeks after birth, as does her actual physical recovery. Each Surrogate’s Case Manager follows her progress postpartum to offer encouragement and resources for a successful recovery. For those who are donating breastmilk, we have a Postpartum Coordinator who can guide her on logistics and best practices regarding pumping and shipping.
There can be quite a bit of administrative work after your baby has been delivered, and Family Makers assists with making sure that it all gets done. Even with extensive preparation and instruction, sometimes medical providers and hospitals make errors with regard to filing insurance. Sometimes insurance claims aren’t paid correctly or completely, and need to be appealed.
Each journey we oversee has a dedicated escrow account which funds some of the larger costs related to your journey. The contract with your Surrogate will determine how long after delivery the account must remain open cover expected or unexpected costs. We will verify what expenses we are still expecting, and work with your Surrogate to provide any necessary documentation needed to process anything still owed. Once a final audit of your account has taken place, all unused funds are immediately refunded to you.
For our international clients, your baby is considered a U.S. citizen and is entitled to a U.S. passport in order to travel home. Family Makers can assist with obtaining a passport for your newborn, ensure that newborn insurance is in place, and that steps for citizenship are completed. Family Makers always recommends that all Intended Parents consult with an attorney in their home country to review specific processes and requirements for returning home with your baby.