Gestational Surrogacy

Gestational surrogacy offers a way for people to become parents who otherwise would have very limited options to form a family. It is a process where intended parents contract with a woman to carry a baby for the intended parents to raise.

At Friberg Fertility, we offer a full-service gestational carrier program to help our patients select the gestational carrier that is right for them. Dr. Friberg has years of experience helping patients from Chicago, the Midwest and all around the world to have successful surrogacy cycles.

How Gestational Surrogacy Works

A surrogacy pregnancy program is where intended parents or a single intended parent (man or woman) enters into a contract with a woman to be implanted with an embryo that is created without the use of that woman’s own eggs (gametes).

There are two types of gestational surrogacy — gestational or traditional surrogacy:

In gestational surrogacy, an embryo is transplanted to the woman’s uterus where the eggs are obtained from the intended parents, but donor sperm and donor egg may also be used. In gestational surrogacy the woman who carries the baby is usually monetarily compensated and is sometimes a friend or relative, but increasingly, a hired unknown woman is contracted to become the surrogate.

Traditional surrogacy is a process where the woman who carries the baby also provides the egg. U.S. surrogacy legislation usually does not support traditional surrogacy, and it is considered more like an adoption-type process.

The pregnancy is initiated with an in vitro fertilization (IVF) procedure:


Prior to the embryo transfer, the gestational carrier’s uterine lining is primed first with estrogen and then with progesterone after a down regulation of the pituitary has been achieved with gonadotrophin releasing hormone agonists or antagonists.


On the 5th or 6th day of progesterone treatment, a blastocyst is usually transferred to the uterus transvaginally under strict sterile conditions. The natural cycle may also be used.


The gestational carrier is usually implanted with one or two embryos obtained from the intended parents.


The patient/gestational carrier rests a few minutes on the transfer table and then is returned to normal activities.


Seven to 10 days after the transfer, a pregnancy test is performed, and supervision of the pregnancy is carefully monitored.

The Pregnancy and Delivery

The gestational carrier frequently allows information about the progress of the pregnancy to be provided to the intended parents. She typically provides a consent for the intended parents to discuss the pregnancy with the treating doctor or a specifically assigned person.

Care should be taken to review the delivery conditions where the delivery will take place. In addition, you should determine if the intended parent or parents can be present at the delivery or if the gestational carrier prefers to have somebody else provide support during the delivery. It is common for both parties to take a prior hospital tour to make them familiar with the labor and delivery area as well as the postpartum part of their care.

If a caesarean section will be necessary, it is important to discuss the policy of most hospitals to allow one support person to be present in the operating room.

Arrangements should be made so that the intended parents can meet and bond with the baby soon after the delivery. The gestational carrier is frequently discharged early from the hospital, and it is important to discuss contraception as well as lactation suppression or make plans if the gestational carrier should provide the baby with expressed breast milk. If the intended parents will attempt to try to induce milk production on the intended mother-to-be, careful arrangements have to be performed long before the delivery.

About the Gestational Carrier

A gestational carrier is expected to be healthy and have a strong family environment as well as good emotional support for the pregnancy:
  • Before a woman can become a gestational carrier, she is usually cleared medically by a physician.
  • She is expected to have at least one previous pregnancy, and it is preferable to review a chart from any previous pregnancies to confirm the woman’s suitability to carry the pregnancy.
  • A gestational carrier also typically needs clearance by a mental health professional, including consultation and testing, to prove her suitability to perform this role.
There are many reasons women choose to become gestational carriers:
  • Many women enjoy being pregnant.
  • They feel like they are helping others and are supporting society.
  • Many women have friends or relatives who have struggled with infertility and understand the difficulty of forming a family.
Studies with both 1- and 10-year psychological follow up with gestational carriers have shown a positive experience for the women with a high level of satisfaction. In addition, postpartum depression and psychological problems are rare.

During the pregnancy, it is important to have open communication system so that the gestational carrier can talk with the treating doctor and also convey information to the intended parents. It’s important to emphasize that the treating doctor has the primary responsibility to the pregnant gestational carrier, but the doctor also has an obligation to keep the intended parents informed about the progress of the pregnancy. Sometimes a social worker or special person is assigned to these communications processes.

Regular obstetric supervision of the pregnancy is performed, but several studies have indicated an overrepresentation of preeclampsia, hypertension, diabetes and placental abnormalities in these gestations. Problems with birth defects in gestational carrier pregnancies appear to be equivalent to those we see in the general population where IVF is used.

About the Intended Parents

Parents who choose to use a gestational carrier may do so for a number of reasons:

  • Congenital abnormalities of the uterus
  • Absence of a uterus
  • Medical conditions that do not permit a pregnancy
  • Multiple miscarriages due to autoimmune disorders or other complications
  • Inability to carry a pregnancy

Often an OB/GYN will bring up the discussion about gestational carrier pregnancy after the intended parents have experienced multiple complications of pregnancy.

Great care should be taken to outline and prepare a contract that is suitable for all partners. The intended parents should fully understand all of the implications and ramifications of what the contract says. See “What You Need to Know About the Legal Aspects of Gestational Surrogacy” below.

You should also know the financial implications of a gestational carrier arrangement. The preparation for a gestational carrier contract, expenses for IVF insurance, attorney and agent fees frequently stretch well over $100,000. Taking into consideration all of the potential complications that can occur during pregnancy, it is nice to be able to select a gestational carrier whose insurance policy covers those expenses.

What You Need to Know About the Legal Aspects of Gestational Surrogacy

Within the United States, the legality of gestational surrogacy is still developing. Over 20 states have laws allowing gestational surrogacy contracts, but they vary considerably between states and therefore, it is essential to be working with a lawyer familiar with the condition in the state where the gestational surrogate is going to deliver.
  • An agent or agency is usually used to find a suitable gestational carrier and performs the initial communication between the gestational carrier and the intended parents.
  • After initial contact, the intended parents work with an attorney of their own liking with knowledge in the field. A different attorney is contacted for the gestational carrier.
  • After discussion has taken place, a contract is drawn up which satisfies all partners. These contracts usually address questions like the number of embryos to transfer, potential for multi-fetal reduction, pregnancy termination, pregnancy testing, planning of the pregnancy with discussion of the location for the delivery, and compensation to the gestational carrier. Expense reimbursement for the gestational carrier is also included. This covers expenses like travel, maternity clothing expenses and reimbursement for medications as well as insurance and payment of doctors’ and hospital bills.
  • Special care has to be assigned to the children where there are risks for prematurity, birth defects, cesarean section or prolonged hospitalization which may result in loss of income for the gestational carrier.
  • Currently there are no Federal or State laws giving information about issues regarding taxation of compensation of women who are gestational carriers or if medical insurance would cover the procedures. Some insurance companies specifically exclude it, and others have it included in the benefits. The landscape is complicated, and agents and attorneys can help inform both intended parents and gestational carriers about the process.
  • Another important part is the establishment of parentage after the delivery. Some states need a pre-birth certificate agreement in order to have the intended parents’ names on the birth certificate. Other states request a post-birth hearing to change the birth certificate to indicate the intended parents’ parentage. Other states use a process similar to what is performed in adoption.
  • New York and Michigan have specific legal codes that criminalize and penalize compensation pay to women to be gestational carriers. Many other states have no specific laws regarding gestational surrogacy and are relying upon court practice or specific law cases to navigate the landscape.

Gestational Surrogacy Around the World

The gestational surrogacy process is more widely known now and has increased in popularity quite considerably over the past 10 years. Compensated gestational surrogacy is a practice that is fairly specific to the United States. Many countries have banned all surrogacy, and very few have any legislation that supports it.

Uncompensated surrogacy, however, is permitted in many European countries and elsewhere in the world. Countries like India and Thailand were previously popular destinations for intended parents to create a surrogacy pregnancy, but these countries have closed their borders for compensated gestational surrogacy. Foreign surrogacy was banned in 2015, and in 2018, India completely banned compensated gestational surrogacy.

To learn more about using a surrogate, please fill out this brief questionnaire, and we will be in touch with you shortly.

To learn more about becoming a surrogate, please fill out this brief questionnaire, and we will be in touch with you shortly.