Let's Get Surrogacy Right

The steps we are taking to ensure an ethical surrogacy process

Author’s Note: For those new to Irreplicable, I was born with a genetic condition called Turner Syndrome. Assigned female at birth, I learned at the age of 12 that I only have one X chromosome instead of two. Because I have a single sex chromosome my ovaries did not develop. I don’t have any eggs with which to reproduce. I relied on estrogen and progesterone hormone therapy to go through puberty. I continue to rely on hormone therapy to maintain my health. Learn more about my diagnosis with Turner’s here. Because of a Turner’s-related heart condition, my husband and I are in the process of growing our family via surrogacy.

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I didn’t expect to work with a surrogate when I learned at the age of 12 that I couldn’t have biological children. There were lots of different reasons for that. Now that I am on a surrogacy journey as an intended parent, I keep coming back to the same conclusion: We owe it to queer families, cancer survivors, and families struggling with their fertility to get surrogacy right.

I was told early on about the options of adoption and using an egg donor. It was 2003, the era of “Jon and Kate Plus 8”.¹ There seemed every reason to believe that fertility options would expand and improve in the 20 or so years before I would be ready to have a child. My health was strong enough that I assumed I would be able to carry a child through IVF even if I couldn’t conceive naturally. I don’t remember discussing surrogacy in early conversations about my fertility. It wasn’t until my 30’s after my diagnosis with aortic dilatation made pregnancy life-threatening that I came around to the idea that surrogacy would be right for our family.

I also assumed that surrogacy would be too expensive. I carried a misconception that surrogacy existed primarily for celebrities and billionaires. The examples of surrogacy in the news and in pop culture were not encouraging. When I met Matt, he was clear from the beginning about both his commitment to me and his desire for biological children. Surrogacy was the path that made sense for us both.

I see enormous potential in surrogacy to be an ethical transaction. Individuals and institutions, science and social work and the law, all come together to support a growing family and a pregnant person. That’s an amazing feat of teamwork. We can put in place transparent regulations that protect the autonomy of the surrogate and prevent abuse. We chose an agency that is modeling these practices. Our surrogacy agency that is a member of the Society for Ethics in Egg Donation and Surrogacy (SEEDS) to facilitate this sensitive relationship.

The expense of IVF and surrogacy complicate surrogacy arrangements from the beginning. We will be paying our surrogate a substantial fee. That seems more than fair. We are asking her to undergo irreversible physical changes during her pregnancy. That being said, surrogates should never be dependent on surrogacy to earn a living. She must agree to the pregnancy of her own free will. Our agency proactively avoids reproductive coercion by requiring all surrogates to be financially independent without participating in surrogacy.

Surrogacy would still be out of reach for us without fertility benefits from Matt’s work. My own work in reproductive healthcare doesn’t even offer fertility-specific insurance coverage, let alone surrogacy support. Organizations like Resolve and The Surrogacy Foundation offer grants and financial support for fertility care but they aren’t able to fill the gap in coverage. Because of the large sums involved, the money for our surrogacy journey goes through a third party escrow account. We do not pay our surrogate directly. Our surrogacy agency is also separate from our escrow provider.

We also ask a third party to help ensure clear communication and establish healthy boundaries between us and our surrogate from the beginning. I am, as Matt says, “a giant cheese ball.” I am the one who asks everyone at Thanksgiving dinner to share what they are grateful for. And even to me, the psychosocial part of the match process feels… thorough. But that’s intentional! Matt and I have gone through two psychoeducational consultations with two psychologists. One was prior to embryo formation because we were using a donor. Our second session happened recently at the request of our surrogacy agency. Surrogates and their partners go through a psychoeducational consult as well. Our surrogate not only has to have the physical record of healthy, low-risk pregnancies, she also needs the social background of parenting a child. She understands what she’s getting into. Once we match, we all go back to the psychologist together. The psychologist even joked that, by that appointment, the conversation should feel repetitive. We have reviewed multiple times both verbally and in writing the most common decisions that we will need to make together. That includes everything from how often we will communicate during the pregnancy to decisions regarding abortion and birth defects. By the time we match, there should be very few surprises. Clear communication is key. It is not left to chance. Regardless of how close we become with our surrogate, our relationship will continue to be mediated by the agency throughout this process.

Becoming a surrogate is an incredible and generous choice even after substantial compensation. Surrogates choose to carry a pregnancy for another family because they view it as a way of giving back to their community. It can be a really beautiful labor of love. The more I have learned about surrogacy, the more urgency I feel to bring this family-building option into the mainstream. Regulations around surrogacy that protect women and families should be transparent and broadly applied. We can look to the guidelines that SEEDS and its peer organizations already have in place to protect the surrogates and intended parents as a framework. Abuse of surrogacy has overshadowed its potential in creating a world of cherished children. I want every girl diagnosed with Turner’s to have surrogacy as an option. We can make that happen.

1. For those of you who missed it, “Jon and Kate Plus 8” was a reality TV show featuring a family that had first twins and then sextuplets via IVF. I thought it was the height of messy reality TV at the time.