As we mentioned, the legality around gestational surrogacy is highly-variable and so too are the costs (if any) associated with the process.
Below we chronicle some of the line items intended parents see in a country where compensation is legal. These costs exclude IVF costs which vary dramatically by region.
While there are often alternative ways of funding fertility treatment, gestational surrogacy can create an immediate financial drain on intended parents.
In countries where compensating a carrier is legal, more often than not, intended parents will work with a carrier who insists upon compensation (unless a friend or family member is prepared to be an “altruistic” gestational carrier).
In this case, costs typically adjust based on a few factors. “Supply-and-demand” market forces allow gestational carriers living in surrogacy-friendly regions to ask for more compensation.
Similarly, a gestational carrier who’s been through the process before typically commands a premium, the intuition being they’re more prepared for, and more reliable during, a complex process.
Finally, a carrier who’s prepared to carry twins (we’ll discuss the risks of this more in depth in a later lesson) also tend to be compensated more highly.
Often, intended parents need to be introduced to a gestational carrier. While some intended parents will use their own network to market their needs and find a match (known as “independent surrogacy”), most will enlist a third party (e.g. agency, attorney) to make a connection.
Gestational surrogacy can involve numerous steps and moving parts—agencies that provide more resources and hand-holding, and which are more established, tend to cost more. As you’ll see in our next lesson, intended parents often pay third parties upon milestones (e.g. successful match, signed contract, confirmed fetal heartbeat, delivery).
Private health insurers often dislike covering a pregnancy under an existing policy if it’s a pregnancy via surrogacy. As a result, alternatives may need to be found, and they’ll cost money.
Addendums to update an existing plan, or an altogether new plan, may feature steeper premiums or higher deductibles as insurers know they’ll be paying for a major medical expense in short order and want to factor that into the charges they’ll collect from you.
Insurers are particularly worried about surrogacy pregnancies because as recently as 2016, in situations where multiple embryos were created, 80% of transfers to a surrogate used two-or-more embryos. That matters because the cost of delivery goes up substantially in the case of twin-or-triplet pregnancies. For a sense of proportion of how the costs rise (regardless of who may be paying), below is data published in the American Journal of Obstetrics and Gynecology.
The cost of policies can adjust depending upon how many embryos were transferred (if coverage is obtained before the transfer) or how many heartbeats were seen on ultrasound (if coverage is obtained after).
For this reason, some employers who pay for portions of the surrogacy bill tend to insist on transferring one embryo at a time.
It’s considered best practice for both the intended parents and a prospective gestational carrier to receive third party guidance from attorneys and therapists.
For intended parents, the psychological evaluation can help explore the tradeoffs of gestational surrogacy, and if relevant, address any lingering grief about not carrying. For the gestational carrier, the “psych eval” can help determine if they’re prepared mentally and emotionally for a complex process.
Typically, intended parents cover the cost for both legal and psychological counseling for both parties and for intended parents and a gestational carrier to use different attorneys. Agencies can be helpful in locating attorneys and therapists,helping to ensure appointments are made, documents move swiftly, and needless friction is removed.
Legal costs tend to outstrip psychological costs, and it's important to use attorneys familiar with the intricacies of gestational surrogacy in the region where the delivery will happen. As you’d expect, the more nuances and details to hammer out (which we’ll cover in the next lesson), the quicker prices rise.
Often gestational carriers and intended parents don’t live nearby, and so somebody will need to travel for in-person get togethers, appointments, and the delivery. Costs vary dramatically between who goes where, with what frequency, and how long stays last. For some intended parents, it’s critical they be at every appointment. For others, they come to recognize they can be more selective when they travel and use the found time or money put to other good uses.
Many societies highlight the value of breastfeeding for infants, and so it’s customary for intended parents to want (and gestational carriers to provide) milk for a few months post-delivery.
Specifically, many societies recommend a child consume breast milk for multiple months, which may mitigate the risk of pneumonia, as you can see below.
The process of getting milk to intended parents requires pumping, freezing, and often shipping on dry-ice, which can be an intensive and exhausting process. The process becomes a burden on carriers and many have trouble doing this for longer than a few months.
The costs vary but this process can cost upwards of $1,000 per month. In some regions of the world (e.g. California,) there are breast milk banks where parents-via-surrogacy can get milk shipped to their home.
Sometimes, gestational carriers will be compensated if the pregnancy forces them to forego work for stretches as brief as a few days or significantly longer.
It’s common for a gestational carrier (and a partner or spouse) to take time off of work to travel for an initial evaluation by a fertility doctor, for the transfer, and for ultrasound and monitoring appointments.
What’s more, some gestational carriers work in jobs that can be physically or emotionally demanding, and the pregnancy may require they pause work, turn down shifts, or stop altogether.
During the contracting phase (which we’ll cover in the next lesson), the risk and implications of any sort of work stoppage should be contemplated.