Chairman of Urology, Weill Cornell Medical Center
Former President, ASRM
Medical Director, Saint Barnabas Medical Center
Family Planning Coordinator, The L.G.B.T. Community Center
Reproductive Attorney, Law Office of Brian Esser
Director, Male Reproductive Medicine, Mount Sinai Medical Center
Single and gay fathers may have the most complex journey to parenthood of any group that shows up at a fertility clinic. The number of parties that need to be selected, and coordinated, can be as dizzying as the total cost.
So where do you start? Some say start with finding a clinic, because they may also be able to provide an egg donor and save you the agony of a donor search. Others believe you should start with finding a surrogate because that is the hardest and longest search and until you have that in place, all timelines are tentative. Others suggest starting with finding a donor because if that falls through, your surrogate won't wait and will move on to the next couple.
There are really two choices when it comes to locating an egg donor. The first is to go the "known donor" route, which involves using the eggs of someone a parent knows. In the circumstance of a gay couple, that often means a relative or sibling of the partner not contributing sperm. The benefit here is that both partners get to have a biological relationship with the child, but this choice requires a fair amount of work to make sure the arrangement is optimal for all parties involved.
Another route is to locate an egg donor through an agency or an egg bank. This option is more expensive than using a known donor because it involves paying a third party to do the matching. The pros to going through a clinic: the process is cheaper, donors have been closely vetted, and the clinic handles most of the logistics to obtain the donor's eggs. The pros to using a standalone agency: their pool of donors is often larger, and you're likely to work directly with the owner of the agency.
You can expect to pay a donor anywhere from $5,000 - $30,000 and an agency $3,000 - $15,000. While the difficulty of the donor search pales in comparison to a surrogacy search, it can still be frustrating. There is a finite supply of desirable donors, and they can get taken "off the market" relatively quickly.
The first thing to consider when it comes to finding a surrogate is the law in the state in which she lives. States like California and Connectituct have laws that make paid surrogacy agreements enforceable, while states like Michigan and Louisiana do not. The implications are that the surrogate may, or may not, have a legal claim of parentage over the child once it's born.
Most intended parents locate a surrogate through an agency which, like egg donation agencies, are often small businesses operating in an unregulated field. The degree to which agencies vet their surrogates varies dramatically. Agencies typically charge $15,000 - $30,000 and most add on to their quoted price with additional charges in the fine print.
Surrogates need to meet a number of strict criteria and pass a thorough medical evaluation to ensure they can carry a healthy pregnancy. They must also undergo a psychological evaluation to ensure that they are emotionally able to relinquish the child. Additionally, they need to be comfortable with the fact that the child will be raised in a single father, or gay couple's, household. What's more, there needs to be general agreement on how many embryos will be transferred, and what will happen if there is a need to "selectively reduce," or terminate the pregnancy altogether. Surrogates can cost anywhere from $20,000 - $50,000, with prices climbing if the surrogate has been a surrogate in the past or is willing to carry twins.
Fertility clinics and fertility doctors vary in their approach to protocols, how the clinic opeates, the quality of their laboratory and the prices they charge, amongst other factors. In this circumstance, they also vary in terms of how experienced they are in working with single and gay dads: this process is more complex than it is for most heterosexual couple clients.
There are a spectrum of medical questions for single and gay dads to contemplate, and whether to transfer one or multiple embryos is high on that list. The benefit to transfering multiple embryos is that it increases the odds that a child will result from that transfer, gives each member of a gay couple the chance to become a biological father at the same time, and offers a "two-for-the-price of-one" bonus. The downside to transferring multiple embryos is that health risks rise for the carrier and offspring. Many clinics will say they do not want to do a multiple embryo transfer, but quietly many make exceptions for single dads and gay couples.
By our count, the costs of this process range from $64,000 - $195,000. Unfortunately, most employers will not cover the expense. But there are ways in which single and gay men can defray some of the costs. First, men should have a semen analysis performed and, if the resulsts consistently reflect that the man may have a fertility challenge, he is in a better position to qualify as "infertile" and pick up coverage.
Second, men should look into the spectrum of programs available to help subsidize the costs. Men living in New York may be eligible for a generous subsidy from the state to address medical expenses, and there are other organizations, like Men Having Babies and BabyQuest, that offer grants to address egg donor and surrogacy needs.
There is a 50% chance your clinic will offer you the chance to buy cycles in-bulk, up-front, at a discount and potentially with a refund feature ("baby or your money back"). We've done a fair amount of reporting on the subject and if this is something you're considering, pay close attention as to why you are being invited to participate, what success rates look for others like you who joined (key question: did they succeed early and thus overpay?) and pay close attention to the costs you'll accrue for treatments not covered by the program.
Finally, there are plenty of examples of people who have found ways to cut back on the surrogacy process itself by working with no-frills agencies and selecting donors who have been overlooked by other customers.
Given the multitude of required parties and steps involved, it's unclear where someone should begin. Here are the better arguments we’ve heard for starting with the clinic first, the egg donor first, or the surrogate first:
Finding a clinic that understands this process from the gay couple’s point of view is important, and many of these clinics should know both good egg donation, and surrogacy, agencies. Most major clinics will themselves have an egg donation agency, and if they happen to have an egg donor you like, you will have saved a ton of time and energy.
You will want to ensure you have frozen embryos before you start the more arduous, less predictable journey of finding a surrogate. If you land a surrogate, but then lose months of time trying to line up the right egg donor, that surrogate may get antsy and move on to carrying for someone else, leaving you back at square one. Or, if you select a surrogate, but do a haphazard job of choosing an egg donor, your efforts have been for naught.
Finding the surrogate is often the hardest portion of the search, and is the “long pole in the tent.” Nailing this should be your focus when you are early in the process, and freshest. As we mentioned, surrogates get antsy, and so once you have a surrogate, you have a self-created, but real, deadline: have the transfer in the next few months, or the surrogate will likely leave you. This can force you to be decisive about selecting your egg donor and clinic.