Today we talk about the journey of surrogacy, what it means to build a family with the help of a surrogate. I'm Doctor Mark Ammels and this is taco. About fertility Tuesday. Welcome back to Taco Bout fertility Tuesday. I'm Doctor Mark Ammels. If you've been following along, you know we've been covering using donor eggs and sperm donors in our last couple of episodes. Today we're diving into another topic that's becoming more and more common in the world of
fertility surrogacy. Whether due to medical conditions, family building options for same sex couples or other reasons, surrogacy offers a path to parenthood to form many people who cant carry a pregnancy themselves. But its not a journey taken lightly and involves legal, emotional, physical and financial considerations. Today were really lucky to be joined by a surrogate who graciously agreed to share her personal experiences, shedding light on surrogacy process and what its
really like. Well discuss the role of the surrogate, how theyre matched with the intended parenthood, the emotional journey and of course well answer some common questions and concerns. So lets get started. Well welcome back to another episode, the talk about fertility Tuesday. Im Doctor Mark Amos and if youve been following along, you know weve covered using donor eggs and sperm donors in our
last couple of episodes. Today were diving into another topic thats becoming more and more common in the world of fertility surrogacy. Whether its due to medical conditions, family building options for same sex couples, or other reasons, surrogacy offers a path to parenthood for many people who cant carry a pregnancy themselves. But its not a journey taken lightly. It involves legal, emotional, physical
and financial considerations. Today were lucky to be joined by a surrogate who graciously agreed to share her personal experiences, shedding light onto the surrogacy process and what it's really like. We'll discuss the role of the surrogates, how they're matched with intended parents, the emotional journey, and of course we'll answer some common questions and concerns. So let's get started. So the common term you may hear is surrogate
or gestational surrogate. And there is a difference between what we call traditional surrogacy and gestational surrogacy. Traditional surrogacy really is not used much anymore and that essentially is where you are placing sperm into a woman who is going to carry the baby but using her own eggs. So for example, let's say someone had severe egg quality and couldn't have a child of their own and had uterine problems. Their partner could, using donor
sperm. Their partner could, using frozen sperm, inject that sperm through a, iuI, intrauterine. Their partner could, using frozen sperm, inject that sperm into the person's uterus like an IUI, which is an intrauterine insemination to form a pregnancy. And then she could carry that pregnancy to terminal, and then they can get their child. This is not a very common form of surrogacy. The most common form is going to be a gestational
surrogate. This is a surrogate who carries an embryo that has been created by, let's say, a couple, which are the intended parents, and then that surrogate will carry that pregnancy but will have no genetic relationship to the baby that they're carrying. This is by far the most common cause of surrogacy used today. There are many reasons why someone may use a surrogate. One of the more uncommon reasons is because someone might be missing a uterus. There are some women
born without a uterus. There are also some women who have undergone a delivery and had to have their uterus removed during the delivery due to hemorrhage. There are also medical reasons if someone is too dangerous for them to get pregnant, or maybe they have a history of, recurrent miscarriages. Other times, there can be same sex male couples who want to build a family and will need a uterus to be able to build their family. Very similar to using donor eggs or donor
sperm. Very few people don't want to use their own uterus. Matter of fact, many people hate the idea of having to use a surrogate, but it is the only way they're going to be able to have a child. There are very few people who are using surrogates just because they don't want to be pregnant. The next step is trying to find the surrogate. There are a couple ways you can do that. The first way is you can use an agency. This company has surrogates who are ready to go who will then help you
in the surrogacy process. They will not only get you the surrogate, but they will help you with a lot of the legal paperwork and, financial things that have to go with that. On the other hand, you can use a personal surrogate. This would be someone who is a friend or a family member, which obviously will reduce the financial cost, but it will also then put the burden on you to have the contracts and everything else done that maybe the agency would have done. Some clinics can do this
in house, some clinics cannot. So some clinics are going to require you to use an agency, whereas other clinics, if they do this all in house, will not require that. Regardless, if you pick a circuit from an agency or someone who is a family member, the criteria are still going to be the same. They're still going to have to go through psychological medical evaluations to
determine if they're a good candidate. The difference is that if someone is using a family member, there is some times that you will use a surrogate that you normally wouldn't pay for, but you can still use them. For example, when my wife was going to be a surrogate for my family member, she's not a great surrogate. She's had medical history. That's not great for pregnancies such as preterm labor and preeclampsia.
But in this situation was a family member. So we can look the other way in that situation, as long as it's not dangerous to the baby. Not everyone has the benefit of using a personal family member or friend. So in that situation, they use an agency. And if you're going to be paying a lot of money for that, you really want them to have no medical issues at all, especially when it comes to the pregnancy. Interesting enough when, when it comes to using surrogate,
there are some states that are better than others. And one of the more interesting things is Texas has very good surrogacy laws and there are legal agreements that have to occur for many things, not just to make sure you have your parental rights, but there are special details that have to be done with the legal agreements, financial agreements. So both sides of this, the surrogate and then tenant parents need to have some type of legal representation to protect
their rights when going through this process. As I mentioned, some states are a little bit more friendly to surrogate see than other states. Now, as I mentioned earlier, that the surrogate has to undergo some type of medical screening. Well, so do the intended parents. And the goal here is to make sure no one is going to be having any type of infectious diseases that they could be passing along. Whats interesting is
not everyone knows theyre going to have to use a surrogate. So obviously, if you dont have a uterus, you know youre going to have to use a surrogate. So in that situation, from the very beginning, when you make your embryos, youre going to make sure your embryos have been tested for all of the FDA requirements. So when you go to use a surrogate, theres no waiver that has to be signed. However, most people are not going to know theyre going to need a surrogate.
You could have situations where you lost your uterus or maybe youre just not getting pregnant with your own uterus or have had recurrent miscarriages and youre moving on to a surrogate. Well, at that point, you never planned on using a surrogate. So all of the testing you did is not to the
requirements of the FDA. And for that reason, what happens is now they have to be tested again, not the embryos, but the intended parents, to make sure they don't have any diseases that could potentially be affecting the surrogate. These tests are very similar to maybe testing you did when you went through the IVF process, but they're a little bit more in depth on
the surrogate side. You want to also make sure that their uterus is good, so they want to undergo testing, such as a sonohistogram or hysteroscopy to make sure they have a ah, uterus. That's going to give you a good chance. Now, when it comes to the embryo transfer, it's pretty standard now that only one embryo is transferred.
A lot of times people will also do genetic testing on their embryos, so they have a higher chance per transfer because you are paying this surrogate to do these transfers and so you don't want to spend a lot of money per transfer and then find out the embryos are not good and it costs you more money in the long run. So for the transfer, it's pretty standard now to do one embryo at a time and to also have genetic testing on them.
Matter of fact, I was recently reviewing the surrogate, and they actually had on their theme that they won't even allow embryos to be transferred into them if they're not genetically tested, which is quite unusual since that's how everyone else gets pregnant. They don't test their embryos when they're having intercourse. So I thought that was a little strange, but it shows you that there really is a big trend
going that way. Now, after the transfer, the surrogate will be monitored, and usually they'll communicate with the intended parents, who will then, you know, tell them how certain pregnancy things are going at different scans, and they could even be there. Sometimes they'll even be at the clinic, you know, doing the ultrasound. But the point is that it doesn't just
end with the transfer. Throughout the whole process, throughout the whole pregnancy, you will be talking to your surrogate, and then when it comes to the birth, the same thing. You can be there for the birth and most surrogates are going to be
okay with you being there. But again, on that sheet, when I was looking at this surrogate, I noticed that there was the option for them to not have the intended parents in the room when birthing, which I don't think many would actually put that, but again, that is their choice. And that brings up the point of these contracts. The whole point of these legal contracts is to make sure everyone's on the same page. In that same page, we want to make sure
that the intended parents also have rights. And so usually what you do is you have a birthing plan, and that is to make sure that both the intended parent and the surrogate are all in agreement when it comes to the birthing plan. Now, what's interesting is that even though you might have plans, it's always important to understand that a surrogate is always going to be more important than the baby. Now, what do I mean by
that? What I'm saying is that if you have a baby in your body and let's say you get severe preeclampsia, you are allowed to legally make the choice to say, I'm willing to take risk to keep my baby in my body for a couple more days if it helps the baby. However, for the surrogate, you cannot ask that. As a matter of fact, that's what some of the legal documents talk about, is that if the mother is ever at any risk being the surrogate, it would be important for them to deliver.
And that's something you have to agree upon, which obviously seems to make sense. I would agree with that. But again, it's just different when it's in your own body. The last thing before we get into this interview I want to talk about is financial. We know agencies can charge somewhere between $15 to $30,000. Surrogates can be anywhere between 35,000, can be up to 50,000, sometimes even into the hundred thousands. And then there's legal fees, which can also cost you around ten to 15,000.
Then there's medical expenses, whether the person has to go and stay in the hospital the whole time. So that could be 20 to 40,000. There's also expenses. If they have to stop work, you have to pay for the work. When they're not able to go to work, there's insurance that you have to get for health insurance in case their insurance doesn't cover for the pregnancy. And so when you add this all up, most of the time it's somewhere between about 100,000 to 150,000. If you were using a surrogate who
is from an agency. Now, when using family members, it can be much lower cost. And if that family member's insurance allows her to carry the baby even though she's being a surrogate, then it also reduced cost them. In the end, this is not a low cost option, and many people can do it. It's important to know that there are some companies out there that do support surrogacy and even help pay for it.
And so if you are one of those people who potentially need to use a surrogate, look for those jobs and see if you can maybe get on those insurance plans. There's a lot more that I could, go over every little nuance, but I think the best thing now is let's go to the interview, because I think at that point, you're getting to hear it from a surrogate themselves versus me explaining it.
Welcome to talk about fertility Tuesday. I'm excited to talk to you because we've been doing some episodes on things like donor eggs, we've been doing donor sperm, and now we're going to be talking about surrogates. And I thought I could talk about it and I could tell everyone how to do it, but what would be better than hearing it from someone's mouth? And you have a very unique perspective, because what you may introduce to people is not only have you done this before, but
you are also a fertility nurse. And I think that gives you a kind of view that other people wouldn't have. And so I wanted to first thank you for coming on the podcast.
Oh, no, definitely. Thank you for having me on your show. Doctor Emmels. This is definitely an honor.
So if you wanted to share a little bit about yourself and kind of what inspired you to become a surrogate?
I have been a surrogate. I'm on my third journey now. And, what initially inspired me to be a surrogate was my love of being a mom. It sounds corny, but that's what it was. I love being a mom so very much, and, I'm almost starting to cry just talking about it now. But, And after I had my son, I just felt that, like, there are people out there who would be such amazing parents and love being a mom or
dad as much as I do. And the fact that there are people out there that couldn't when there are so many people out there who can and are not good parents, it just hurt my heart. So, I went on the path to be a surrogate.
Was there something about being a surrogate was it that you liked pregnancy a lot, or was it, you know, is that what you mean? Like, you really enjoyed being pregnant as well?
Yeah. Pregnancy has always been really easy for me. I've been very lucky in the fact that my pregnancies always go very, very well without a lot of symptoms. And, that was probably another one of the reasons why I took that path to be a surrogate was I enjoy pregnancy. Pregnancy is relatively easy for me, and I felt that I could help in that way.
And so the day that you figured out you wanted to be a surrogate, I mean, how did you know what the next step is? Like, how did you say, like, you know, hey, I want to be a surrogate. Where do I go next? Where do I sign up? Like, how did you figure that out?
A lot of Internet research. I was really lucky that I actually have a family member who's actually a surrogate as well, has been a surrogate as well. And she helped me point. Point me in the right direction. But, in the end, it was a lot of, like, research on agencies and the time that it takes to actually do a cert, like a journey. It's not like I say I want to be a surrogate, and the next day I go to the fertility clinic.
So it's weird. There's not a lot of surrogates out there. I know this because I have patients who want to have a surrogate, and there's just not a plethora of people want to be surrogate. Is that you think. Because I know this is just your opinion, but is that because it's just so difficult to go through? I mean, again, I can't imagine doing anything for nine months, you know, that you have to just do.
But is it because of how much it is evolved or is it because there are obstacles that you felt when you were going through that could really stop people from wanting to do it?
I think there's a mix. One, you have to be the right type of person. Not every person can hold a baby in their belly for nine months and be able to give it to their parents. I think, Ah, a lot of surrogates, you have to have the right criteria. That sounds silly, but, you have to have already had a baby. You have to be okay being done having babies. Like, if I had to have an emergency c section that caused me to have a hysterectomy, I'd be done. I couldn't have any more kids.
So, you have to be okay with, the time involved. you have to have easy pregnancies. You can't have had issues like gestational diabetes or preeclampsia. So there's a lot of obstacles, and then I think there's a lot of people who maybe don't know about it.
Too, when it comes to the process. there's obviously a lot of testing that has to be done. for example, obviously you have to have infectious disease testing. There are, psychological evaluations that you and your partner need to go through. talking specifically about that. How was that for you and your partner? I can understand as a partner going. Yeah, I'm okay if you go through it. But then they're like, wait, I have to be involved too. The partner is involved.
I mean, there is part of that. How did your partner take it when you wanted to be a surgeon? You told them so.
My husband has always been really, really supportive of me, and, he is understanding of the fact that he has to go through a lot too. Like, he has to have the blood tests, he has to have the psyche vowels, he has to have all of the interviews with me, he has to meet the intended parents with me. a lot of agencies require that the partner travels with you to the fertility clinics, wherever they may be, and for the transfers, as like, support
persons, so that you're not just going by yourself. So he has to take time off of work. and he knows my passion about helping people, and so he's really supportive of that. I mean, I can see how some other, other partners may not be, though, right? Because it's a lot on both sides.
Was there anything, you know, I talked about earlier, in this podcast about. Some of the medical screening that people. Have to go through, both the wife and the husband, and, for a partner in that situation sometimes. but was there any part on the medical screen that you felt was difficult, that you felt like, I don't know why I want to do this, or did you feel it was overall nothing too difficult to do?
no. The medical screening has never been too terrible. It's always been, they go through all of my Ob GyN records, and then I have, Usually I'll have an SHG, which some people can find uncomfortable, but they've never really bothered me particularly. And then we'll have to. Sometimes they'll do like a mock transfer, sometimes they'll do a mock cycle to watch your lining grow. and they've never, it's never been too terribly difficult, a little time consuming, but that's really about it.
I'm not sure if you're aware, but. My wife and I, we were going to be a surrogate for my sister, and, unfortunately, it didn't work. We weren't ever able to be successful. but there were some emotional things that we had to think about. For example, if my wife was at danger, we would want to deliver right away if possible. But if it was my own kid, we may be willing to wait a little bit longer. We may be able to say, hey, if we can give the kid two more
days. Whereas with my wife, I can't lose my wife just for someone else. And we had to have that conversation with my sister saying, please understand that we will do everything we can, but there is a point where there's only so much risk we can take. Does that conversation come up between you and your partner and tenant parents?
It does, and it's part of the surrogacy contract. So, when it comes to my health, it's gonna come first to the point of, if it's, like, at risk, if something is super, like, if this baby doesn't come out right now, I might die. I'm gonna put myself for it first, and everybody is okay with that, and it's understanding of that. However, if there is time to give the baby time, then we're going to do that.
When. When you were caring for the baby because you've carried for your own, and now you're caring for someone else's. I know you, so I don't think you probably did anything different. But was there a feeling, like, of doing something different? Like, you're like, well, it's not my kid, or. Or when you're caring for someone else, is even the other way where you're like, this isn't my kid. I even have to do more. What did you feel in that situation when you're caring for someone else?
So I go above and beyond for both my kids and my surrogate babies. but I definitely have this feeling of I have to do more. It's not mine. so even when it comes to Tylenol, I'll take. I won't even take Tylenol for a headache unless I have to, because it's not my baby. Right. So anything like that, that I'm doing, like that is putting somebody else's child at risk. And so I'm. I'm gonna go even beyond what I would have done for my own. Does that make sense?
Absolutely. I mean, I wouldn't expect anything different from you. I think that's probably. I think people go through that conundrum, you know, of, like, hey, like, this isn't my career, to do more, you know, like almost this feeling of guilt if they don't, if they don't think well. And talking about them. Were there any emotional challenges that you had through the process and if you did have them, how do you navigate those? I mean, when you're going through this?
So, you go into the process knowing. Right. You know, that in the end, you deliver the baby and it goes to the parents. So, I think I said it earlier, it just kind of takes a different type of person to be able to think that way.
Is it tough?
I'm trying. for me, no, it's not at all. I know I get this question a lot. Honestly, the question I get the most, is it hard to give it up at the end? And, no, for me, it's not. I love the day that the mom or the dad get to hold the baby. It just makes my heart so full.
Was there any physical, challenges being the surrogate, or was it pretty much just like your other pregnancies?
They've all been very similar to my other pregnancies. I think that if I had a lot of physical challenges, I probably wouldn't have been a surrogate again.
One of the things I really want to go into, just a couple more things, is kind of your relationship with intended parents. How did you first connect with intended parents, and what was that initial meeting like? Do you kind of interview them just. Like they're interviewing you or, you know. I know the doctors. Like, in my case, I interview the surrogates and decide if they're good or not. in your situation, how did it go?
So, all of the times that I've met my intended parents has been, the agency will both send our profiles to each other.
Right.
So I'll get their profile and they'll get my profile, and it kind of goes off of our history, like who we are, what we live, where we live, our hobbies, our likes, our dislikes, any previous kids we might have, that kind of stuff. And then why we want to go on the journey we're going on. And after we read the profile and decide that, yes, I do want to meet this person, then we'll, they set up a meeting.
Things like boundaries and guidelines. Are those then set between you and the parents?
A lot of them, yes. You know, we'll discuss things like, what kind of contact do you want after birth and stuff like that. And if I wanted more contact than they wanted me to have, you know, then they want to have or whatever, then maybe we won't mesh well.
What about communication during the pregnancy? I mean, is there. Do you guys maintain that throughout when you go to appointments or, you know, how are they getting the information? Is it directly from you? Is it going from the clinic?
so for the fertility part, they got a lot of their information from the fertility clinic, and, then me afterwards. But for the actual pregnancy part, I'll go to my ob Gyn and then I'll tell them, you know, hey, this is what happened at this appointment, but they can always, always, always go and ask my ob gyn anything that they want. So, the whole pregnancy is open to that. My records are open to them.
So the last two areas I wanted to talk about were, one, just the post birth experience that you had and how that is. And then the last part is just your own opinion, advice to people who. Want to do this. But if we can start first with what was it like after giving birth and handing baby over to the intended parents emotionally, it sounds like you really enjoyed it. But what was that transition then from carrying this baby the whole time to
nothing? And, you know, if you can kind of describe that for us.
so when you have your own child, you know, you. You go to the hospital and you have the baby and they put the baby on you and, you know, you feed the baby however you decide you were going to feed them, and, you know, you snuggle with them and you get to know them in your room and all of that. When you're a surrogate, though, the bait, you know, the baby is born and they go to their little incubator pod thing. I'm m sure it has a
name that I can't think of right now. And then the parents go there, and the funny thing is, is my husband also goes there and he starts taking pictures. So usually it's just me and the doctor hanging out, chit chatting. but then, you know, I'll go to my own recovery room, and the baby and the parents will go to their own little nesting room so that the baby can continue to be monitored post birth. And for me, it's fine because I know that, hey, this is what I was going into.
Emotionally, it's almost kind of a relief to be done because by the time you're 40 weeks pregnant, you're like, I just want this baby out of me. And then, it's like, it's also this, oh, I can finally sleep. And, I know that sounds silly, but that's how it is for me. it's just this excitement that they get to have their baby and I can go about being myself again.
What about the intended parents? How did they handle, I mean, have you found since you've done this more than once? Like, do they handle it different to some, you know, it's kind of like, oh, we're happy now, we'll take our baby and leave? Or is it more like, you know, no. Can we keep in contact? How did that go in the different experiences?
So my m first intended parents, they stayed for two weeks, and they came over and they bring the baby over once in a while, because I pump for them, so they come and pick up the milk and, they would bring the baby over and I'd be able to say hi and that kind of stuff. And then when they left to go back home, I get pictures on her birthday, which is really fun for me. And then my second intended parents, they stayed for three months, because I think that's just their culture.
but I never got to meet her, after birth. And then after they went home, I get a couple pictures once in a while, but we don't have as close contact. And, it's a little sad because I'd love to see how she's growing up, but I also know that it's their life and they're busy and, you know, I'm sure she's okay.
I feel like it would be slightly different than, let's say, with donor eggs because I know a lot of people struggle with the idea of, do I tell my kid it wasn't my egg? But telling your kid you couldn't carry. A baby, you know, isn't something that anyone I feel like would be ashamed of, just like someone shouldn't be ashamed of getting a donor egg. But I know a lot of people struggle with that. And so, yeah, it seems like most people wouldn't
mind letting their kid know, like, oh, this is the person. Where's the surrogate? Did you feel it was hard not knowing, you know, not having as much, contact that time? Was that. Was that harder?
I do. I do feel a little sad. I wish I kind of gotten to say bye before she left for home because she lives in China, but in the end, I mean, I know she's happy and I know her parents adore her.
There is a financial portion to this, right, other than if it's a family member. When you are using a surrogate and you're using an agency, there is going to be a financial component, right? And there's financial components not just from the standpoint of, of paying the agency, paying for medical stuff, but even the surrogate usually will have some type of financial benefit because, again, for nine months, they're going to buy through this. And so I think what you said hit the nail on the
head. People sometimes are concerned that is this person just doing for money. And it sounds like what you're saying is that no one would just do this for money because of all the work they had to go through just to get to this point.
Absolutely.
what you're saying is that no one really would just do this just for the money.
Absolutely. Absolutely. The, the time involved to even get to the point where you start getting paid is so much that it would, the people who, you know, probably did maybe start out for it would have already left. They would have been like, no, this is too much for me.
That makes sense. Like I said, it's, it's something even I've thought before. But you're right. I mean, everyone I meet, you know, they've been through a lot to get to this point. And, you know, my job as the physician is just to make sure they're a good candidate, you know, that there wasn't anything in their history that would make them a bad surrogate. and, Yeah. Well, I really appreciate everything you've done here, and talk to us. One last thing is just, is there.
Anything you want to say that maybe. I didn't ask do you think might be important for people knowing that we can leave on?
I honestly think you touched on a lot of the points that I get questions on almost all the time when I tell somebody that I'm a surrogate. So I think you covered a lot of it. Doctor Amos.
Well, thanks so much, Megan. Well, I really appreciate it. Like I said, the fact you've done this three times is amazing. I mean, I just donated my hair one time, and I thought that was a lot of work for three years, and so. And I'm, like, questioned by whether I want to do that again. So the fact that you carried the baby three times, to me, shows you how bad men are at wanting to commit to something so long. So, which is the reason why babies.
I know this was a very long episode, and I usually don't make them. This long, but I thought it was. Such a great interview, and I wanted you to be able to hear it, not just from my perspective, but also from the surrogate perspective. I have some other episodes coming up as well where I'm, interviewing people. And if you like this, let me know. You know, please send me an email on TBF or even through one of our pages. Let me know and I'll try to do more of these. As always, I
greatly appreciate everyone that listens to the podcast. I hope this was helpful for you and maybe you know someone else who may benefit from it. So tell them about it. But the main thing is, if you like us, tell everyone about us. Give us a five star review on your favorite medium. But most important, keep coming back to talk about fertility Tuesday.