Surrogacy: A Path to Parenthood That’s on the Rise

Bringing home a baby through surrogacy is something more families are considering and sharing openly. For couples and individuals who want to have a baby but face medical or other obstacles, working with a gestational carrier can offer a path forward when it feels like every door has closed.

“A gestational carrier is such an important option we can provide to our patients in their fertility journey,” says Rachel Weinerman, MD, a reproductive endocrinology and infertility specialist at University Hospitals Fertility Center. “I love seeing the families that are created through this process, and the relationships that develop along the way.”

From the beginning, there is a standard process to ensure a positive experience for parents and gestational carriers alike. Dr. Weinerman breaks down the steps for anyone considering becoming a parent through surrogacy.

When Is Surrogacy the Right Choice?

First, Dr. Weinerman notes that there’s an important distinction between the commonly used term “surrogate” and the gestational carrier who is part of modern surrogacy. Before in vitro fertilization (IVF) was available, “traditional surrogacy” meant the woman carrying the pregnancy used her own egg, making her genetically related to the baby. Now, an embryo is created in the lab using eggs and sperm from the intended parents and/or donors. That embryo is then transferred to the gestational carrier’s uterus.

The reasons people choose surrogacy vary. For some, it’s because a woman doesn’t have a uterus to carry a baby. She may have been born without a uterus, needed a hysterectomy or have scarring in the uterus that makes carrying a pregnancy impossible or unsafe.

For others, the barrier is a medical condition, such as certain heart or lung diseases, autoimmune disorders like lupus or other health problems can make pregnancy dangerous. “In these cases, a gestational carrier can allow a woman to have a child without putting her health at risk,” Dr. Weinerman adds.

Gestational carriers are also increasingly used when IVF fails repeatedly despite good-quality embryos. When a woman has had multiple miscarriages with chromosomally normal embryos, or repeated failed embryo transfers, Dr. Weinerman will discuss a gestational carrier as an option.

Surrogacy is also an important option for LGBTQ+ families and single parents who do not have a uterus, such as male same-sex couples or single men who want a biological child.

The Search for the Right Carrier

Once someone decides to explore surrogacy, the next question is how to find a carrier. Though some people find a carrier among friends or family, most work with a gestational carrier agency. Carriers are typically women who have had at least one healthy pregnancy and delivery, and who are in good overall health.

Equally important is the home environment. “We want gestational carriers to be in stable, safe situations,” Dr. Weinerman notes. “Everyone in the household should understand and support what she’s doing.”

Once a candidate is identified, a fertility workup and psychological screening are completed by both the carrier and intended parents, and each side works with an attorney on a legal contract. The contract outlines compensation and expenses, along with practical questions: How many embryos will be transferred? How many transfer attempts are expected? What happens if a prenatal test finds a possible genetic problem?

“Everyone has a different relationship to the fetus and different beliefs about medical termination in case of a severe complication,” Dr. Weinerman says. “Those conversations need to happen before a pregnancy.”

Preparing for Transfer

Intended parents then undergo IVF if they haven’t already created embryos in a prior cycle. Dr. Weinerman generally recommends genetic carrier screening for the intended parents, along with preimplantation genetic testing in embryos, to reduce the chance of a chromosomal problem that could lead to a nonviable pregnancy.

When it’s time for the embryo transfer, the carrier takes hormones to prepare the uterus for pregnancy. Her ovulation is suppressed so doctors can be certain that a pregnancy is from the transferred embryo, not her own egg. If the transferred embryo takes hold, the carrier transitions to routine prenatal care with her obstetrician.

From First Trimester to Delivery Day

How closely do intended parents stay involved in the day-to-day of pregnancy with a carrier? Some come to ultrasound appointments, others video-chat into visits and some prefer regular updates rather than attending in person. Those preferences are usually discussed early on, and often written into the contract.

Dr. Weinerman says a reward of her work is watching the relationship between carriers and intended parents grow over the course of a pregnancy. “Many of them stay in touch for years,” she says. “It’s a very special bond.”

When it comes time for delivery, intended parents are typically invited to be in the hospital, often in the delivery room. In many states, including Ohio, legal steps taken before birth allow the intended parents to be listed on the baby’s birth certificate right away.

A Different Path to Family

Using a gestational carrier to have a baby can be complex and costly. It asks intended parents to navigate the emotional reality of building a family in a way they may not have originally imagined, and the timeline can be long.

“It’s a marathon, not a sprint,” Dr. Weinerman says. “There can be false starts, and it requires patience and support. But for most couples, we do ultimately have success.”

Dr. Weinerman often encourages patients to think about parenthood in three parts: having a genetic link, carrying the pregnancy and raising the child. A gestational carrier changes only one of those pieces – and for many people, that shift opens the door to the possibility they’ve been waiting for.

“There’s something very liberating about knowing there are other ways to have a baby,” Dr. Weinerman says. “For people who never thought pregnancy was possible – because they don’t have a uterus, or they had to have it removed, or they’ve had one loss after another – finally having success through a nontraditional route can be incredibly beautiful.”

She emphasizes that involving a gestational carrier doesn’t diminish the family you’re building. “You’re not losing anything,” she says. “You’re gaining another person who loves and supports your child. I see so much joy in the families created this way.”

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University Hospitals provides comprehensive fertility care, offering personalized evaluation, advanced reproductive treatments including IVF and expert guidance to support patients at every step of their family-building journey.