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Surrogacy 101

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Surrogacy 101 Surrogacy 101 Presentation Transcript

  • Surrogacy 101
  • Surrogacy 101 • The purpose of this workshop is to prepare you to make decisions regarding your surrogacy journey, particularly picking an agency and clinic. • In order to move through the presentation effectively we will stop for questions at the end of each slide. But if the table of contents indicates that your question will most likely be addressed later in the presentation, please keep your question for later. • If you have questions that have not been answered, you may find that they will be answered by the end of today. After today you can always post your question to the Men Having Babies Facebook’s group or email me at AsafRosenheim@gmail.com 2
  • Table of Content •What is surrogacy and what is the difference between traditional and gestational surrogacy •Who should consider independent surrogacy and who should use an agency •How does it work? A short description of the medical process •Common IVF Considerations •Where can I do it? A review of Countries and US States •Parental Establishment •Same Sex Parents •Who are the involved parties: •The surrogacy agency and the surrogate •The fertility clinic •The egg donor agency and the egg donor •The attorneys for the surrogacy contract and the parental hearing •Who to pick first? •Picking a surrogacy agency •Picking a fertility clinic •Picking an egg donor agency •Short Legal overview •Estimated Cost of Gestational Surrogacy •Social and moral aspects of surrogacy and egg donation faced by gay men •Agenda for remaining of the day 3
  • What is surrogacy Definition: The act of a woman, altruistic by nature, gestating a child for another individual or couple, with the intent to give said child to the intended parents at birth. Traditional Surrogacy Gestational Surrogacy Independent Agency 4
  • What is surrogacy Definition: The act of a woman, altruistic by nature, gestating a child for another individual or couple, with the intent to give said child to the intended parents at birth. Traditional Surrogacy •The surrogate is both the egg donor and carrier of the baby conceived. •The child is usually the biological child of the intended father, and of the surrogate. •The child will be conceived with the surrogate carrier's eggs and the sperm of the intended father. •The surrogate will go through Artificial Insemination with the sperm of the intended father in order to become pregnant. •Traditional surrogacy can be done either through basic home insemination or a clinic intrauterine insemination (IUI). Independent Gestational Surrogacy Agency 5
  • What is surrogacy Definition: The act of a woman, altruistic by nature, gestating a child for another individual or couple, with the intent to give said child to the intended parents at birth. Traditional Surrogacy Gestational Surrogacy Independent •Intended Parents will search and find a surrogate through various means (friends, message boards, newspaper adds). •A clinic and an attorney will be used both for the surrogacy agreement and the parental hearing and/or adoption. Agency 6
  • What is surrogacy Definition: The act of a woman, altruistic by nature, gestating a child for another individual or couple, with the intent to give said child to the intended parents at birth. Gestational Surrogacy Traditional Surrogacy Independent •A gestational surrogate mother is not the biological mother of the baby conceived. •The child is either the biological child of the intended mother, or of an egg donor and the intended father (or one of the intended fathers). •A gestational carrier will go through IVF, In-Vitro Fertilization, to become pregnant. This is where the intended mother's or donor’s eggs, and the intended father’ /s sperm, are combined in a laboratory to create viable embryos. •Then, one or more of these embryos are implanted into the surrogate's womb in order to become pregnant. Agency 7
  • What is surrogacy Definition: The act of a woman, altruistic by nature, gestating a child for another individual or couple, with the intent to give said child to the intended parents at birth. Traditional Surrogacy Gestational Surrogacy Agency Independent •An agency will match the Intended Parents with a surrogate. •The agency will coordinate the egg donor and surrogate cycles, work closely with the clinic on getting the IP’s pregnant, usually until pregnancy is achieved. •The agency will coordinate both the surrogacy agreement legal procedure and the parental hearing and/or adoption. •The agency will continue managing the relationship between IP and surrogate, as needed. 8
  • Today we will focus on Gestational Surrogacy using an Agency. But the information in the presentation can benefit intended parents who choose other routes as well Gestational Surrogacy Traditional Surrogacy •A gestational surrogate mother is not the biological mother of the baby conceived. •The child is either the biological child of the intended mother, or of an egg donor and the intended father (or one of the intended fathers). •A gestational carrier will go through IVF, In-Vitro Fertilization, to become pregnant. This is where the intended mother's or donor’s eggs, and the intended father’ /s sperm, are mixed in a laboratory to create viable embryos. •Then, one or more of these embryos are implanted into the surrogate's womb in order to become pregnant. Agency Independent •An agency will match the Intended Parents with a surrogate. •The agency will coordinate the egg donor and surrogate cycles, work closely with the clinic on getting the IP’s pregnant, usually until pregnancy is achieved. •The agency will coordinate both the surrogacy agreement legal procedure and the parental hearing and/or adoption. •The agency will continue managing the relationship between IP and surrogate, as needed. 9
  • Traditional versus Gestational Traditional Gestational Your reasons Your reasons No IVF May be less difficult for surrogate More affordable Child related to IPs Clear bio mom Legal reasons 10
  • How does it work: a short description of the medical process For gestational surrogacy In IVF, fertilization occurs outside the woman's body, both egg donor and surrogate. The donor’s eggs and the man’s (men’s) sperm are united in the laboratory. Once fertilization occurs, the early embryo(s) are transferred to the surrogate’s uterus. In gestational surrogacy there are 3 (or 4) parties with no infertility problems: egg donor, gestational carrier and father(s) Cycle Monitoring: To begin the process of IVF, the egg donor is given fertility drugs to stimulate egg production and control the timing of ovulation. This helps maximize the number of eggs produced (target 10-25). Frequent blood tests to monitor hormone levels and ultrasounds to monitor follicle development are required. Meanwhile hormones are given to the GS to suppress her menstrual cycle and make he uterus suitable to receive an embryo (or embryos). Egg Retrieval: The eggs are harvested from the egg donor primarily through a transvaginal ultrasound-guided procedure. The ultrasound-guided egg retrieval is performed on an outpatient basis with monitored I.V. sedation. Recovery from the sedation requires thirty minutes. Fertilizations: Once the eggs are retrieved and the sperm sample collected from the IP(s), they are immediately given to the embryology laboratory for incubation. The man's semen is specially prepared in order to select the most viable sperm. In conventional IVF, the sperm are then placed together with the eggs in an incubator for 12-18 hours to allow for fertilization. Following normal fertilization, early embryonic development is closely observed on a daily basis. The egg donor is no longer part of the process. Embryo Transfer: Within 72 hours (and up to 5 days) after egg retrieval, about half of the eggs have developed into embryos and are generally ready to be transferred into the woman's uterus through a thin tube, or catheter, gently inserted through the cervix. This is a non-surgical procedure performed under ultrasound guidance with no need of sedation. About ten to twelve days following the embryo transfer, the GS’s blood is drawn and tested to determine if pregnancy has occurred Adapted from http://rba-online.com/ivf/index.php?IVF-Program-17 with the assistance of Georges Sylvestre, MD 11
  • Common IVF Considerations Single or Frozen Genetic or Fresh Testing multiple Embryos 12
  • Where can I do it? A review of Countries and US States Overseas • Usually no governing law • India • Thailand • Nepal • Mexico US: Bans or Voids & Penalizes US: Prohibits Some/Allows Others: US: Allows and/but Regulates (either by Statue or Published Case) • New York • DC • Sometimes allows only gestational but not traditional, or only allows uncompensated • Florida • New Jersey • Texas • North Dakota • Illinois • California US: VacuumNo Statue/No published case • PBO routinely granted • PBO unpredicted • Post birth adoption http://www.creativefamilyconnections.com/state-map-surrogacy-law-practices http://www.americanprogress.org/issues/women/news/2007/12/17/3758/guide-to-state-surrogacy-laws/ 13
  • Parental Establishment Pre-Birth Order Granted Post Birth Second (it is still up in the air whether a PBO actually Order or Parent creates a universally recognizable legal relationship between a non-bio parent and Second Adoption the child born through surrogacy. It can, Parent must be however, make the second or step parent adoption process easier if there is a PBO, Adoption completed although an experienced attorney can successfully process the adoption without at Place of at home one. The adoption is the only assured way of creating a fully transportable legal right Birth State between the non-bio dad and the child.) 14
  • Same Sex Parents Favorable Unfavorable 15
  • Who are the involved parties The surrogacy agency and the surrogate The attorneys: surrogacy contract & parental establishment* Intended parents The egg donor agency and the egg donor The fertility clinic 16
  • Who to pick first? The surrogacy agency Most IP’s will start with one of these The fertility clinic 17
  • Who to pick first? The attorneys Some will start with one of these The egg donor agency 18
  • Picking a surrogacy Agency Level of service: correlated to agency fee Limited Service Full service • Matching • Some coordinating • Service providers like attorney Clinic and Egg donor agency recommended but not included in agency fee • Matching • All coordinating • Attorney and psychological fees included VIP • Like Full Service but with a lot of hand holding • Many times surrogates are prescreened and the cost of the prescreening is included Agencies that are run by attorneys: • • Attorneys, in general, have a detailed set of practice and ethical rules that govern their behavior, If they violate these rules, they risk losing their license to practice law and their occupation attorneys are encouraged (but not required) to carry malpractice insurance to protect their clients from their negligence in performing their legal duties to their clients. This is an important protection to cover proper legal work, but it only covers their work as a lawyer, not as an to OBGYN at 10-12 ask every Releasedagency. It is important to weeks prospective attorney (agency-related or not) whether they carry such insurance. Main contact is with agency, surrogate and clinic, not egg donor 19
  • Other considerations when picking an agency Surrogates are • Pre screened: low risk • Basic pre-screening: IP’s pay for medical, background check and psychological screening with risk • The process of sourcing the surrogates Availability / Waiting time • Short • Long • Long for surrogate with insurance • In general can take 3-12 months to match and start the process Experience with surrogacy, same-sex couples and international IP’s • Worked with surrogates/same-sex couples/international IP’s regularly and can demonstrate experience • Have worked with some surrogates/same-sex couples/international IP’s but not much experience • Only worked with a couple of surrogates/same-sex couples/international IP’s • Have experience with working with attorneys that can do both the surrogacy agreement and the parental agreement for same sex couples Relationship with service providers like attorney, clinic and egg donor agency • In-house and must use them • In-house but can use anyone • Must pick from list • Recommended only Others • Reputations, personal connection and recommendations • Men Having Babies Surveys http://menhavingbabies.org/surrogacyresources/directory/agencyratings/ • Geographical locations of surrogates • Will use surrogates insurance • Rematching process and cost • Sibling journey cost (same surrogate, other surrogate) 20
  • Agencies are the only participants in ART that are wholly unregulated. But you can take some steps to obtain the reassurance of some meaningful regulation by working with agencies run by professionals, such as attorneys, who are already regulated for other reasons not related to the agency. When this is accomplished, together with a professional liability insurance and criminal bond, the client is protected as completely as possible during this difficult and expensive process. • Attorneys, in general, have a detailed set of practice and ethical rules that govern their behavior, if they violate these rules, they risk losing their license to practice law and their occupation. • Attorneys are encouraged (but not necessarily required in every state) to carry malpractice insurance to protect their clients from their negligence in performing their legal duties to their clients. This is an important protection to cover proper legal work, but it only covers their work as a lawyer, not as an agency. It is important to ask every prospective attorney (agency-related or not) whether they carry such insurance. • For every agency that performs any matching or other administrative duties for third-party reproduction programs (surrogacy, egg donation, embryo donation, etc.) the administrative activities in this role will not be covered by an attorney's legal malpractice policy; therefore, a different kind of business insurance is required. This would be professional liability insurance of the kind every business can obtain to protect its clients against the agency's negligence or malfeasance in its administrative duties. • That being said, anyone can break the law and steal, even attorneys. Therefore, it is recommended the every agency has applied for and been granted a criminal bond by a reliable bonding company to protect the agency's clients against the theft of their funds. Agencies handle thousands of dollars of client funds throughout surrogacy and other programs, and if this money is under the control of the agency, it is susceptible to criminal activity such as theft or embezzlement. A criminal bond insures that a reliable company has assessed the agency's manner of handling their clients' money and found it to be acceptable and reliable enough to grant the company a bond to protect its clients against the company's theft of client funds. This has happened with past agencies, and it is a protection all agencies should offer. 21
  • Using and Agency or going Independent? Using an Agency Independent • Agencies are experts in surrogacy laws and medical standards, many of which change state to state. • Agencies have long experience working with gestational carriers. • Agencies find gestational carriers and manage all the required psychological and medical screening to find a good match for you. • Agencies can be expensive, with total costs for agency, legal, gestational carrier, donor and IVF clinic well above $100,000 (less if you have eggs donated by a family member or use an egg bank). • Agencies do not coordinate everything; you still have to be a very active participant. 22
  • Picking a fertility clinic Experience with surrogacy, same-sex couples and international IP’s • Worked with surrogates/same-sex couples/international IP’s regularly and can demonstrate experience • Have worked with some surrogates/same-sex couples/international IP’s but not much experience • Only worked with a couple of surrogates/same-sex couples/international IP’s Cost & Treatment Option Plans •Minimum egg guarantee •Known non-anonymous donations •Unlimited IVF package •Automatic progressive discounts •Money-back option Relationship with surrogacy / egg donors agencies • In house and must use them • In house but can use anyone • Must pick from list • Recommended only Location •Close to your home •Close to egg donor: most screening and monitoring •Close to your surrogate: some screening and monitoring. Many clinics will allow surrogates to screen and monitor close to her home and will only see her for the transfer. Some wont. Statistics • Specifically with surrogates • Specifically with frozen eggs and/or embryos • Check http sart.org Others •Reputations, connection and recommendations •Men Having Babies Surveys http://menhavingbabies.org/surrogacyresources/directory/clinicratings/ •Genetic testing •Prefer to freeze eggs or embryos •Prefer single embryo transfer •Egg & Embryos banks 23
  • Picking an egg donor agency The agency • Reputations, personal connection and recommendations • Level of support in the process • Relationship with surrogacy agencies and clinics (some are exclusives, this may be a good sign!) • Experience with surrogacy, same-sex couples and international IP’s Costs • Rematching process and cost • Sibling journey cost (same egg donor, other egg donor) • Registration fee to see database • Costs and Treatment Option Plans (agency and donor fee) • Unshared and Shared cycles • Frozen eggs from donor egg banks The donors • Geographical locations of egg donors • Sourcing of egg donors • Screening of egg donors: pre-screened or basic pre screening • Ages of egg donors • Donors availability and waiting times • Experienced egg donors • How many donors are in their database Information and presentation • On-line database • Type of information regarding donor (profile, videos, photos, adult/childhood/family photos) • Meeting the donor in person • Anonymous / non-anonymous donations 24
  • Short Legal overview Agreement with agency •Will cover parties responsibility and costs •Rarely will IP’s hire an attorney to represent them Surrogacy Agreement •The agreement between the surrogate and the parents must be signed before cycle begins. •Will cover base compensation, reimbursement and other monetary obligations •Will discuss relationship between IP’s and surrogate •Risks and responsibilities of both parties •Should cover cycling, transfer, pregnancy, delivery, and relationship post delivery •Termination •Expenses and insurance •IP’s will pay surrogate's attorney fee Parental Establishment Picking an attorney •Each State and sometimes county are different •Pre birth order is considered a preferred method, but some couples , especially intentional or those who live in States that do not recognize same sex parenting, adoption and/or marriage, should peruse a post birth court rolling and/or second parent adoption. •Depending on State aw and courts the surrogate and sometimes her husband will relinquish their parental rights to the (unborn or born) child •Sometimes only one father will be put on the birth certificate at this time, and the second father will either do a second parent adoption in the local State or back in the home State •In many cases, a pre birth order will be granted without the name of the surrogate ever going on the birth certificate. •Make sure you understand the process and the length post birth legal process as it will help you plan your return home. •The attorney for the surrogacy agreement and the attorney for the parental establishment may or may not be the same person. •The attorney for the surrogacy agreement should be licensed in the state of where the surrogates lives and will deliver. •The attorney for the parental establishment MUST be licensed in the state of where the surrogates lives and will deliver. •She must be experienced, and able to demonstrate this experience, in surrogacy law. •You should ask the parental establishment attorney if she has been able to establish parental rights through pre birth order or second parent adoption in the county where the surrogate will live or deliver or in the county where birth certificates are issued for the State. This is not always available, but should be considered. 25
  • Estimated Cost of Gestational Surrogacy: Large variance based on level of service, experience of surrogate, number of cycles, number of children and location. Men Having Babies’ survey indicates an all in range of $76-$168 thousand US Dollars. http://www.menhavingbabies.org/surrogacy-resources/directory/agencyratings/ Surrogacy Agency & Program • Agency Fee for Surrogacy Program/Coordination Fee • Legal Counsel representation for Intended Parent/s • Escrow Account Management • Review of Surrogate Insurance Policy • Surrogate's Attorney's Fee to Review Contract Legal Fees for Parentage Proceedings • Representation of IP's (court pleading and/or Pre-Birth Order) • Representation of Surrogate • Birth Document Expenses and Compensation During Pregnancy Screening Fees & Medical Expenses • Surrogate Base Compensation • Monthly Allowance • Maternity Clothing Allowance • Surrogate Embryo Transfer Fee • Surrogate Embryo Transfer Expenses and travel • Lost Wages for Surrogate and Spouse • Travel Expenses / Local Travel • Bed Rest Compensation • Child Care • Surrogate/IP Psychological Evaluation • Surrogate Criminal Background Check • Surrogate and her partner's Infectious Disease Testing • Surrogate Medical Evaluation • Fresh/Frozen IVF Cycle Fee & Medication • Medication for Surrogate • Intended Parents' Infectious Disease Testing Insurance Egg Donation and Egg Donor Agency • Medical Insurance for Surrogate • Surrogate Life Insurance Policy • Disability Insurance • Health Insurance for born children • Surrogate's Estate Planning • Egg Donation Program • Egg Donation Contract Legal Fee • Medication for egg donor • Egg donor Compensation 26
  • Social and moral aspects of surrogacy and egg donation faced by gay men •Surrogacy is a challenging journey, which requires patience, compassion and a good sense of humor. •Choose when and what to share with friends and family •Surrogacy pregnancy requires a village. Accept it, and be grateful for the people who chose to accompany you on this journey •Pick good advisors that are outside your network of paid service providers. You also need a good friend to lean on. •You and your partner are going through a lot right now, this is a good time to nourish your relationship. •Every journey to parenthood, especially gestational surrogacy is accompanied by the feeling of loss. Accept them, they are normal and part of the process. •The loss of your freedom •Large expenses •Being depended on so many people you hardly know •Accepting that you need one or two women to carry out your dream of parenthood •Failed cycles, lost pregnancies •Harsh and unfair reactions from strangers or friends and family •The disappointment when there is a lack of thrill when you meet your surrogate or egg donor •Your surrogate and you are going through this journey for the first time, and there is no hand book. Speak with your surrogate, by phone or Skype and not just email and text message, as much as you can. •Visit her and her family. Remember that all of them, especially her children, are affected by this pregnancy. •Don’t be shy to ask the agency, a professional or a friend that went through this before you for help. •Remember, you decided to become a parent, you will! It is just a matter of time (ok, and money) •Good luck! 27