Controversies

Defining the parent

Many gay couples choose to inseminate one egg each, hoping for twins. When only one child is born the question arises as to whether to publicise who was the successful donor. Friends will commonly ask, "who is the father"?. For some couples this can be an intrusive question.

There is no correct way to deal with this. Some couples say that the experience of parenting rather than who is the parent is more important. Others say they do not know, explaining that the surrogacy agencies take care of such issues. Others choose to reveal the father's name from the start. As the baby grows they will be loved by those around them and this question will become less important.

Knowing the egg donor

Usually a close relationship develops between the surrogate and the intended parents. Conversely, the intended parents normally never meet the egg donor. Some egg donors say that they are happy to consider meeting the child in the future. But clearly things change over time and it may well be that this will never be possible. The authors view is that this is not a major issue if the child/children are brought up in a loving household.

Post-birth relationship with the gestational carrier

Most gestational carriers in the US are primarily motivated by a desire to help a couple in need. While they love the child growing inside them, they realise she will be raised by another couple - another couple who generally would not have children without their help. Many view surrogacy as a nine month long baby-sitting experience. After the surrogacy, they will (naturally) want to know the child is being well cared for, but generally do not seek an active role in the child’s life.

While the above is typical it is by no means the only type of relationship available. It is critical to ensure that your expectations post-birth are aligned with those of your gestational carrier. Such expectations should be discussed openly and thoroughly before embarking on the journey.

Sex selection

During the IVF process, two embryos are typically implanted with the hope that one or both will grow to term. Sometimes an IVF process will produce more than two viable embryos. If you have opted to perform genetic screening before implanting embryos, your doctor may know the sex of each embryo. In some such cases where there are more than two healthy embryos, the doctor may allow you to choose the sex of embryos that are implanted. On the other hand, some doctors will not do so for ethical reasons. If sex selection is an important option that you would like to keep open, then you should openly discuss this issue with a prospective IVF clinic and doctor before selecting the one that is appropriate for you.

Insurance

The carrier very likely would not qualify for Medicaid due to the amount that she is being paid /reimbursed as a gestational carrier. Therefore you will have to either purchase a policy or rely on an existing (usually work-based) insurance. Some of the latter specifically exclude surrogacy. Insurance coverage for neo-natal care for international intended parents is complicated and somewhat controversial. Some lawyers have been successful in getting the baby covered under the carrier's insurance policy. In order to do this, do not do a pre-birth order but rather clarify parental rights post-birth. Success will depend in part on the language in the carrier's insurance policy about when a person can add a "dependent" to the plan and whether the dependent is defined as a "natural child". Your surrogacy agency can advise but it is worth looking at the policy yourself too. Carriers who have health insurance through their employer can be a better option because you don't have to pay for an outside policy. However, these plans are becoming rarer; employer policies can differ dramatically and the language on adding a "dependent" may not be as favourable as a commercial policy; and employer funds are more autonomous and governed by federal law which may be less supportive than state law. So, working with a carrier who does not have health insurance through her employer may be better.

There are insurance policies that can be purchased to cover neo-natal care. This avoids potential issues with the insurance questioning whether cover should be provided. This needs to be organized before 23 weeks but is only enacted on the day of birth- some policies can start 1 day after birth (in CO and CA and some other states). The cost is similar to the maternal policy with a deductable that varies dependent on policy from $3650 - $6350. Multiple pregnancies would cost double. Remember the premiums would only have to be paid until healthy hospital discharge as one could then purchase a comprehensive travel insurance. ART Risk Solutions provide a facility called The Newborn Resource. This costs $3250 ($4250 for multiple pregnancies). This provides cover for their negotiating lower fees for IPs and is useful for those undertaking surrogacy in a state that does not allow newborn insurance. This is an not insurance policy per se, but utilizes the negotiating power of the agency in mitigating post-birth fees by up to 50%. ART Risk Solutions provide good advice to help with all insurance needs and are commended. Another agency is New Life Agency.

There is a useful web site from where one can find temporary insurance providers to suit dad and baby: http://finder.healthcare.gov/. For example one couple we know used this to obtain a very affordable temporary insurance policy from http://www.assuranthealth.com/corp/ah/HealthPlans/short-term-health-insurance.htm

We would propose to also have a comprehensive travel insurance in place, and like the look of the BUPA international policy, which covers newborns from three days after birth, even if born in another country, but would not cover pre-existing medical conditions so therefore would not cover immediate neonatal care, which hopefully would be covered by the surrogates insurance.

Other potential issues

It's rare for the surrogacy journey to be entirely smooth. Therefore it is worth being prepared for some things to go wrong: for example, we have heard of potential gestational surrogates “disappearing”; or of surrogates not taking their injections during the IVF process. Quite often there is a low yield of healthy day-5 blastocysts, which may mean no pregnancy despite (the expense and stress of) an IVF cycle. We have been warned to avoid allowing IVF clinics to freeze blastocysts in batches, as excess are lost on thawing. Sometimes, the insurance policy carries a significant co-pay or does not cover neo-natal care. But persevere because most (but not all) get there in the end.

We now recognize the value of our group, in supporting each other when things go wrong. If you are reading this, having had failed implantations, or failed pregnancies, please reach out to us; likely others have suffered the same before, and usually then gone on to succeed. Generally, it’s a numbers game.