(CNN) — For heterosexual couples who want to have children, surrogacy is often one of the last options they consider, following time-consuming and emotionally and physically exhausting consultations with a fertility specialist. But for gay couples who want kids, surrogacy is one of only two options (the other being adoption). It is a lengthy and expensive process, and because of differing laws from state to state, it can be an even more complicated process for same-sex prospective parents.
We asked three experts from a leading surrogacy agency, Circle Surrogacy and Egg Donation, to answer the top 10 questions asked by same-sex couples seeking its services. Sam Hyde is the company’s president, John Weltman is the founder, and Kristin Marsoli is the marketing director and a parent through surrogacy. Their answers have been edited for length and clarity.
1. What is involved in the surrogacy process?
Marsoli: A surrogacy journey is a monumental experience but also a complex process. The process itself can be broken down into five major milestones, with many mini-milestones within.
Consultation and sign-on. This first step in the surrogacy process is one of the biggest ones: making the decision to grow your family through surrogacy and choosing an agency. Intended parents will also match with an egg donor and create their embryos if needed.
Matching with a surrogate. The matching stage is one of the most exciting. Intended parents will find the amazing woman who will help them grow their family. A match will be presented to both the surrogate and the intended parents. If both parties are interested, they will be officially matched.
Medical screenings and legal work. During the medical and legal phase, the gestational carrier will go to the intended parents’ IVF clinic for her medical screening. From there, she will receive her protocol and begin her medications and monitoring at her local clinic. Parents will work with their lawyer to draft their surrogacy contract while their carrier works with her own lawyer. When the time is right, the surrogate will go to the IVF clinic for the embryo transfer. Many intended parents attend this milestone in person and spend time with their surrogate. Once she returns home, she will continue to go to the local clinic for testing until there is a (fingers crossed!) confirmation of heartbeat.
Pregnancy. The pregnancy stage is usually the longest step in the surrogacy journey. During this milestone, intended parents will continue to develop a strong bond with their surrogate as she shares updates on the pregnancy and baby. She’ll be released to her own OB/GYN and will continue with ultrasound check-ins. The 20-week ultrasound is a big milestone that many intended parents attend in person. It’s also a good time for intended parents to tour the hospital where their baby (or babies) will be born. Intended parents will work with their lawyer and local counsel to establish their parental rights. Parents will also prepare for their baby’s arrival, packing, and booking travel.
Parenthood. The moment has arrived when intended parents finally meet and hold their baby for the first time. When the doctor releases the baby from the hospital, parents usually travel home shortly thereafter.
2. Who are the people involved in a surrogacy journey?
Marsoli: Intended parents who embark on a surrogacy journey will work with many people along the way who will support them. Those involved in a surrogacy journey include:
Surrogacy agency staff
Gestational carrier (and her family)
IVF clinic professionals
Gestational carrier’s OB/GYN
Hospital staff where the carrier will deliver
3. How are surrogates and egg donors screened?
Hyde: Surrogates, egg donors, and intended parents undergo screening before they are accepted to our program.
For intended parents, we perform criminal background checks, and all intended parents must meet basic requirements for the program (such as age cutoffs), as well as demonstrate an actual need for a surrogate (we do not accept social surrogacy cases).
For egg donors, we are primarily concerned with their personal and family medical history, as well as any past donations.
The screening process is more involved for surrogates. The initial screening involves reviewing basic information, such as pregnancy history, medical complications, and matching preferences. Surrogates who make it through the initial screening then have a two-hour screening call with a social worker, undergo formal psychological screening, and have their medical records reviewed by an IVF physician. The surrogate’s partner or support person will also undergo screening with a social worker.
4. How do we decide on an egg donor? Who becomes the biological father?
Weltman: Like anyone selecting an egg donor, gay singles and couples review egg donor databases and look for a young woman who meets certain criteria. They may choose an egg donor based on her appearance, her intelligence, her artistic and athletic ability; perhaps they will select someone who looks like one of them or resembles a close family friend. Lastly, they may select an egg donor once they meet her and like her in person, should they decide to connect in person.
Once an egg donor is selected, the intended parents must decide who will be the biological father. Many gay couples desire two children, in which case they will create embryos using the same egg donor and the biology from each of the dads. Half of the eggs will be fertilized with one dad’s biology and the other half with the second dad’s. From there, the intended parents may try for twins – one child from each of their biologies. Or they will decide which dad will be the first biological father, and the other dad will be the biological dad of the second child. Occasionally, one dad wishes to be a biological dad more than the other, and they just use the biology of one dad for one or two kids.
5. How are parents and surrogates matched?
Hyde: There are three main requirements that we use to connect a surrogate and intended parent(s): legal fit, personality fit, and views on selective reduction and abortion. Intended parents and surrogates are both screened prior to matching. As the first step in matching, our team determines what legal procedures the intended parents need and what states allow such procedures. The law of the state where the surrogate resides controls many of the legal aspects of the journey.
We then review the surrogate’s and intended parents’ profiles and preferences to make a recommendation of the best potential match. The intended parents’ and surrogate’s profiles are exchanged, and if they both agree they would like to meet, we help set up a video call. After that call, if all parties are interested in moving forward, they are considered “matched,” and both sides move to begin negotiating a contract.
6. What happens in the case of a medical complication?
Hyde: The contract and all forms signed at the hospital make clear that the intended parents are responsible for decisions about the child once the child is born. While the child is still in utero, the surrogate will agree to make decisions that do not harm the child, unless her own health could be compromised. If a surrogate’s health is at risk, her health will take priority.
7. What’s the relationship between the intended parents and gestational carrier during and after the pregnancy?
Marsoli: A strong relationship between gestational carriers and intended parents is not only beneficial to help ensure a smooth journey, but it’s also helpful after the journey when parents share the child’s birth story with him or her. No two journeys are the same, and the type of relationship between a gestational carrier and an intended parent is different for everyone.
At a minimum, carriers and intended parents are asked to connect via video at least once a week. However, many communicate multiple times a week and even daily. Surrogates and intended parents have shared with us that throughout the journey, they have become like family, and many go on to keep in touch after the baby’s birth, even visiting each other and vacationing together. For parents, a strong relationship with their surrogates enables them to feel a part of the pregnancy and to be open and honest about their feelings and desires as the pregnancy progresses.
8. What legal and custody issues might same-sex couples and singles face? What laws apply? Whose name goes on the birth certificate?
Weltman: The laws of the state where the surrogate delivers the baby (or babies) apply. As long as it’s a surrogacy-friendly state (New York and Michigan are the only two states that still have laws against surrogacy; both are expected to change their laws to become surrogate-friendly this year), there are no custody challenges in which a gestational surrogate has ever gotten legal rights to a child. Also, both dads would have equal rights to a child – no matter who was the biological father – as long as they did a pre-or post-birth order or second-parent adoption, which secures both of their names on the birth certificate.
9. How much does surrogacy cost? Does insurance cover it?
Hyde: The cost of surrogacy depends on many factors but essentially breaks down into five categories: professional fees, carrier fees, and expenses, donor program costs (if necessary), insurance expenses, and IVF expenses. In total, the professional fees, carrier fees and expenses, and insurance costs are about $100,000 to $140,000. If an egg donor program is needed, that will add around $20,000 to $30,000. IVF may be covered by some intended parents’ insurance, but if it is not, the cost to create embryos and perform transfers is usually between $15,000 and $40,000.
10. How long does the surrogacy process take?
Hyde: The entire journey typically takes around 15 to 18 months and consists of three separate parts. The first is the time to find a match with a surrogate. Agencies have different waiting times, but most agencies will match intended parents in about three to six months. After a match, an in-person screening is needed at the IVF clinic; a contract needs to be negotiated and a trust account established, and the surrogate begins medications. This part of the process should take about two to three months.
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Finally, once a surrogate is pregnant, the gestation period is hopefully nine months. The other time consideration is the embryo creation process, whether that involves an intended mother having an egg retrieval herself or matching with an egg donor. The embryo-creation process will take two to three months and can run concurrently with the surrogate search and match phase of the process. Or some intended parents choose to create embryos first and then begin the search for a surrogate.