Gay men desiring to start a family need assistance coordinating the complex process of egg donation and gestational surrogacy. Choosing your egg donor, either anonymous or known, as well as determining who your surrogate or gestational carrier will be and whether or not they will be someone you know or rather, someone you find through a surrogacy agency or clinic, are very important elements to consider. With this in mind, I recommend beginning with a medical consultation with a fertility specialist, such as a board-certified Reproductive Endocrinologist. A fertility specialist will:
(1) Assess you (and/or your partner) for sperm quality and its use
(2) Screen potential egg donors for suitable egg quality and quantity and health/genetic history. Some fertility centers have their own pre-screened anonymous egg donor pool.
(3) Evaluate the gestational carrier for likelihood of successful term delivery
(4) Explain and perform FDA-mandated infectious disease screening on all required parties
(5) Coordinate and conduct the actual getting pregnant part (IVF)
A fertility specialist can help you develop an efficient “family plan,” taking into account the number of children you ultimately desire. They may counsel you regarding options such as pre-implantation genetic screening, which tests embryos for chromosomal abnormalities prior to transferring them to your gestational carrier. This may improve implantation rates and decrease risk of miscarriage or IVF failure, potentially decreasing overall costs to delivery.
Once you have established care with a fertility specialist, you then have a solid foundation for moving forward and selecting the egg donor and gestational carrier. Some fertility clinics have their own pool of egg donors, which gives them the ability to screen donors on their own and possibly get to know them on a more personal level. Most specialists also work with egg donor agencies who also utilize screening processes. If you have a friend or family member willing to donate eggs, they too will need to be screened prior to the process beginning. Screening includes some psychological testing as well as an assessment of ovarian reserve with an ultrasound and an AMH (anti-mullerian hormone) level as well as basic genetic screening, including at a minimum, cystic fibrosis. Certain ethnic groups may have additional genetic screening recommended. Most anonymous egg donors are typically compensated between $5,000-$10,000 per cycle.
For a gestational carrier, I recommend you retain the services of a surrogacy, or gestational carrier agency. Agencies will have a fee for their services, which usually includes finding a carrier, coordinating with your fertility specialist, and shepherding you and your carrier through the pregnancy. Most gestational carriers receive compensation around $30,000 –$50,000, with some fee retained regardless of whether a delivery occurs. It is important to obtain a clear list of services included in your fee package to assist you in understanding you final, overall cost. Your gestational carrier should be evaluated by your fertility specialist or an obstetrician prior to an embryo transfer to ensure she is a good candidate to carry an uncomplicated pregnancy to term. You will also want to have an informed discussion with your physician and gestational carrier regarding elective single embryo transfer and the risks associated with multiple gestations, such as twins or triplets. Your agency can also help you hire an attorney if they do not have in-house legal staff. An attorney will draft contracts between you, your donor and your carrier, as well as set up an escrow account to assist in payment for services.
Financially, fees will be associated with each member of your team - your fertility specialist, your gestational carrier agency and gestational carrier, your donor and your attorney. Other fees may include obstetrical costs, medications, health insurance for your surrogate and other expenses.
Using an egg donor and a gestational carrier is a realistic and rewarding way to build a family and can run smoothly with the right team on your side. Take the time to research and find a fertility specialist and gestational carrier agency to guide you through this complicated and exciting process!
Wendy B. Shelly, M.D., FACOG is a reproductive endocrinologist with Fertility Specialists Medical Group in San Diego