Introduction to Surrogacy for Queer Men
There is a lot to get your head around when embarking on a journey to fatherhood through IVF and surrogacy.
I have been writing about our own journey and all topics related to queer intended dads and surrogacy for over half a year now, but I have not yet shared a general overview of surrogacy.
In this article, I will attempt to rectify that with my version of ‘Surrogacy 101.’ The article will go through the process by describing it through the 7 key questions, each starting with one of the following introductions: Who? What? When? Where? Why? and How?
Before beginning, I do want to mention that while I and BabyMoon Family are focused on helping queer men become fathers through IVF and surrogacy, there are other ways to achieve the goal of fatherhood. Adopting and fostering are two great methods, and so it’s important to research all your options in order to understand what is best for you and your rainbow family dreams.
Who is Surrogacy For?
In general, surrogacy is for any intended parent (IP) who is not able to carry a pregnancy themselves. For straight couples, there can be a number of reasons the female partner is unable to either get or remain pregnant.
For gay men, surrogacy is an absolutely essential part of the reproductive journey as genetic men do not have a uterus and so cannot carry and develop a fetus.
In general, the medical definition that encapsulates those who need surrogacy to have a genetically-related child is ‘infertile.’ Previously, ‘infertile’ would only describe the physical and medical reasons that a straight couple could not reproduce. However, the American Society of Reproductive Medicine (ASRM) has recently expanded the definition of ‘infertile’ to include queer men, with their CEO, Dr. Jared Robins, stating:
“This revised definition reflects that all persons, regardless of marital status, sexual orientation, or gender identity, deserve equal access to reproductive medicine. This inclusive definition helps ensure that anyone seeking to build a family has equitable access to infertility treatment and care.” (1)
ASRM and their guidelines have a significant impact on insurance policies, regulations, and this new definition has already led to more states and companies offering inclusive family building benefits. In fact, it is this definition that helped motivate me to try and expand the fertility benefits at my own company, which you can read more about here (https://www.babymoonfamily.com/original-articles/expanding-fertility-benefits). Hopefully, this is a trend that will continue in order to make it easier logistically and financially for more queer men to become parents through IVF and surrogacy.
What is Surrogacy?
Surrogacy is when a surrogate, or more often referred to as a gestational carrier (GC), carries a pregnancy for another person or people, known as the intended parent(s) (IPs).
There are two types of surrogacy: Traditional and gestational.
Traditional surrogacy is when the egg donor and GC are the same women. Taking a step back to quickly discuss in vitro fertilization (IVF). IVF is the process by which sperm from a man and eggs from a woman are combined outside of a person to make embryos. The eggs for this process can be collected and frozen or retrieved ‘fresh’ from a procedure that I describe in more detail here (https://www.babymoonfamily.com/original-articles/egg-donation-procedure). Once the sperm and eggs combine and the embryos are made, they can then be implanted into a GC for the pregnancy.
In traditional surrogacy, the egg donor and the women who carry the pregnancy are the same, so she is the biological mother and the woman who delivers the child. This also means that she could technically get pregnant through a procedure known as intrauterine insemination (IUI), where sperm is placed directly into the uterus using a small catheter. As her own eggs are being used for the embryo creation, this does not have to happen in a lab as with IVF but can happen in the GC’s own body.
Traditional surrogacy is less common than gestational surrogacy, which is where the egg donor and GC are different women. In gestational surrogacy, IVF is the only option for embryo creation and implantation, so it can be more expensive, but what it does is compartmentalize the process more. This means that the egg donor or biological mother is not the woman who carries and delivers the baby. This is emotionally and psychologically healthier for the GC and IPs, and it means that queer men can have more flexibility in picking an egg donor who helps reflect their own genetics as a couple and a GC who they are more compatible with.
Another distinction with surrogacy journeys is there are two types of financial arrangements: Altruistic and compensated/commercial.
Altruistic surrogacy is when the GC does not receive any direct compensation for carrying the pregnancy. While in commercial surrogacy, the IP(s) agree to pay the GC an amount specifically for her compensation.
However, this does not mean that altruistic surrogacy is free, and the biggest difference between the two types is not just money but also time.
In terms of cost comparisons, altruistic surrogacy is prevalent in Canada and on average can range from $55,000 and $85,000 USD (2), as these arrangements still cover things such as medications, missed work, clothing, childcare, and other costs for the GC during the pregnancy.
The range for commercial surrogacy is more variable depending on where you pursue your journey. The United States is the world leader for commercial surrogacy, but because of its medical and legal expertise and protections, the cost is also the highest in the world and on average ranges between $110,000 and $170,000 USD (3).
However, many IPs, especially queer men, are now opting for commercial surrogacy arrangements in countries like Mexico, where the price is considerably lower and starts at approximately Є47,000 (or about $50,745 USD). I have recently written a more detailed review of surrogacy costs for my husband and I in the U.S. compared to a journey in Mexico, which you can read about here (https://www.babymoonfamily.com/original-articles/ivf-and-surrogacy-abroad).
Timing is also an important distinction between altruistic and commercial surrogacy. For altruistic journeys in Canada, waiting times are estimated between 10 and 18 months before IPs can match with a GC and begin their pregnancy (4). By contrast, U.S. agencies estimate that matching with a GC can be as short as 30 to 90 days (5).
Given the United States’ leading status for commercial surrogacy, the number of international IPs who have gone to the U.S. has increased in recent years, and I wrote about a study that showed these results (https://www.babymoonfamily.com/original-articles/international-gestational-surrogacy-unitedstates). However, with Thailand reopening for commercial surrogacy (https://www.babymoonfamily.com/original-articles/thailand-reopens-international-surrogacy) and the overall cost of surrogacy being less expensive with altruistic surrogacy and countries like Mexico, the logistics of a journey abroad could be appealing to some queer intended dads.
When Should I/We Start My/Our Journey?
Although men do not have the same ‘biological clock’ as women, many of us do not want to wait too long to start our families. Thinking about this timing for you and possibly your partner is different for everyone. However, like most important things in life, it’s better to discuss this early and often to gain alignment with your own personal desires as well as your partner.
Compared to straight couples, ‘getting pregnant’ for queer men takes a tremendous amount of time, emotional bandwidth, and finances.
With that in mind, my general advice would be to plan early. If you know or even think you might want to be a father through IVF or surrogacy, start saving and budgeting and discussing it as soon as you can. Getting ready to even start can take years of planning, and then the actual embryo creation through IVF and surrogacy itself can add several more years.
While it may seem like a 9 month sprint, trust me, that is only for the straight people. For queer men, you have to prepare for a marathon so start ‘training’ early.
Where Can I/We Go Through Surrogacy?
Given the medical, social, and legal complexities, surrogacy is highly regulated, especially in countries like the U.S.
This is a good thing. Regulations should exist to protect IPs, egg donors, GCs, and - most importantly - the baby.
Surrogacy occurs all over the globe, but countries can be grouped into the following categories (6):
Altruistic surrogacy only: Canada, United Kingdom, Portugal, Belgium, Netherlands, Denmark, Hungary, Greece, Georgia, Israel, India, Vietnam, South Africa, Australia, New Zealand, Cuba.
Altruistic and commercial surrogacy: U.S. (California is the leader, but it varies by state with some being altruistic only), Thailand, Ukraine, Russia, Georgia.
No formal regulations but commercial surrogacy is practiced: Mexico, Colombia, Argentina.
All forms of surrogacy are banned: Much of Europe, China, and the Middle East.
It is important to note that the countries listed above also sometimes have restrictions on working with same-sex couples or LGBTQ+ identified single IPs. Regulations are also constantly evolving, as evidenced by Italy’s recent attempts to ban international surrogacy and erase rainbow families entirely, described in an article that I wrote previously (https://www.babymoonfamily.com/original-articles/italy-attacks-surrogacy-rainbow-families).
Another factor to consider in terms of where to go through surrogacy is how easy/hard it will be to return to your home country after the journey. In general, the U.S. is the easiest surrogacy destination given the strong legal and regulatory framework, but it’s important to know that other countries have started to implement processes to attempt to regulate returning parents who have completed surrogacy journeys abroad.
I have reviewed legislation proposals from Ireland (https://www.babymoonfamily.com/original-articles/ireland-international-surrogacy) and Denmark (https://www.babymoonfamily.com/original-articles/denmark-surrogacy-laws) that describe how these countries want IPs to pursue surrogacy abroad in order to make it easier for them to return home with their child.
Ensuring compliance with these regulations may mean that pursuing surrogacy in one country is more difficult than another, so it’s important to keep up to date with local and international laws around surrogacy. Following @babymoonfamily on all social media platforms can also help with this, as news and developments on surrogacy regulations are covered daily.
Why Choose Surrogacy?
As I stated above, adopting and fostering are two other equally viable options for queer men to become fathers. Reasons men choose surrogacy over these options vary. Interestingly, while a genetic connection to their children is an important factor in choosing surrogacy, it is not the main one for queer men. The top reason queer men pursue surrogacy is more related to the ability to ‘control’ and ‘predict’ the process in a way that is very different from adopting and fostering. I describe this topic and the evolving methods for LGBTQ+ family building in a previous article (https://www.babymoonfamily.com/original-articles/rainbow-family-planning).
In brief, the process of becoming a father as a queer man is already so challenging, that while the costs and timing for IVF and surrogacy are significant, they do come with more assurance than adopting or fostering. Both adopting and fostering can also cost considerable time and money, and they also offer with very little probability of success if you are interested in newborn children.
How to Go Through Surrogacy?
There is no one path through IVF and surrogacy. From my experience, research is the best place to start. You’re reading this article, which is a great start. In addition to BabyMoon Family and the content available on our website (www.babymoonfamily.com) and Medium page (https://medium.com/@babymoonfamily), there is a number of other great resources that are available:
Men Having Babies: This non-profit organizes conferences all over the world that offer socializing with other queer intended and current dads; education; and the ability to meet with healthcare providers, agencies, and lawyers. My husband and I started our journey after attending one of these conferences, and I would highly recommend it (https://menhavingbabies.org/surrogacy-seminars/upcoming/).
National Groups: There are support groups in many countries such as the UK [Two Dads UK Surrogacy Support (https://www.twodadsuk.com/)] and Ireland [Irish Gay Dads (https://irishgaydads.ie/]. A simple Google search for gay/queer dads in your country or state can help connect you with other men who can offer support and guidance.
Facebook: There are a number of Facebook groups to join, read through past posts, and ask questions. They are generally closed and fairly well-moderated, but I would recommend this as more of a social tool and starting point, ensuring you independently verify all the information that is shared. Two groups I am in are:
Gay Fathers Surrogacy Network (https://www.facebook.com/groups/605109401595827)
Gay Fathers Through Surrogacy (https://www.facebook.com/groups/Gaydadssurrogacy)
Another key aspect that you have to decide with regard to your journey is if you want to go independent or with an agency.
This is a crucial decision point, as it will then determine how you navigate the entire process.
Independent journeys mean that you as the IP navigate largely on your own. This means that you pick a clinic and egg donor, and once embryos are made, you find a GC on your own. This is in contrast to an agency, where the agency often has an egg donor database, works with a clinic to help expedite the embryo creation, and matches you with a GC. Also, there are agencies that work for altruistic and commercial surrogacy arrangements in all countries.
Deciding to go independent or with an agency depends on your comfort level, possible personal connections you may have to help with your journey (such as a friend/family member who can be your egg donor or GC), finances (agency costs are at least $20,000 to $30,000 USD), and your ability to manage all the logistics, especially if it is happening in another country.
Regardless of the path you choose, there are several key players that all journeys will have for queer men: IVF clinic, egg donor, GC, and a lawyer.
Lawyers are crucial to the process. While it may seem tedious and a possible avenue for cost savings, do not skimp on the legal support in any way, shape, or form during the process. Lawyers are needed for all the contracts between the IPs, egg donor, GC, and they are crucial for getting the documentation for before and after the birth in order to make it possible for you to travel home with your child, even if it is within the same country. Lawyers are more than a necessity when it comes to a surrogacy journey.
While this overview has shared a lot of information on the basics and process of IVF and surrogacy, there is still a lot more to learn and explore.
Please continue reading through all the other articles on the BabyMoon Family website or Medium page, suggest other topics you are interested in, and share any insights you may have from your own experience with me at bryan@babymoonfamily.com.
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