Confused. That’s how I would describe the facial expression of the woman at the Social Security office. I was there to apply for my new son’s Social Security number. Normally, hospitals handle that application for new parents, but since he was born via surrogate, the burden of his federal identification falls on my girlfriend and me. Upon seeing this employee’s reaction when I explained we had another woman carry our child, I realized she, like so many people, was ignorant of the process of surrogacy.

I reached out to Carey Flamer-Powell, the director and founder of All Families Surrogacy, LLC, a gestational surrogacy agency based in Portland, Oregon. Her primary clientele are gay and lesbian intended parents, so I asked her to share and answer the Top 5 questions she gets about surrogacy.

Is the surrogate related to the baby?

Flamer-Powell says it depends on which type of surrogacy you’re talking about. “Gestational surrogacy means a surrogate only carries the pregnancy. There is no biological relation between the child and the surrogate,” she says. “Using IVF [in-vitro fertilization], the embryo that was created by the intended parents is transferred to the surrogate, resulting in pregnancy. Traditional surrogacy, where the surrogate is also the egg donor, is much less common.”

Won’t the surrogate want to keep the baby?

“Surrogates undergo intensive screening,” says Flamer-Powell, “including a psychological evaluation, to be sure they are emotionally and mentally prepared to carry someone else’s child. Surrogates sign legal documents before becoming pregnant, affirming that the biological parents have all rights to the child. Women who become surrogates genuinely desire to help another person or couple have a child and view themselves as a caretaker of someone else’s child for 9 months—essentially a ‘prenatal nanny.'”

Why would someone need a surrogate? Why not just adopt?

According to Flamer-Powell, most people seek a surrogate because of infertility issues.

“Sometimes women may not be able to safely carry a pregnancy due to medical conditions. Many gay males also seek out surrogacy in order to become parents. In most cases, the parents choose surrogacy because they desire a biological tie to the child and/or want to be involved the pregnancy process,” she says. “There are many ways to create a family and surrogacy is just one of the options out there.”

Isn’t surrogacy extremely expensive?

“There is no question that surrogacy can be very costly,” says Flamer-Powell, “due to the extensive process both the parents and surrogates must undergo with IVF and related screenings, medications, etc. There is also a great deal of legal work that must be done by lawyers on both sides.

“However, most couples who pursue surrogacy are just regular people who find creative ways to make it work for them. Some choose to forgo an agency and pursue an independent surrogacy (it’s a good idea to shop around first, as agency fees vary widely); some have a family member or friend serve as their surrogate at a reduced fee or free, and some just simply save until they have enough to start the process. There are also fertility financing as well as scholarship programs available, such as Men Having Babies, where agencies like mine have offered their services free (or at a greatly reduced fee) for scholarship winners.”

Isn’t surrogacy illegal?

“Surrogacy is actually legal in most states in the U.S. Each state has its own specific statutes, and laws are constantly evolving,” she says. “There are some states, such as Oregon and California, where surrogacy laws make it very easy for parents to have children via surrogacy.

“Unfortunately, surrogacy does remain illegal in many other countries, which is why many couples from all over the world seek out surrogacy agencies and top fertility clinics in America to help them build their families.”

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