Category: Surrogacy Medical Process

The medical surrogacy process is fascinating… and complex. These articles will guide you through it, from fertility medications to embryo transfer and beyond.

Should You Get the COVID-19 Vaccine If You’re Pregnant?

On December 16, 2020, the American Society for Reproductive Medicine (ASRM) released a statement for people who are pregnant or who are planning to get pregnant regarding the COVID-19 vaccine. This has significant meaning for gestational surrogates and intended parents, who were previously in a wait-and-see holding pattern.

The statement says that pregnant people, and anyone planning to get pregnant, cango ahead and get vaccinated — as long as your health provider gives you the OK to do so.

Ultimately, you’re free to choose whether or not you get vaccinated. It’s a discussion that intended parents and gestational surrogates should have, along with their American Surrogacy specialist.

If you’re (understandably) nervous about COVID or about getting the COVID-19 vaccine, this guide will help gestational surrogates and intended parents to make a decision on what’s best for them, and for the baby. Please note: You should still talk to your doctor first! They can offer you medical advice based on your individual situation.

COVID-19 Vaccine Basics

Here’s a brief introductory lesson on the COVID-19 vaccine, and some considerations for surrogates and intended parents:

  • As you probably know, pregnant women are at a greater risk for becoming seriously sick as a result of COVID-19.
  • Two different pharmaceutical companies, Moderna and Pfizer, have produced COVID-19 vaccines — both are about 95% effective. You probably won’t be able to choose which one you receive.
  • More vaccines are on the way, and they will also probably be safe for pregnant women.
  • The vaccine requires two doses, administered 21-28 days apart, depending on which vaccine you receive.
  • You will need to receive both doses of the vaccine in order for it to be effective.
  • The first shot is a primer and then the second is a booster shot.
  • The vaccine does not contain the live virus itself, and cannot give you COVID-19.
  • You will need to continue wearing your mask, practicing good hand-washing and hygiene habits and social distancing even after you’ve received both doses of the vaccine.
  • Common side effects include injection site pain, fatigue, headache, muscle and join pain. A handful of people have experienced fevers or allergic reactions. You may want to consider taking a day off to rest up after receiving the booster dose — some recipients say they feel a bit tired and achy for a day or two.
  • Vaccine side effects are a sign that your immune system is working as it should, not a sign that a vaccine isn’t working or that something is wrong. However, monitor how you feel after receiving the vaccine, and call your doctor if you’re worried.
  • If you’ve had a severe allergic reaction to a vaccine in the past, you should check with your doctor before getting the COVID vaccine.
  • Pregnant people were not included in the testing groups for the vaccine, which was why health organizations were initially wary to conclusively state that the vaccine was safe for pregnant women. However, so far there have been no harmful effects for pregnant women or for fetuses, and these organizations have concluded that the likely benefits outweigh the unlikely risks. Because the vaccine does not include the live virus, experts have little reason to believe that the vaccine would be harmful to pregnant women or to unborn babies. But, we understand the lack of data may be too great a worry for you.
  • There are still some unknowns, like how long the vaccine protects you, whether it can protect you against an asymptomatic infection, or if you can transmit the virus if you do become infected and are asymptomatic.

Ultimately, when weighing the potential pros and cons, experts say that it’s fine to get the vaccine when it’s available to you. That being said, you should always consult with your doctor before getting vaccinated, especially if you are pregnant or are planning to get pregnant as a gestational surrogate!

Gestational surrogates and intended parents should also talk about the choice to get vaccinated with their American Surrogacy specialist. It’s important for you all to be on the same page.

What the ASRM Says About Pregnancy and the Vaccine

In the statement released December 16 of 2020, the American Society for Reproductive had this to say to anyone who is pregnant (or plans to become pregnant):

  • “The Task Force does not recommend withholding the vaccine from patients who are planning to conceive, who are currently pregnant, or who are lactating. These recommendations are in line with those of the Advisory Committee for Immunization Practices (ACIP) of the U.S. Centers for Disease Prevention and Control (CDC), the American College of Obstetricians and Gynecologists (ACOG), and the Society for Maternal-Fetal Medicine (SMFM).”

What that means for you: The general consensus among professionals who are responsible for the health of pregnant women and fetuses is that the vaccine can be administered to surrogates.

  • “Patients undergoing fertility treatment and pregnant patients should be encouraged to receive vaccination based on eligibility criteria. Since the vaccine is not a live virus, there is no reason to delay pregnancy attempts because of vaccination administration or to defer treatment until the second dose has been administered.”

What that means for you: Getting vaccinated is still likely safe for surrogates who are currently undergoing, or are planning to undergo fertility treatments, IVF, embryo transfers and pregnancy. It’s also probably safe for intended parents planning to harvest their gametes for the surrogacy journey. Wherever you’re at in your surrogacy journey, that journey will not be affected or delayed if you choose to receive a COVID vaccine.

  • “Recent studies have suggested that pregnancy is a risk factor for severe COVID-19 disease. Furthermore, many women who are pregnant or contemplating pregnancy have additional risk factors such as obesity, hypertension or diabetes which may further increase the chance of severe disease from COVID-19 infection. These considerations should be included in decisions regarding vaccination.”

What that means for you: As you probably know, pregnant women have a higher risk of experiencing severe COVID-19 symptoms. This will be a factor in the conversation with your doctor about getting vaccinated.

  • “Because COVID-19 mRNA vaccines are not composed of live virus, they are not thought to cause an increased risk of infertility, first or second trimester loss, stillbirth, or congenital anomalies. It should be noted that pregnant and lactating women were excluded from the initial phase III trials of these two vaccines, so specific safety data in these populations are not yet available and further studies are planned. However, the mechanism of action of mRNA vaccines and existing safety data provide reassurance regarding the safety of COVID-19 mRNA vaccines during pregnancy. The FDA EUA letter permits the vaccination of pregnant and breastfeeding individuals with a requirement that the company engage in post-authorization observational studies in pregnancy.”

What that means for you: Even though pregnant women weren’t included in the original trials of the vaccine, this type of vaccine has been extensively studied and is generally considered safe for pregnant women and for the pregnancy itself. However, we understand the lack of data may give you pause.

  • “While COVID-19 vaccination can cause fever in some patients (up to 16% of those vaccinated and mostly after the second dose), this risk should not be a concern when deciding whether to vaccinate a pregnant individual or a patient desiring pregnancy. While fever in pregnancy (particularly the 1st trimester) has been associated with an increased risk of neural tube defects, a recent study demonstrated the association no longer remained significant if the patient is taking >400 mcg of folic acid daily. Another large Danish cohort study did not demonstrate any increased risk of congenital anomalies of those who reported fever in the first trimester. Additionally, the most common symptom of COVID-19 infection itself is fever (83-99% of affected patients). Patients who experience fever following vaccination should take an antipyretic medication, like acetaminophen.”

What that means for you: Even if a gestational surrogate experiences vaccine side effects like a fever, it shouldn’t harm the surrogate or the pregnancy, especially if you’re taking your recommended folic acid.

  • “Patients who conceive in the window between the first and second dose of the vaccine should be offered the second dose of the vaccine at the appropriate interval.”

What that means for you: It’s OK if you become pregnant in between your first and second dose. Go ahead and get your second vaccine dose as scheduled.

  • “Physicians should promote vaccination to patients, their communities, and to the public. Preliminary data suggests that those populations at greatest risk of severe disease from COVID-19 may also be the most hesitant to be vaccinated, and specific efforts to increase vaccine uptake in these communities should be undertaken.”

What that means for you: We know you’re worried about the health and safety of this pregnancy, as well as your own safety. But, after checking in with your doctor, you’re free to schedule your COVID vaccine as soon as it’s available to you. The benefits may outweigh the risks.

What American Surrogacy Recommends

We know that if you’re a gestational surrogate or an intended parent, or if you’re thinking about starting your surrogacy journey as a surrogate or parent, you’re probably worried about how COVID-19 affects your surrogacy journey. During a surrogacy journey, the gestational surrogate and intended parents worry about everything that goes into the surrogate’s body — everyone’s priority is the health and safety of the surrogate and baby.

With that top priority in mind, and with the recommendations of trusted health organizations, American Surrogacy joins in recommending that gestational surrogates can receive the COVID-19 vaccine, as long as the surrogate, the intended parents and the surrogate’s doctor are all comfortable with this. However, a COVID-19 vaccine is not currently required for our surrogates — the decision to receive the vaccine is still at the discretion of the surrogate, the intended parents and the surrogate’s doctor.

Wherever you’re currently at in your surrogacy journey, we suggest speaking to your doctor about getting vaccinated. Ask your doctor when a COVID-19 vaccine might be available to you, and ask if they think you might have any health conditions or risk factors that would make the vaccine inadvisable in your situation.

As long as your doctor and your surrogacy partners agree with this choice, you’re free to get the vaccine when it’s available to you. But, when in doubt, consult your American Surrogacy specialist!

Do You Need to Purchase Newborn Insurance for Your Surrogacy?

Bringing your baby home is one of the most exciting parts about becoming a new parent. But figuring out your insurance details? Not so much.

While insurance is often a confusing process, surrogacy insurance is even trickier — especially if you’re an international intended parent. Every insurance company has their own polices about how they will cover a surrogate pregnancy, and every situation is different, which makes it hard to figure out what you need for your gestational surrogacy.

If you’re like most families, then you’ve probably got a lot of questions. We plan to answer them in this guide to newborn insurance for international intended parents and surrogacy insurance for domestic parents. However, please speak with your insurance provider for the most accurate and personal advice.

Do Domestic Intended Parents Need to Purchase Newborn Insurance?

This is often the first question intended parents ask about their insurance when they live in the United States. If you have to purchase an extra policy for your gestational surrogate, then it’s natural to wonder if you need to purchase newborn insurance for your baby, as well.

The good news is that, as a domestic intended parent pursuing surrogacy in the United States, you don’t need to worry about this extra step. The insurance you already have will cover your baby at birth, so you shouldn’t have to look elsewhere for your baby’s coverage.

The process of adding your child to your insurance may vary from provider to provider. We encourage you to reach out to your provider early on to ensure your child is adequately covered after they are born.

As a domestic intended parent, you may only have to worry about buying an extra policy for your gestational surrogate, if necessary. Your gestational carrier will usually have her own insurance separate from yours, and she may be able to get some coverage for her medical expenses. In the event that she can’t, surrogacy insurance is a separate policy intended to cover her medical costs.

Keep in mind that any out-of-pocket medical costs incurred will be your responsibility as the intended parent. Your gestational surrogate will never be financially responsible for any medical costs for your newborn baby.

Your surrogacy specialist will go over the ins and outs of your policy in more detail before you begin. Before you buy separate surrogacy insurance, reach out to your specialist first. They will assess your own insurance coverage and inform you of any additional required costs.

What About International Intended Parents?

Becoming an international intended parent is exciting, but figuring out insurance for another country can be confusing — especially in the United States.

Because international intended parents’ insurance won’t carry over to the United States, newborn insurance is typically purchased in these journeys. When you’re an international intended parent, it is your responsibility to ensure that your newborn has coverage in the U.S. from the moment of birth.

Newborn claims and expenses can be the most overwhelming part of the process for parents who do not have coverage in the United States. Insurance is already tricky enough for domestic parents, so you’re not alone if you’re confused.

After your child is born, you should be soaking up every minute with your little one — not on the phone dealing with hospitals and providers. Buying newborn insurance in advance takes some of the weight off your shoulders. Surrogacy is already expensive enough, so make sure that you have your insurance sorted out to save as much money as possible.

While American Surrogacy only works with domestic intended parents, there are many surrogacy agencies that work with international families. To learn more about newborn insurance for international surrogacy, please contact one of the following professionals.

Where Can I Find Newborn Insurance as an International Intended Parent?

When you travel to the United States, there are several options for purchasing newborn insurance before your baby is born. Because there are many different types, research your options to figure out which one is right for you. Below are a few that you might consider:

  • Expat insurance: If you’re already a U.S. citizen and living abroad, there are options that will cover you and your newborn when you return to the United States.
  • Travel insurance: If you’re traveling in the U.S., consider travel insurance for you and your baby. Some companies, like Allianz, require both parents be insured., require both parents be insured.
  • Newborn resource plan: If you’re only planning on insuring your newborn, you can use a newborn resource plan, such as the International Newborn Care Card. Be aware, however, that this is technically not insurance. This card only allows for significant discounts on any claims. There is no cap on the financial responsibility of the parent, and it is your responsibility to pay for any additional costs. This card also excludes any and all claims related to your surrogate. Another option for newborn insurance is a discounted hospital cash payment. An insurance broker can help you determine which option is less expensive.

It is important that you speak with an insurance representative to understand the specifics of each plan and to decide what is best for you.

Get the Protection You Need for Your Surrogacy Journey

We know that insurance can be confusing while you’re in another country or in the United States. But making sure that you have the right protection is imperative to making sure that your baby and your surrogate are covered during this journey. The last thing that you want to do is pay more than you have to.

If you have any questions at all about insurance as a domestic intended parent, please don’t hesitate to reach out to one of your surrogacy specialists, your attorney or an insurance representative. They want to help you save as much as you can during this journey so that you can put it toward what’s important: your new family.

3 Things Surrogates Can Expect at Ultrasound Appointments

If you’re preparing to become a surrogate, you most likely know that this process is far from simple. There’s the intense screening before you get started, the exact timing of the embryo transfer, the relationship with the intended parents and 100 other things to consider.

In all of that, there may be one step that slips through the cracks: your ultrasound appointments. These appointments are obviously exciting. You’ve experienced this from ultrasounds for your own children, and maybe even previously as a surrogate. You know that ultrasounds are not very demanding, from a medical perspective.

What you may not know about are the unexpected and sometimes challenging emotions that may arise during the ultrasound appointments, both in yourself and in the intended parents. This step of the journey — as with the rest of the surrogacy process — is often more complex than it appears, but it is also so rewarding.

If you’re considering surrogacy or already in the midst of the process, here are three things you may not know about the ultrasound appointments.

1. You will probably feel excited and a bit nervous.

You’ve experienced an ultrasound before, and you know how amazing it can be. Seeing movement and the form of a baby taking shape, hearing the heartbeat — it can be a beautiful experience.

You may also be nervous. Doctor’s visits can make anyone nervous, even for the “routine” stuff. If the intended parents are there, that could add to your nerves, as well, since you want everything to go perfect for them. If you’re feeling nervous leading up to your ultrasound appointment, that’s completely normal.

Talk to your surrogacy specialist if your nerves are giving you trouble. They’ll understand and help you process your anxiety so that you can focus on the excitement. Or, if you’d like to hear what the experience was like for someone else in your position, you can ask a surrogate.

2. You may feel a confusing sense of sadness or jealousy.

Nervousness isn’t the only uncomfortable feeling that you could experience during your ultrasound appointment as a surrogate. Every experience is unique, but it’s common for surrogates to report feelings of sadness, confusion and even jealousy during the ultrasound.

What’s that all about?

Mentally, you know what you are doing. And you’re proud of it, as you should be! Biologically, it can be a bit more challenging to get your body to understand what’s happening — that you are carrying a baby that isn’t yours. This clash of biological mechanisms (like the hormones naturally released at the sight of a baby moving inside of you) and your cerebral understanding (this baby is not mine) can create an unexplainable sense of sadness. There could be jealousy toward the intended parents, too.

These are natural feelings. They are not bad; you do not need to feel ashamed if you have them. Be aware that this is a complex situation and you might feel sad, jealous or many other uncomfortable emotions. Rather than let these feelings make you feel defeated, you can prepare for coping with them.

3. There may be several awkward moments.

Ultrasounds when the intended parents are present can put the medical professionals in an awkward situation. Your doctor may lose track of who they should be talking to. They could look at you and tell you about “your baby,” or look at the intended parents when communicating medical information about your body.

Try to have some grace in these moments. Laugh them off instead of letting tension build. Everyone is on the same team, so it’s okay when these things happen. Be prepared for a couple awkward moments.

Understanding Intended Parents’ Feelings at the Ultrasound

Every intended parent has a unique experience at the ultrasound appointments. Oftentimes, they are experiencing a confusing mix of emotions, similar to the things you might feel. If things start to feel awkward during or after the ultrasound, it could be that the intended parents are trying to process what they feel.

Being aware of this can help you leave space for the intended parents to process their emotions, just as they create the space for you to process, too.

Speak With Your Specialist

Are you nervous about your ultrasound or confused about what to expect? Talk to your specialist. They can provide guidance and support for this, and every other, step of the process.

If you’re still considering surrogacy and don’t have a specialist yet, contact us today. You can reach out online or call 1-800-875-BABY(2229) to speak with a specialist, free of charge.

What You Should Know About Ultrasound Appointments: Intended Parent

The surrogacy process can sometimes feel like an out-of-body experience for intended parents. You walk through all the steps of a pregnancy, witness the ups and downs of the trimesters, follow along with prenatal care, prepare for delivery and everything else — except it’s not your body.

Yet, intended parents can still feel the emotions as if it is their pregnancy, or something close to it. Along with this, there’s a confusing mix of emotions that are distinct to this unique position as an intended parent in the surrogacy process.

Perhaps no step of the journey will illustrate this emotional cocktail better than the ultrasound appointments. A big moment in any pregnancy and in your surrogacy process, these appointments can usher in a confusing wave of emotions.

If you are considering surrogacy as an intended parent or already part of the process, here’s what you need to know about ultrasound appointments, as well as a few tips for enjoying this beautiful part of your journey.

Preparing for Ultrasound Appointments

There are plenty of steps in the process before you get to the ultrasound — too many to cover in-depth here. Instead, we’ll skip to the beginning of the medical process.

As an intended parent, you’ll work together with the surrogate (according to the parameters in your surrogacy contract) to pick a medical provider for these steps of the process.

The surrogate will go through intensive screening, a mock cycle, preparation for the embryonic transfer, the embryonic transfer and a confirmation of pregnancy before the six-week ultrasound. If that sounds like a lot, well, it is! Don’t worry; your surrogacy specialist will be working as hard as possible to make sure everything goes according to plan.

Once the pregnancy is confirmed, it’ll be time to schedule the six-week ultrasound with the fertility clinic. Depending on your fertility clinic, there may be a second ultrasound appointment at 12 weeks before prenatal care fully transfers to the OBGYN. Once in the care of the OBGYN, there will be several more ultrasound appointments.

It will be up to you how many of the ultrasound appointments to attend. If your surrogate lives close by, this will be easier to plan. If you have to travel, then you will need to decide what the cost and time is worth.

What to Expect During Ultrasound Appointments

The practical preparation for ultrasound appointments is relatively straightforward. The emotional work you’ll need to do before, during and after can be more challenging.

When you’re an intended parent, these are some of the strong emotions you should expect to feel when you’re present at ultrasound appointments:

Joy

That’s your child! Take this moment in. You’re getting a glimpse at the future of your family thanks to the wonders of modern medical technology. It’s a beautiful sight.

Jealousy

That’s quite a swing, isn’t it? We hate the feeling of jealousy. It makes us uncomfortable. But it’s actually a fairly common emotion for intended parents who, in many cases, spent years dreaming of this moment for themselves. Be aware that this feeling may come on unexpectedly and with force during the ultrasound appointments.

Confusion

Medical professionals are not always sure how to address a room with both the surrogate and intended parents present. Who to look at and speak to can be confusing, and it can create a tense dynamic. The doctor may address the surrogate when you feel they should be addressing you, or vice versa.

Ways to Get the Most Out of Your Ultrasound Appointments

These emotions and more are common. Not only that — they are normal and should be expected. Nothing you feel during the ultrasound appointments is inherently bad. The good or bad of the situation depends on your response.

It won’t be easy to process all of that on the fly. Here are a few things you can do to prepare yourself and get the most out of the ultrasound appointments:

Stay in close contact with your surrogacy specialist.

Your specialist is there to guide you through the process. From practical help preparing for appointments to emotional counseling during difficult times, call your specialist.

Have honest conversations with your partner (if applicable).

If you have a spouse or partner, are you on the same page with them? Unity and an understanding of the other’s mental state make it easier to support each other. Don’t hide some of the more uncomfortable emotions from your partner. Speak openly and often about how you’re feeling, especially before and after ultrasound appointments.

Prepare for uncomfortable feelings.

You are, in a sense, already doing this. By reading this article, you’re becoming aware of some of the challenging things to expect at ultrasound appointments. That means you can be prepared rather than caught off guard. Develop plans for how you’ll respond to feeling of sadness or jealousy to minimize the impact those emotions have on your experience.

Find ways to focus on the good feelings.

This is not to say that you should ignore or deny the more frustrating emotions. Instead, find ways to focus on the good ones that are also present in the moment.

Some people find practices like daily journaling or mindfulness practices helpful, or you can find breathing exercises to bring your emotions back under control in the moment. Anything that helps you is a good practice to develop.

Speak With Your Specialist

Your surrogacy specialist should be your most trusted resource during your process, and a complex step like the ultrasound appointments is a perfect example of why. Our specialists have experience guiding other intended parents through these challenging emotions, and they can help you, too.

Feeling nervous about your ultrasound appointments as an intended parent? Call your specialist today. Still considering surrogacy as a family-building option? Contact us online now to learn more, or call 1-800-875-BABY(2229).

What Happens if Your Baby Goes to the NICU?

Babies don’t come on a schedule. As much as we would all like our babies to be healthy, full-term infants, this isn’t always the case. Premature labor and delivery are always scary situations – but it’s even more so when you add in the complicated details of surrogacy.

Every year, about 15 million babies are born premature around the world. And, because many surrogacy journeys involve twins, the rate can be high in gestational surrogacy. While your surrogate and her doctor will do all they can to reduce the likelihood of a premature birth, it will still be a possibility.

If your baby is born premature and ends up in the neonatal intensive care unit (NICU), you probably won’t know what to expect. Rest assured that your specialist will support you through this step, although most of the information will come from your child’s doctors.

Here are just a few things you might expect when your baby goes into the NICU after birth via surrogacy.

1. You’ll need to stay in the surrogate’s state a lot longer.

Most surrogacies take place across state borders. So, if your surrogate went into labor early, you were probably already trying to get to her quickly, with little time to prepare. Now that you’re here and your child is in the NICU, you will likely face a long stay in her state with no plan.

How long you stay in a surrogate’s state will depend on how long your child remains in the NICU. You’ll need to speak with your child’s doctor for guidance. Use whatever information you have to create a plan with your spouse or support person during this time.

Here are a few tips:

  • If you have older children, consider sending one spouse home to care for them and set up long-term care with a friend or relative.
  • Look at long-term, furnished apartment rentals to give yourself a “home base” during this uncertain time.
  • Look at your finances and make a budget for this stay. Your hospital costs will likely balloon during your child’s stint in the NICU, so save where you can. Consider reaching out to a financial advisor to stay one step ahead.
  • Ask your surrogate for suggestions on where to eat and stay in the area (more on that below).

2. Your child won’t look like you expect.

All intended parents dream of the time they first meet their children. None of those visions involve the scary sights associated with the NICU.

Your child will likely look impossibly small and fragile among all the wires and monitors required in the NICU. It’s a shock for any parent, but preparing yourself ahead of time can minimize those staggering emotions and help you jump right in to supporting your child. Remember that this is normal for a child in the NICU, although it may not be a “normal” sight for you.

Your child may not look how you imagined, but they are still your child – and they still deserve bravery and strength from their parents.

3. There will be strict NICU rules.

Babies in the NICU are dealing with a variety of health concerns, so a safe, sterile environment is critical in keeping them safe. Hospitals have strict policies on NICU visitation, and your child’s doctor will give you the information you need.

Visiting hours may be shortened, and hospitals may prohibit extended family members from visiting. You may be required to wear a hospital gown, mask or gloves when in the NICU, and you will be required to wash your hands diligently and frequently.

Depending on your child’s health, you may or may not be able to hold them right away. Even if you can’t hold your child, you may still be able to hold your baby’s hand, stroke their head and talk to them. Defer to your doctor’s advice about what is best for your child at this time, and be patient. Every recommendation from the hospital is designed to give your child the best start at life possible.

4. Your surrogate may be a greater support than you think.

Your surrogacy partnership doesn’t end after your baby is born. Most intended parents and surrogates create a genuine friendship during pregnancy, and that relationship often continues after birth, too.

Your surrogate will be just as worried about your baby as you, and she may even feel guilty that she couldn’t carry your child to term like she expected. Remind her that it’s not her fault and, if you feel comfortable, invite her to spend time with the baby in the NICU. This may help her emotional and physical recovery after birth.

Don’t forget that you are on the surrogate’s home turf. She will likely have many suggestions for places to eat and places to stay in the area, and she may even offer to go grocery shopping or run other errands for you during your NICU stay. Don’t be afraid to accept the support she gives; she will be trying to help however she can.

As always, if you ever have questions about your relationship with your surrogate, your specialist is only a phone call away.

5. You’ll need to look out for yourself, too.

When your baby is admitted into the NICU, it’s tempting to focus all of your energy on them. You’ll likely spend all the time you can by their side, going through the same motions of feeding, rocking, holding and just being there. But, as any caregiver will tell you, sitting by a hospital bed for 12 hours straight every day will get exhausting – and it will wear you down.

As tough as it can be, remember your own health during this time. Make sure you’re getting the rest you need, and don’t forget to keep a healthy intake of food and drink, even when you don’t feel like it. During a NICU stay, you will be grieving your original plans for bringing your child home, and that will impact your mental health. Lean on your partner, if you have one, and make a plan, so each of you can get a break. It can be hard to step away from your little one’s bedside, but remember that the doctors and nurses in the NICU are taking good care of your baby.

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As you navigate the NICU stay, remember that your specialist at American Surrogacy will always be there for you. They will be just as invested as you in your child’s health, so don’t be afraid to check in with updates and for support. We know how tough this time will be, which is why we will do our best to coordinate with your attorney and other surrogacy professionals and let you focus on your child’s health.

How COVID-19 May Impact Your Prenatal Visits and Hospital Plans

A Surrogate’s Guide to Changing Policies & Recommendations

Beginning or continuing the surrogacy process as a gestational surrogate is still very possible for you, even in the midst of the COVID-19 pandemic. However, there will be a few changes. Social distancing and safety measures may affect your hospital experience, interactions with the intended parents, prenatal checkups and surrogacy-related medical appointments, and more.

It can be upsetting to have your carefully made plans and excitement marred by an experience that isn’t quite what you imagined. But the health and safety of everyone involved, especially you and the baby, are what come first.

Here are some changes you may notice as you move forward in your journey as a gestational surrogate, as well as quite a few things that won’t be changed by COVID-19:

Your Time with Your Intended Parents

If your match is long-distance and the intended parents live in another city or state, many of your day-to-day interactions wouldn’t have been in-person anyway. Gestational surrogates and intended parents most commonly communicate through phone calls, video chats, texts or emails.

However, due to social distancing measures, you and the parents may not be able to have as much face-to-face bonding as other surrogate-parent partnerships might have had before COVID-19. Do your best to get to know one another and build that connection through other means — start a casual Words With Friends game with one another, swap a couple recipes to try out or send them letters “from” their baby throughout your pregnancy in addition to your virtual conversations. It can be fun, and you’ll hopefully get to know one another a bit better, even when you can’t meet in person.

Having the intended parents present for the baby’s birth is one of the most rewarding moments for a gestational surrogate and one of the most exciting moments for the new parents. But some hospitals may have policies about how many people can be in the room with you during your labor and delivery. This may mean that only one intended parent may accompany you, or neither of them, so that your spouse can be with you. This is something that we’ll touch on more momentarily, but that you’ll want to ask your hospital about in advance.

Your Prenatal Medical Care and Surrogacy-Related Medical Appointments

Contact your OB-GYN and your fertility clinic to ask about their COVID-19 policies. Do they prefer minor check-ins to be conducted virtually? Are you allowed to bring the intended parents or your spouse? If they do have new policies regarding COVID-19 prevention, you’ll want to know about it before the intended parents or your spouse come with you to these appointments and have to wait in the car!

Of course, in-person visits will be unavoidable throughout your surrogacy process. For these, you’ll want to bring a mask and sanitize your hands before and after your appointment. The doctor’s office or clinic will likely take your temperature before you enter, in addition to other precautions.

Your Hospital and Delivery Experience

Hospital policy regarding labor and delivery during this time will vary. Some hospitals, for example, will limit the number of visitors you may have during your labor, delivery and recovery. At other hospitals, they’ll simply take more precautions — like taking the temperature of visitors and asking that everyone wash their hands and wear masks.

In more extreme situations, surrogates have had to choose just one intended parent to have with them in the delivery room, or just the surrogate’s spouse was in the room to support them. This can be tough for everyone involved if your hospital has this type of policy. While American Surrogacy hasn’t encountered this yet, policies simply depend on the hospital and the rapidly changing pandemic situation.

Check in with your American Surrogacy specialist and your intended parents. Together, you’ll communicate with your chosen hospital to determine any changes that might need to be made to your ideal birth plan. It’s best to talk about these plans in advance, so you aren’t caught off guard when you go to the hospital and discover that they have a new COVID-related policy that affects you.

Your Precautionary Measures for Health and Safety

You already know how to stay healthy and safe when you’re planning to become pregnant (or are pregnant), even before the coronavirus became a factor. And everyone, not just pregnant women, should be taking appropriate measures to reduce and slow the spread of COVID-19 by staying at home as much as possible, social distancing, frequently washing hands and wearing masks when around others.

But now, carefully adhering to preventative measures regarding COVID-19 is especially important for gestational surrogates and the people around them.

The CDC states that “pregnant people appear to have the same risk of COVID-19 as adults who are not pregnant. However, much remains unknown. We do know that pregnant people have had a higher risk of severe illness when infected with viruses that are similar to COVID-19, as well as other viral respiratory infections, such as influenza.

“We also know that pregnant people have changes in their bodies that may increase their risk of some infections. Therefore, if you are pregnant, it is always important for you to try to protect yourself from illnesses whenever possible.”

As for increased risks to newborns, very little is known at this time, but they may be more likely to suffer from severe illness stemming from the virus, similar to pregnant people.

The main takeaway: Protect yourself from illness just as you would with any pregnancy, but continue to:

  • Stay home when possible
  • Wash your hands often
  • Practice social distancing
  • Wear your mask when around anyone outside of your “quarantine bubble”
  • Remind your immediate family members to do the same in order to protect one another

You’ll need to be cautious about who you, and your family, come into contact with. Your family will need to practice the same safety measures as you to prevent them from contracting the virus and potentially spreading it to you. You probably aren’t at any greater risk than anyone else, but everyone should take reasonable precautions, regardless.

You can’t keep yourself in a bubble throughout the entirety of your surrogacy journey, and no one is expecting you to do so. However, being extra vigilant about reducing your exposure and increasing hygiene steps can help mitigate the risk of contracting or spreading the virus during your surrogacy experience.

If you have any questions about how COVID-19 may affect you as a surrogate — including through IVF, pregnancy, delivery and more — don’t hesitate to contact your American Surrogacy specialist. Remember: Becoming a surrogate or continuing your surrogacy process is still safe, as long as you continue to practice the prescribed basic health and safety measures.

What Is Embryo Grading?

You’ll come across many new things when starting a family through surrogacy. It’s a complicated process.

One of the least understood steps of the surrogacy process is embryo grading. And for good reason — it can be confusing and intimidating.

We’ve created this article to answer several of the biggest questions about embryo grading. We hope that, by the end, you have a better understanding of this medical process, as well as a release from any pressure it is causing you to feel.

While we are not medical professionals and cannot fulfill the required steps for IVF, American Surrogacy is a national surrogacy agency, and our specialists know all about the process. Contact us any time with additional questions about becoming intended parents or a surrogate.

What Is Embryo Grading?

Scientific advances in recent years have unlocked valuable information that would’ve been unimaginable even 10 or 20 years ago. The process in which an egg and sperm join together to form an embryo was previously unobservable. Today, we have great insight into how this takes place and can watch it happen. Embryo grading is an evaluation used by embryologists to analyze this process.

How Do Clinics Perform Embryo Grading?

Embryo grading takes place post-fertilization. Once the eggs have been extracted from the intended mother or donor and the sperm has been injected into the eggs, the period of embryo grading can begin.

While the embryo waits in an incubator, clinicians will observe it and look for specific cellular developments, particularly from days 3-5 of fertilization. Based on what they see (or don’t see), they will assign an embryo grade, which will factor into whether or not the embryo is used in the IVF process or is frozen.

What Gives an Embryo a Good Grade?

Embryologists are typically looking for several things from days 3-5 of the incubation process:

  • Cell Count and Multiplication: Between days 3-5, the observed number of cells should move from around eight to as many as 150 or more. This growth is a positive sign that an embryo is developing properly.
  • Stabilization: Embryos that show stable structure, including symmetrical growth, are believed by some clinics to be more likely to result in successful pregnancies. However, clinics differ on this point. For some, simply seeing sustained growth is all that’s required, while others want to see symmetrical growth.
  • Fragmentation: Haphazard development, on the other hand, is a negative sign. An embryo growing without clear structure and organization will likely be graded lower.

The caveat here, as we have already noted, is that embryo grading is still new to the medical community. Common standards are not always agreed upon. Each clinic uses its own system to score results, while some clinics do not take part in the practice at all. One may place a very high emphasis on symmetry, while another’s grading metric might prioritize cell count.

This means the same embryo could receive very different grades from two different clinics. We’ll explore what this means about your embryo grade below.

What Impact Does Embryo Grading Have on Success Rate?

Due to the complicated nature of grading and the different procedures used from clinic to clinic, it is nearly impossible to say what effect the grade an embryo receives has on the success rate of the transfer.

Generally speaking, embryos with an abundance of desired qualities — exponential cell growth, stable structures, etc. — will receive higher grades and are believed to have a better chance in resulting in a successful pregnancy.

However, the science is not exact. Embryos with high grades can still result in failed pregnancies, and vice-versa for embryos that receive lower grades.

So, Why Does Embryo Grading Matter?

While even highly graded embryos can result in a failed pregnancy, this practice can be very useful at catching a failing embryo before the IVF process. There are some embryos that, by day five, are clearly heading down the wrong path.

Embryo grading can be a useful tool for embryologists to determine the best candidates for IVF. But, it is only one tool in the toolbox. There are other factors to determine the likely success rate of embryo transfers.

When you’re an intended parent, it can be disappointing to hear that your embryo has received a low grade from the clinic. But, this shouldn’t be taken as devastating news. Grades are not final says. And, even if the grade is too low to move forward with that embryo, there will be alternative routes as you continue to pursue your dreams of parenthood.

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Where does that leave you?

You’ll want to use all available medical technologies at your disposal during this process, but you shouldn’t stake your hopes on a single grade. Trust the professionals leading you on your journey, and take heart. Challenges will arise during this process, but the end of the road is the beginning of your family.

If you have more questions about the surrogacy process, or are interested in starting the process with our agency, let’s talk. You can contact us online at any time or call us at 1-800-875-BABY (2229).

When an Embryo Splits: A Surrogate’s Guide

When you go in for your first ultrasound post-embryo transfer, you and your intended parents will simply be hoping for a healthy, strong heartbeat. It will probably come as a shock to both of you if the doctor picks up two — it means you’re carrying twins!

Even though reproductive endocrinologists often do all they can to ensure a healthy singleton pregnancy with little risks, sometimes nature has other plans. You may not have seen yourself carrying twins for someone else for nine months. But, now that you’re in this situation, what can you do?

We know getting news of a multiples pregnancy can be shocking. Remember, your American Surrogacy specialist will always be there to answer your questions and support you moving forward.

While identical twins are rare, they can happen. Here’s what you should do if you find yourself in this situation:

1. First, Talk with Your Intended Parents

An identical twin pregnancy can bring up a lot of complicated emotions, and that’s especially true in a gestational surrogacy. You and the intended parents may need some time to process this news and what it means for your journey, but it’s crucial that you’re all on the same page moving forward.

Make sure that you are open about your thoughts and emotions during this time. Fortunately, you’ll have a roadmap for the next nine months (see below about your contract), but there will always be opportunities to update that plan as you figure out what works best for you. Having an open conversation and building a solid team dynamic from the beginning will make the challenges ahead much easier.

Remember: You have as much of a say in this gestational surrogacy as the intended parents, so don’t be afraid to share your feelings about this unexpected situation.

2. Look to Your Contract

The first decision you’ll make together is whether or not to continue this pregnancy. Because identical twins share a placenta, it’s nearly impossible to safely reduce the pregnancy to one fetus. Instead, you will be faced with an “all-or-none” decision: to continue with the twin pregnancy or terminate in hopes of a healthy singleton pregnancy during your next transfer.

Your path forward will be laid out in your surrogacy contract. Making this important decision in the heat of emotions is incredibly difficult; that’s why we require all intended parents to discuss these complex situations ahead of time with a lawyer. Your contract will likely inform your next steps.

Your contract will also address the additional compensation you are entitled to during a multiples pregnancy: the additional payment for carrying twins, bedrest compensation, wages for missed work and additional compensation for invasive procedures (such as a Cesarean-section). If you ever have any questions about your surrogate compensation, talk with your surrogacy specialist or attorney.

3. Remember the Risks

There’s a reason why reproductive endocrinologists take steps to ensure singleton pregnancies in IVF and gestational surrogacies. Carrying more than one baby increases the health risks for both carrier and babies.

If you and your intended parents will move forward with an identical twin pregnancy, you’ll need to be comfortable with the additional risks this can create, including:

  • Preterm labor and delivery
  • Low birth weight
  • Preeclampsia
  • Gestational diabetes
  • Cesarean-section
  • Placental abruption
  • Fetal death

You will need to be extremely careful and take certain precautions to keep yourself and the intended parents’ babies safe. This may mean you undergo a planned c-section before your due date or spend the last few weeks of your pregnancy on bedrest or limited in the activity you can do.

Your surrogacy contract will address the worst-case scenario (disability compensation and life insurance), but you must be comfortable with these risks before you agree to continuing a multiples pregnancy.

4. Create a Plan for Your Family

Because a multiples pregnancy comes with the risks mentioned above, you’ll need to work with your spouse and immediate family members to create a plan. This will come in handy, should you be placed on bedrest, have to take maternity leave early or have an extended recovery from a c-section.

Your family should have a plan for:

  • Who will watch your children and pets while you are unable to
  • Who will put together meals for your family while you’re incapacitated
  • Who will bring you supplies when you’re at the hospital
  • And more

Your surrogacy specialist can give you suggestions of things to plan for, based on her experience with other surrogates.

This is where having a great support system of family and friends can come in handy. Reach out to your support system; see if someone would be willing to prep some ready-made meals for your family, or take some of your laundry to the laundromat after delivery. You may be surprised at just how much help you’ll get!

5. Take it One Day at a Time

In many ways, a multiples gestational pregnancy is no different from a singleton gestational pregnancy. Yes, there are some added risks but, by taking things slow and keeping yourself safe, you can still have a successful, memorable surrogacy experience.

The last thing you’ll want to do is stress yourself out with all the “what-ifs.” You and your intended parents should instead focus on all the things you can control: your birth plan, your relationship during surrogacy and the beautiful experience you’re having together. A positive outlook can make all the difference during the uncertainty of a multiples pregnancy.

Remember, if you are ever in need of additional support or guidance, American Surrogacy will always be there for you.

When An Embryo Splits: An Intended Parent’s Guide

In most IVF and surrogacy journeys, creating one healthy pregnancy can be hard enough. But, what happens when the embryo you’ve transferred to your gestational surrogate splits — and you now have identical twins on the way?

This surprise is enough to make even the most level-headed hopeful parents’ heads spin. But you’re not the first parents to experience this shock, and you won’t be the last. What’s important is moving forward with a clear head and a clear set of steps and responsibilities.

Remember, your American Surrogacy specialist will always be there for you in unexpected situations, including identical twins. You can always reach out to them for support and guidance moving forward.

There are usually a few tips we recommend to intended parents in this position:

1. First, Take Stock of Your Situation

Getting the news you’re having twins can be a huge shock. It’s normal to need some time to process this change in your family-building journey. Don’t be afraid to take a beat to accept this news.

Talk with your spouse, if applicable. Talk with your gestational surrogate, too. There is often a great deal of complicated emotions that come with this exciting news, and you are all in this gestational surrogacy journey together. Wherever you go from here, you will need to be on the same page.

However, don’t take too long for this step. Your reproductive endocrinologist will likely present a few paths moving forward (we’ll talk more about those below).

2. Recognize How This Changes Your Financial Situation

It’s no secret that having one baby is expensive. When you have two babies at once, those costs will often more than double.

Being a parent of twins means spending more on:

  • Baby supplies (clothing, diapers, formula, etc.)
  • Childcare
  • Extracurricular activities
  • School and college tuition
  • And more

You should also consider the unique costs associated with a multiples gestational pregnancy. You will need to pay your surrogate an additional retainer for carrying more than one embryo, and you should be prepared for the extra costs associated with bedrest, invasive procedures or more time off work. These costs can quickly add up, so make sure you talk about them in depth with your surrogacy specialist.

Remember that a multiples pregnancy is much riskier than a singleton pregnancy. In the worst-case scenario, a gestational surrogate’s health could be permanently affected, and you could pay additional disability and even death compensation. While these situations are rare, they are always a possibility you should consider.

3. Remember the Risks of a Multiples Pregnancy

There’s a reason why most medical professionals no longer complete multiple-embryo transfers. The risks of a multiples pregnancy are just too great, to both the surrogate and the babies she carries. A multiples pregnancy can increase the possibility of:

  • Preterm labor and delivery
  • Low birth weight
  • Preeclampsia
  • Gestational diabetes
  • Cesarean-section
  • Placental abruption
  • Fetal death

Your gestational surrogate will always be at risk in a multiples pregnancy, no matter how careful she is. This is why intended parents must talk at length with their surrogate before transfer and determine what both parties are comfortable with. If you choose to move forward with a twin pregnancy, your surrogate will have to accept this increased risk, and you will need to pay additional retainers, as mentioned above.

Unlike with multiple embryo transfers, twins that result from a single split embryo transfer often cannot be reduced. Identical twins will most likely share a placenta, making it impossible to remove one fetus to give the other the best chance of a healthy birth. Most reproductive endocrinologists will offer an “all-or-none” option: Either the surrogate must carry both fetuses to term, or the pregnancy will be terminated in hopes of a successful singleton pregnancy next time.

These are complicated conversations to have, made more difficult in the emotions of the moment. That’s why surrogacy contracts are so important — they will address situations like this ahead of time and lay out a clear path forward, should they occur.

4. Prepare for Parenting Two Newborns at Once

There’s a lot more to preparing for twins than getting your bank account in order. You’ll have twice as many responsibilities as caring for a single baby, and you’ll need to take a few steps to make that as easy as possible.

If you can, put these measures in place prior to even coming home with your new additions:

  • Recruit some family members or friends to stay with you the first few weeks after the babies are born.
  • Talk to and get advice from other parents raising multiple babies at once.
  • Create a schedule for when your babies come home — who will feed the babies during the day and night, who will change diapers, who will put together your family’s meals, etc.
  • Set up your first pediatrician’s appointment.

While you can’t prepare for all of the unknowns that come with raising children, taking a few steps ahead of time will save you a great deal of stress in the long run.

5. Finally, Take a Deep Breath

Becoming a parent is stressful. When you’re unexpectedly becoming a parent to two little babies, it’s easy to get overwhelmed.

Remember that every emotion you’re feeling — excitement, worry, sadness, guilt and terror — is all completely normal. You will never be a “bad” parent, as long as you take the steps now to prepare your family for this new journey. That means taking care of your mental health, too.

Don’t forget that your surrogate is likely feeling all kinds of complicated emotions, too. Take the time to reach out to her and remind her of your support. While the journey ahead may be unexpected, you can get through it together.

And, if you ever need any additional help or support, American Surrogacy will always be there for you.

5 Tips for Bedrest During Surrogacy

When you became a surrogate, you probably had a vision in your head of how your pregnancy would go. You’d be able to carry the intended parents’ baby nine months without a hitch, simultaneously focusing on your job and your family with only minimal adjustments.

But we all know life doesn’t go according to plan — and pregnancy can be especially surprising. If you’ve found yourself facing down the remainder of your pregnancy on bedrest, you’re not alone.

While bedrest is important for your physical health, it can also seem like a death sentence for your mental and social health. But there are some steps you can take to make your bedrest as easy as possible for you, your family and your intended parents.

1. Prepare as Much as You Can

The success of your bedrest will depend upon what steps you take to prepare yourself. Bedrest certainly isn’t easy, despite its name, and you’ll need to actively prepare for how this will affect your life moving forward.

Your surrogacy specialist and doctor will always give you suggestions, but here are just a few things to think about:

  • Preparing yourself: A routine can make all the difference as you pass days with limited activity and interaction. Plan what you’ll do each day, and make sure you have everything (phone charger, laptop, fluids, snacks, etc.) close at hand. Talk to your employer to see if you can work remotely or if you’ll need to take personal leave.
  • Preparing your family: You won’t be able to take care of your normal responsibilities, so work with your spouse to create a plan. Who will manage childcare while your spouse works? How will you ensure your family has well-balanced, healthy meals to eat? How will you explain your bedrest to your children?
  • Preparing your intended parents: Your intended parents will be understandably worried about you if you develop a high-risk pregnancy, but try to reassure them as much as possible. Set expectations for how often you’ll update them on your well-being, and give them ideas for helping you and your family during this time.

2. Find Out What is and isn’t Allowed

Bedrest may conjure images of you stuck under the covers for weeks, with your only exercise being your walk to the bathroom. But that’s not always the case.

Like most medical prescriptions, bedrest isn’t one-size-fits-all. It’s important that you get all the important details from your doctor: Can you get out of bed to stretch and do gentle exercises? Can you still do easy chores around the house?

Bedrest in its traditional form is rarely prescribed today, but your doctor may use this term to mean a reduced amount of activity and work in your daily routine. While it’s important to play it safe for your health and for the baby’s, don’t be afraid to advocate for your needs and understand exactly what your doctor means when they use this term.

3. Get Creative with Entertainment

When we’re busy in our everyday lives, a day full of Netflix and the couch can seem like heaven. But, when it becomes the only thing you can do for weeks on end, it can quickly get old.

Women who are on bedrest should think of alternative entertainment options. You might consider:

  • Buying an old gaming system to re-live the video games of your youth
  • Filling out crossword puzzles and coloring books
  • Finding a new hobby, like learning a new language or taking an online class
  • Finally reading the stack of books on your bookshelf

As you evaluate what entertainment option is right for you in the moment, don’t forget to evaluate your mental health, too. It’s easy to get into the habit of letting the TV drone on for hours, but taking the steps to challenge yourself mentally during this time is important. You could even include your family in a family game night, hosted from your bedroom!

4. Maintain Your Social Relationships

You will likely feel stir-crazy with only your family to talk to, so don’t forget your friends! While you may not be able to do much out of bed, you could always invite your friends over for a “happy hour.” Or, you can always do the tried-and-true phone call. Talking about something other than your pregnancy can give you a good mental break.

Your friends can also be a great source of support during this time. Don’t be afraid to ask for help, even if it’s something as simple as a pre-made casserole or a babysitter if your usual caregiver needs a break.

5. Keep Your Intended Parents Updated

While bedrest may be more of an inconvenience for you than anything else, a high-risk pregnancy can be extremely frightening for intended parents. There’s nothing they can do to ensure a healthy delivery at this point; they’re just relying on you, so it’s important to reassure them however you can.

Take the time to update them a few times a week on your well-being, if you’re comfortable doing so. Pass along any information from your medical providers, and try to still send happy pregnancy updates (“the baby is kicking!”). While you should only do what you are comfortable doing, remember that your intended parents are putting their whole future in your hands — and they are here to help you, too.

If you need more guidance or support during your bedrest, be sure to let your surrogacy specialist know. We are always here to help.