STEP 1 - Initial Contact
When you contact our office for information, we send you our Intended Parent package which contains background information on Jackie Gorton, Nurse Attorney Inc. along with a letter outlining the surrogate parenting arrangement and potential costs. We need to know the name of the clinic you are working with, whose gametes you will be using (donor gametes or your own), and if you will be using frozen embryos or fresh. We require that you work with a fertility clinic in Northern California. If you have not already found a clinic, we can refer you to several reputable clinics. You must be working with a fertility clinic before setting up a consultation with our agency.
STEP 2 - Intended Parent Consultation and Surrogate Profiles
Since surrogate parenting is a complex process, we require all Intended Parents to participate in an initial consultation at our office. In this consultation we discuss agency services and information on medical, legal, and psychological issues of surrogate parenting. We also give you copies of profiles of surrogate candidates. Each candidate's profile has photos of the surrogate and her family along with the surrogate's self-reported health and pregnancy history. This is the time to ask questions about surrogate parenting and our experiences with other surrogate arrangements.
STEP 3 - Retaining our Agency
After your consultation, you need to complete a psychological evaluation and any outstanding medical testing. Before interviewing any surrogates you need to sign the Agency Contract which outlines our services and your responsibilities as Intended Parents. When you send in the signed Agency Contract, you include the 50% advance on the administrative fee and a deposit to cover surrogate screening costs.
STEP 4 - Surrogate Meeting
We schedule a meeting at our office between you and the potential surrogate candidate(s). During this meeting we discuss the surrogate process and the logistics of working together. If a surrogate is in a relationship, you will meet her partner and learn about her support network. You can ask the candidate questions about her previous pregnancies and her expectations of this arrangement. Each party decides within a few days of this meeting if they want to work together.
STEP 5 - Surrogate Screening
Once you and your surrogate have decided to work together, we refer the surrogate to a therapist to schedule her psychological evaluation. The therapist administers the Personality Assessment Inventory (PAI) and interviews the surrogate and her partner (if applicable). The therapist writes a report based on the outcome of the PAI and interview; a copy of the report is sent to your physician and our office. A summary of the report will be available to you.
After your surrogate's psychological evaluation, your clinic schedules a Medical Screening Appointment (MSA) when your surrogate is in mid-cycle (ovulating). The MSA will include infectious disease testing, toxicology screens, and an ultrasound to assess the thickness of her uterine lining.
It is possible that your clinic or the therapist may not recommend your candidate. In that case, we introduce you to other surrogate candidates.
STEP 6 - Surrogate and Intended Parent IVF Contract
Once your clinic medically clears your surrogate candidate, we send you a copy of the IVF/Gestational Surrogate Contract and refer you to an attorney to represent you regarding your contract rights and obligations. The attorney drafts an Addendum of any changes. This attorney represents you (and your partner) in completing the Parentage Order once your surrogate is pregnant. The remainder of the administrative fee and surrogate fee is due upon completion of the Contract and Addenda. The Contract and Addenda must be signed by both parties and all fees paid before your surrogate starts injectable medications.
STEP 7 - Maternity Care Insurance
At the same time that you are working on your Contract, we refer you to an insurance broker that specializes in surrogate maternity care coverage. You start an application for Medical Insurance on your surrogate's behalf. The insurance broker assists you in explaining the fee schedule and completing the application. We send proof of maternity care insurance coverage to your clinic.
STEP 8 - Escrow Account
The Escrow Account holds your surrogate's fees and funds to cover her expenses. We reimburse her for her expenses once we approve her costs as delineated on her expense chart. Once your surrogate is pregnant she receives $1,500 to $2,000 of her fee and every 4 weeks thereafter. The balance is paid upon delivery as outlined in your Contract. We send you account statements after each transaction, and we request funds to replenish the expense account when the balance falls below $2,000.
STEP 9 - Medication Schedule
Once the Contract is executed, all fees paid, and your surrogate has been approved for medical insurance, your fertility clinic nurse sends you a calendar which identifies dates your surrogate starts injections and the estimated week of embryo transfer (ET). If you are doing a fresh embryo cycle, the fertility clinic nurse synchronizes your surrogate's menstrual cycle with your menstrual cycle or the menstrual cycle of your ovum donor before either party starts injections. If you have frozen embryos the fertility clinic nurse schedules a calendar based on your surrogate's menstrual cycle.
STEP 10 - Embryo Transfer (ET)
Surrogates are paid $750 for each ET procedure. You and your physician determine the number of embryos to transfer. Usually 2-3 high quality embryos are transferred. The physician may prescribe bedrest for your surrogate for 24-28 hours after ET.
STEP 11 - Blood Pregnancy Tests
The fertility clinic nurse schedules a blood pregnancy test for your surrogate approximately 9-11 days after the ET. This blood test is at a medical lab located near your surrogate's home. If the first blood pregnancy test is positive then a second test is scheduled two days later. If the HCG level has doubled an ultrasound confirmation is scheduled approximately 2-4 weeks after ET. If your surrogate does not have a positive blood pregnancy test the clinic instructs her to stop taking medications, and a calendar is set up for a second embryo transfer with the same surrogate upon recommendation of the fertility physician.
STEP 12 - Ultrasound Confirmation
Once your surrogate is pregnant, the fertility clinic schedules an ultrasound 2-4 weeks after ET. The ultrasound confirms the pregnancy and determines how many embryos are thriving. Your surrogate is paid the first $1,500 to $2,000 installment of her fee the day of this ultrasound. At the 8th week of pregnancy the fertility clinic releases your surrogate into the care of her local OB.
STEP 13 - Choosing an OB
You and your surrogate together locate an OB in her community who is a member of the maternity insurance plan and has admitting rights at a hospital with a neo-natal intensive care unit in case the baby needs NICU care. We ask the surrogate to file a medical release with her OB so you can discuss the pregnancy with the OB.
STEP 14 - Life Insurance Application
We refer your pregnant surrogate to a life insurance broker to apply for life insurance around 12 weeks post ET. The broker guides her through the application process and helps her make appointments for any necessary physicals. The Gestational Surrogate Contract states the value of the policy.
STEP 15 - Prenatal Care
The surrogate's local OB provides the pre-natal, delivery and post-natal care. We ask your surrogate to check in with a therapist monthly to discuss any stress. If your surrogate becomes pregnant with triplets and must undergo a selective reduction, the fertility clinic refers her to a specialist in San Francisco. The reduction is done at 12 weeks of gestation and your surrogate will be on mandatory bedrest for 72 hours post reduction. The attending OB prescribes an amniocentesis only if abnormal defects are suspected. An amniocentesis would be done around 20 weeks gestation. If the amnio is positive for genetic defects you (as the parents) decide whether to terminate or continue the pregnancy. With a healthy pregnancy you will attend several of your surrogate's pre-natal appointments and tour the OB unit at the hospital prior to delivery.
STEP 16 - Parentage Order
At the end of the first trimester, you and your attorney file the Parentage Order in your surrogate's jurisdiction. The Parentage Order is a court order that removes the surrogate's name (and husband's name) from the birth certificate and places your name on the birth certificate instead. In case of a stillbirth the Parentage Order places your names on the death certificate. The attorney who originally represented you prepares the Parentage Order. A certified original copy of the Parentage Order is sent to the birth registry department at the hospital where your surrogate delivers.
STEP 17 - Delivery
When your surrogate goes into labor she will contact you and our office as soon as possible so you can travel to the hospital. If you are not local, you may want to discuss with your surrogate traveling to Northern California prior to the due date. As long as a stamped, certified copy of the Parentage Order is on file at the hospital, you will have custody of the baby immediately after the delivery. Congratulations!
STEP 18 - Post-Delivery
The IVF contract that you signed states the terms for reimbursing your surrogate for lost wages, childcare, etc. after delivery. You are responsible for all medical bills and other bills associated with the delivery. Depending on your relationship with your surrogate you may continue contact after the delivery. If agreed, your surrogate may express breast milk for the baby for several days or weeks. We hold any remaining funds in the Escrow Account for about six months to cover any outstanding bills and/or lost wages. We may need to ask you to deposit additional funds in the Escrow Account and we will return any unused balances after all expenses have been paid. We are sure the money will come in handy for your new baby! |
