An overall family building plan should be developed as soon as a couple learns of the infertility diagnosis. All too often we see couples who have spent all of their savings on IVF treatments before considering surrogacy or donor egg. It is important to set a limit of how many IVF cycles will be performed before pursuing third party reproduction options such
as donor egg and/or surrogacy.

IVF Costs:

In order to keep IVF costs down, research which IVF clinics in your area have “shared risk” programs i.e. programs where the IVF clinic will perform a set number of cycles for a flat rate (usually a bit higher than the rate for one cycle, but less than the rate for two cycles), and will return their fee if a pregnancy is not achieved. This option allows the couple to have the funding to pursue additional avenues of family building if IVF if not successful. Many of these programs will cover, for example, two cycles with the Intended Mother’s ovum, and then one cycle with the ovum from an egg donor. Most often these shared risk programs may be used only by Intended Mothers who are under 39 years of age, and/or who agree to use donor egg after one or two failed cycles. In addition, it often makes sense to freeze embryos from one donor egg cycle and use them for a second embryo transfer, if needed, or for sibling for the child down the road.

If advanced reproductive age of the female is determined to be the cause of infertility, then using donor egg may be the right solution. In other cases, if the RE believes that the probability of achieving pregnancy (using either the Intended Mother’s ovum or those of an egg donor) would be greater using a surrogate, due to a condition affecting the uterus such as Asherman’s syndrome or Endometriosis, then it is time to consider surrogacy.

If unexplained or male factor infertility or egg quality is determined to be the cause of infertility, and the couple would still like to pursue having a child that is genetically linked to both the Intended Mother (IM) and the Intended Father (IF), then some RE’s recommended that a procedure called intracytoplasmic sperm injection ICSI be used. With traditional IVF without ICSI thousands of motile sperm are put into the petri dish with the hope that one of these sperm will fertilize the egg on its own. With ICSI a single sperm is chosen and injected directly into the egg with a microscopic laser. This procedure increases the probability of fertilization in such cases. Many very large IVF clinics have protocols where they do not use ICSI for the first few cycles of IVF, but other RE’s are more aggressive, and in such cases, prefer to use ICSI for the first IVF attempt. IP’s should be especially attuned to this is if they are not participating in a shared risk program and are paying IVF costs out of pocket, as the additional costs for ICSI pale in comparison to the costs, both financial and emotional, of pursuing another IVF cycle. Some RE’s will do a “split cycle” where half of the eggs are conceived with ICSI. Some IVF clinics may also use a process called assisted hatching. Again, it is important that you be familiar with the cause of infertility in your case, so that you can discuss these options and their costs and benefits with any RE’s that you may be considering.

Health Insurance Costs:
In almost all cases surrogacy and IVF for the purposes of surrogacy are not covered by either the IP’s or the surrogate’s health insurance. The costs of maternity coverage once the surrogate becomes pregnant will, ideally, be covered by the surrogate’s existing health insurance policy. As surrogacy becomes more common, however, more health insurance carriers are writing exclusions for surrogate pregnancies into their policies. Your surrogacy agency or a surrogacy insurance specialist should analyze the surrogate’s insurance policy to check for such exclusions and to research the history of the surrogate’s health insurance plan with regard to surrogacy. Even if there are no exclusions, an insurance carrier may decide to deny claims when they learn that the pregnancy is for a surrogacy. In rare cases, insurance carriers have paid some claims then upon discovering that a pregnancy is very costly and for a surrogacy, denied claims and left the IP’s with the responsibility of paying for all medical costs related to the pregnancy. With a complicated or multiples pregnancy and delivery these costs could run into the hundreds of thousands of dollars. The greatest financial risk of the surrogacy process is a high risk or complicated pregnancy. There is a slightly higher
risk of complications with an IVF pregnancy, and, of course, with any multiples pregnancy. Most reputable surrogacy agencies and attorneys recommend that: 1) IP’s buy a “back-up” insurance policy designed specifically for surrogate pregnancies, or 2) that the surrogate notify her insurance carrier and get a letter from them specifically stating that they will cover the surrogate pregnancy (often for an additional cost).

Bed-Rest and Other Costs:
Any reputable agency or attorney will require that there are provisions in the Surrogacy Agreement for a case in which the surrogate has to go on doctor ordered bed rest. These provisions will require the IP’s to pay the surrogate for lost wages (or for childcare in the case of a stay at home mom) while on bed rest, and if the surrogate is on bed rest for an extended period of time, these costs can add up. This is another consideration to take into account when searching for the right surrogate. You should look for someone who has a good steady job, but who is not earning a very high salary, as compensating her for lost wages could also become a large expense.

Read Sandra's story about how her experience as an intended mother ...

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