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Understanding Altruistic Surrogacy And How It Works

Surrogacy is possibly the most precious gift that one can give no matter what path is taken. As intended parents join with a surrogate to bring life into the world, they must decide which type of agreement they’d like to proceed with. They can choose either commercial, or compensated surrogacy, or an altruistic surrogacy process. In this article, we are going to dig deeper into altruistic surrogacy, often called compassionate surrogacy, and discuss its pros and cons.

Altruistic Surrogacy Defined

Merriam-Webster defines altruism as “unselfish regard for or devotion to the welfare of others.” Those who put the well-being of others before themselves are considered to be altruistic. Surrogacy in general is a very kind and selfless act. However, when referring to an altruistic surrogacy, the woman carrying the pregnancy chooses not to receive a base compensation. This person is commonly a friend or family member that is already known to the intended parents. The altruistic, or compassionate, surrogate genuinely wants to help them become parents while eliminating their financial burden. It should be noted, however, that in either case, the surrogate should always be reimbursed for medical expenses related to the pregnancy.

How Does It Work?

The formal definition of surrogacy is a method in which a woman agrees to carry a pregnancy for someone else who will be the child’s parent or parents after birth. It’s used when the intended parents are unable to carry a child on their own, often due to medical issues. Members of the LGBTQ community and single individuals who wish to be parents can also pursue parenthood via surrogacy.

An entire surrogacy journey can take up to 15-18 months. If you need to seek an egg and/or sperm donor, you can expect it to take an additional 3-4 months. Surrogacy is a long process, but it is worth the wait!

The general process is often the same no matter the type of agreement you enter into. However, with commercial surrogacy, intended parents are usually matched with their surrogate through a professional agency. A predetermined payment is included to compensate the carrier for their time and efforts throughout the pregnancy.

Altruistic surrogacy differs from commercial in that the surrogate is often someone well-known to the intended parents. They choose to be the gestational carrier solely as an act of generosity with little to no compensation. In these situations, the intended parents are only responsible for covering the cost of any medical and pregnancy-related expenses.

Having the opportunity to save money is a common reason intended parents choose to go this route. However, finances are not the only reason intended parents might choose this type of agreement. In some cases, altruistic surrogacy could be their only option. In some states, the only legal option for surrogacy is through altruistic or compassionate surrogacy. In fact, several countries have bans on compensated surrogacy, such as Canada and the UK.

So, how exactly does surrogacy work? Let’s break down the general process:

Phase 1: Preparation.

During the preparation stage, intended parents either consult with a surrogacy agency that will walk them through the process or they begin their independent journey. Research, interviewing of surrogacy professionals, and beginning the search for the right match surrogate is well under way.

Phase 2: Legal and Medical Screening.

During this stage, intended parents are busy selecting and screening their gestational carrier, ironing out all the legal and medical details, and making any necessary financial arrangements. They also work with an attorney to draft a Gestational Surrogacy Agreement (GSA) that establishes the relationship with the carrier, including details about the nature and expectations of the relationship, and of course outlining the details of compensation for the surrogate.

Phase 3: Embryo Transfer and Pregnancy.

After everyone receives medical and legal clearance to proceed, it’s time to have a baby! The clinic will prepare the carrier’s cycle schedule, and she’ll take medications to prepare her uterus for transfer. If the transfer is successful, then there are about nine months to wait for the baby to arrive! During this time, the intended parents and the surrogate maintain close communication, per the GSA, and the surrogate will receive prenatal care, first with the fertility clinic and then with her own OB/GYN.

It’s a beautiful yet complex process that requires a lot of forethought and planning, but the outcome is well worth it!

How Much Does It Cost?

It’s no secret that the surrogacy process is quite costly. Becoming a parent via surrogacy in the United States can cost between $110,000-200,000. We know that’s a wide range — costs vary greatly depending on several factors, including the clinic, the type of surrogate chosen, and whether or not an agency is used.

Altruistic, or compassionate, surrogacy is often less costly than commercial, or compensated, surrogacy. This is certainly one thing intended parents find appealing about altruistic surrogacy. In many cases, they have already undergone costly fertility treatments before beginning their surrogacy process. Because of this, they can feel more drawn to the cost-saving option of altruistic surrogacy.

Commercial surrogates are compensated for their time and energy in addition to the medical expenses via a base compensation. This can range anywhere from $25,000-60,000, on top of all pregnancy related medical expenses.

Before we get into the pros and cons of altruistic vs. commercial surrogacy, let’s get a clear picture of the types of expenses involved in surrogacy:

  1. The Pre-Conception Expenses – This part is all about creating the embryo and varies by personal circumstances. Will donor eggs be used? Donor sperm? Multiple IVF cycles? Each layer can change the particular costs. IPs can expect at least $8,000-13,000 in medical screening costs, medications, and embryo transfer.

    As an example, using frozen eggs or eggs from a fresh donor cycle can cost anywhere from $12,000 to $30,000 on top of the other medical fees and procedures. If IPs are able to use their own eggs, this cost would obviously not apply.

  2. Professional Fees and Expenses – A whole team of qualified professionals is necessary throughout all stages of the process. Of course, expertise comes at a cost: when screening potential surrogates or drafting legal orders of parentage, there shouldn’t be any corners cut. Below is a list of costs that could be expected for necessary professional services.
    • Mental Health Professionals: $1,000-2,000
    • Legal Fees: $6,500-$15,000
    • Escrow Services: $1,000-2000
    • Surrogacy Agency Fees:

      $15,000-40,000 (Full-service agency — covers full management of the surrogacy journey, from finding the right match, coordinating with all medical professionals, and managing all legal and financial details)

      $6,000-20,000 (Agency that offers limited services of matching and screening surrogates)

  3. Surrogate Expenses – The amount paid to a surrogate in exchange for her time, dedication, risk incurred, and commitment to helping IPs. These fees will vary depending on the type of agreement and care process:
    • Altruistic/Compassionate surrogacy arrangements average – $10,000-20,000
    • Commercial/Compensated surrogacies average – $25,000-60,000

Other potential expenses to consider:

    • Monthly allowance to cover miscellaneous expenses
    • Maternity clothing allowance
    • Childcare and/or housekeeping costs
    • Travel compensation
    • Lost wages due to complications, bed rest, etc.

Though altruistic, or compassionate, surrogates don’t receive a base compensation or monthly allowance, they are still reimbursed for medical expenses, attorney fees, and other related expenses. With a commercial, or compensated, surrogacy, the gestational carrier will also receive an additional base compensation. While surrogates should never be in this for the money, base compensation is seen as a fair exchange for the physical and emotional toll the surrogacy process can take on a woman.

Legal Aspects

The legal aspect of surrogacy can get a bit complicated, so it’s important to reach out to a professional for help. The laws on surrogacy vary by state and are always changing. Some states that ban commercial surrogacy might allow altruistic surrogacy. You can learn more about the surrogacy laws by state here.

It’s important to make sure that the state of both the intended parents and the carrier are surrogacy-friendly states. Unfortunately, it gets more complex than that. Let’s say both parties come from states that allow surrogacy. Well, it is still possible that those two states have laws that do not work well together.

For example, if you are a same-sex couple living in surrogacy-friendly California, but your surrogate lives in surrogacy-friendly Tennessee, you might run into complications when it comes to establishing parenthood. Why? Well, because Tennessee only allows surrogates to be carriers for straight couples.

This is why it’s always a good idea to check the laws in your state and seek guidance from a lawyer who specializes in reproductive law.

Whatever you do, do not try to DIY your surrogacy agreement. Some might think they don’t need to worry about this step as much when they personally know their surrogate. Wrong. It is very important to seek help from an experienced lawyer no matter the type of surrogacy agreement you’ve chosen.

If you want to Google surrogacy contracts, go right ahead. It’s perfectly acceptable to look over checklists and templates as you’re researching so you can better prepare yourself for a meeting, but it’s best to leave the actual legal work to the professionals.

An attorney will help you create a gestational surrogacy agreement (GSA) which will be THE guiding document for your entire surrogacy journey. Chances are you will use it as your roadmap over the course of 12-18 months. It’s legally binding, extremely detailed, and provides protection for all involved parties.

There is A LOT of important information covered in a GSA. Read on to see a list of what is generally included.

  • Acknowledgment of informed consent and awareness of risks..
  • Surrogate is aware of the potential for risk and that she agrees to carry a child without expectation of parental rights.
  • Surrogate agrees to undergo physical and psychological examinations.
  • Everyone agrees on the type of reproductive technology procedures that will be used..
  • Agreement is made about how many embryos will be transferred to the surrogate’s uterus. (ASRM strongly recommends transferring only one embryo to reduce the risk of multiples.)
  • A detailed compensation layout.
  • Agreement of termination and reduction.
  • Agreement of the general number of embryo transfer attempts to be made..
  • Outline of all medical actions surrogate agrees to.
  • Surrogate agrees to follow medical advice, avoid intercourse when medically necessary for success of the journey.
  • The surrogate agrees to avoid smoking, drinking, and using illicit drugs while pregnant.
  • She agrees to get regular prenatal care and follow all medical advice.
  • She and the IPs come to an agreement about who will be present during these prenatal doctor visits. Are the IPs welcome to attend or not?
  • Additional behavioral restrictions/avoiding certain activities?
  • GSA will likely have some language about avoiding risky activities and following generally accepted advice like not spending time in hot tubs or riding on roller coasters.
  • Agreement to limit risky travel to states like Michigan where surrogacy contracts are illegal or out of the country.
  • Communication expectations.
  • When will payments be made and for what purpose?
  • Payment process/escrow?
  • Compensation schedule?
  • General plan for delivery day
  • What happens if the surrogate goes into labor early?
  • General birth plan
  • Most Important – The surrogate and her partner agree that they have no legal claim on the child and will not pursue custody. She agrees that her parental rights will be terminated, either through a pre-birth court order or immediately following the birth of the child. All parties agree that the IPs are the legal parents and custody will be granted immediately.

All incredibly important details, right? This is why it is so important to work with an experienced attorney even if the surrogate is a friend or family member. The attorney will guide you through your surrogacy journey from start to finish to be sure you are fully protected. Hopefully no issues would come up along the way, but it can happen and you will be so thankful to have your lawyer’s help.

Benefits With Altruistic Surrogacy

There are a few factors that intended parents tend to find appealing about altruistic surrogacy. Cost, familiarity and accessibility are all key components that come into play. Below we will break these down and discuss them in more detail.


Surrogacy in general is a costly journey for intended parents. In some cases, some don’t think they could afford to go through a commercial, or compensated, surrogacy. As we discussed earlier, carriers of altruistic surrogacy do not wish to receive payment for their time and efforts. That, of course, limits the expenses to mostly health-related costs. This is why some intended parents feel drawn to altruistic, or compassionate, surrogacy.


In an altruistic surrogacy, the carrier is often a well-known family member or close friend of the intended parents. Already having an established relationship can be helpful in some ways. For example, when there’s already an established relationship, it can create a greater sense of comfort and trust between both parties.

When you’ve decided to take the altruistic surrogacy path, you face one of the biggest and most important questions: Who will be my surrogate?

Asking a close friend or loved one to carry your child for you is extremely personal and can result in complicated emotions for everyone.

Before you approach a friend or family member with this life-changing question, here are some tips:

  1. Know the characteristics and qualifications for surrogates
  2. Be open and honest with your inner circle
  3. Be prepared for either answer
  4. Have a legal contract in place

So you might wonder, what are the characteristics and qualifications of a surrogate?

In general, you need someone who is trustworthy, stable, open-minded, and healthy. The American Society for Reproductive Medicine recommends that a surrogate meet the following criteria:

  • Between the ages of 21-45
  • Does not use tobacco
  • Has had at least one full-term pregnancy and is raising the child
  • Has had no more than 5 vaginal deliveries or 3 C-sections
  • Is financially independent
  • Lives in a stable family situation
  • Spouse/partner is in agreement
  • Has no major health concerns and is within a healthy BMI
  • Can pass a medical and psychological screening

Beyond the black-and-white qualifications listed above, it’s important to realize that this person will be a huge part of your life – through pregnancy and beyond.

You should feel confident enough in your ability to weather stressful situations together, have raw, honest conversations, and set healthy boundaries prior to entering into any sort of agreement. You need to be sure your values, expectations, and intentions align.


As mentioned earlier, surrogacy laws vary greatly which could play a big role in choosing your type of surrogacy agreement. If the intended parents live in a state that is considered non-surrogacy friendly, their options become limited. Because altruistic surrogacy seems to be more widely accepted among states, it might be their only option.

Risks With Altruistic Surrogacy

Now that we know the meaning of altruistic surrogacy and some its pros, let’s dive into the cons. When considering this type of surrogacy agreement, it’s important for both parties to consider the risks that are involved. Below we’ll go over what some of those risks are.

Straining Relationships

As we know, most altruistic surrogates are already well-known to the intended parents. Though this can have it’s benefits, it does have its fair share of downfalls too.

There are times when a family member or friend may feel pressured into being a surrogate with no compensation. Perhaps, they’re afraid to ask to be reimbursed for their time and energy. It can become daunting for the gestational carrier to frequently take time away from work and family to attend appointments. The time off from work and potential need for child care can become costly over time.

When there is no compensation involved, the carrier may start to feel underappreciated. Because she does give up a lot of her time and undergoes risks physically, it can create feelings of resentment towards the intended parents.

Likewise, the intended parents may experience negative feelings as well. When they do not provide payment to the surrogate, they might feel as though they have less control over requests and decisions during the pregnancy.

Cases such as these take the risk of causing harm to the relationship between the surrogate and intended parents. It’s crucial to consider each potential scenario discussed and determine if it is worth jeopardizing a relationship.

Fewer Safeguards

Using an agency makes it safe for the intended parents and surrogate by providing protective measures to both parties. These measures are not always an option with altruistic surrogacy due to the familiarity of both parties, but it is still an option worth pursuing if you’re looking for an impartial third party to help guide your journey.

When using a reputable agency to guide you through the surrogacy process, you don’t have to worry about missing an important step or detail. They are able to guide you through the process with ease. The agency performs background checks, financial stability evaluations, and psychological screenings. Some might shy away from the mental health consultations when the surrogate is someone they know. However, these are all incredibly important steps to take- even with a family member or friend.

The mental health consultation sounds intimidating to some, but it’s a painless prerequisite of becoming a surrogate. It typically involves a simple personality test and one-on-one interview with a mental health specialist. The purpose is to assess the emotional state of potential surrogates to make sure that they are capable of going through the process.

Less Control

The intended parents can feel as though they have less control with altruistic, or compassionate, surrogacy. Because they’re not providing the surrogate base compensation, they might feel less comfortable making requests and decisions.

A Life Altering Experience For Everyone

Surrogacy is an incredible, life-changing journey for everyone involved. While the altruistic surrogacy journey can be an incredible experience for some, it may not fare so well for others. There are both pros and cons to consider when deciding if the process is right for you. It is recommended that you seek help and guidance from professionals to ensure you make the best decision possible.

Our expert team has years of experience in surrogacy and an in-depth understanding of how the third-party family building process works. Schedule a consultation with us today.

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