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Surrogacy 101: The Medical Clearance and Contract Process

Hi, I’m Meriel! I'm one of the Journey Coordinators at Collective Surrogacy, and I am a three-time past surrogate. I’m back with the next addition of our Surrogacy 101 series, where I will discuss the final medical clearance and contract steps. All steps in the surrogacy process are essential, and these two are some of the most detailed. These are the first two steps after a match is confirmed and mark the official start to the journey!


First, the final medical clearance process will occur either before the contract process or in parallel to it. This is when the surrogate will travel overnight for an appointment at the intended parents’ fertility clinic in order to be medically evaluated and cleared by their reproductive endocrinologist. Travel for this appointment is generally required since each intended parent has already selected a fertility clinic, and in most cases, already created embryos, prior to matching with a surrogate.


Woman sitting on exam table talking with physician

A typical medical clearance visit includes flying in the day before your appointment, attending a morning or early afternoon appointment the next day, and returning home later that same day. CS makes all travel arrangements for you, and the parents pay all costs. Many surrogates travel independently for this trip but a travel companion can be requested if preferred.


The appointment itself will usually include blood work, a transvaginal ultrasound to ensure a normal uterine lining, and a meeting with the clinic staff that guide everyone through the embryo transfer cycle. The ultrasound results will usually be communicated to everyone that same day and the rest of the results will follow usually 7-10 days later. If the surrogate has a spouse/partner, it is possible that person will need to travel with the surrogate for screening, although most clinics do not require this. In most cases, the spouse/partner will do their infectious disease bloodwork at a lab in their local area. This is arranged by CS or the fertility clinic.


This step ensures that the surrogate is again healthy to pursue a surrogate pregnancy.


Woman smiling sitting at a table in a legal office
The day I signed my contract

The contract process is where both the intended parents and surrogate retain their own individual legal counsel in order to draft and sign a Gestational Carrier Agreement (or "GCA" for short). This is an agreement that outlines the rights, responsibilities, and expectations of all parties involved. The agreement typically addresses issues such as compensation, expense reimbursement, conduct requirement, legal rights, and "what if" scenarios. 


This process can feel cumbersome, but it is an essential one. My advice is to be patient and remember that the contract is put in place to protect all parties. When I signed my contract in the above picture, I had brought my 4 year old with me to my attorney's office. While we waited she asked to take my picture and of course I obliged. My smile reflects how excited I was to be completing this step and I am thankful for my curious kiddo for giving me this memory.


Here at Collective Surrogacy, our parents and surrogates work with outside counsel, generally in the state where the surrogate lives. Since surrogacy laws vary from state to state, it is important to find an attorney familiar with surrogacy laws in the specific location where the arrangement is taking place. We have developed a network of trusted attorneys and are happy to make a recommendation for you. You are welcome to find your own attorney, so long as they are experienced with surrogacy specifically. All attorney fees are paid for by the intended parents. 


Once a specific gestational carrier agreement is drafted, it is then reviewed by each party with their attorney, and negotiations may take place to confirm the agreement is fair, balance, and matches each party's needs. When finalized, the agreement is signed and you receive what is often referred to as "legal clearance" to move ahead with next steps!


It's also important to mention that after a viable pregnancy is achieved and also after the birth, legal steps are taken to establish the intended parents as the legal parents of the child and to eliminate any parentage presumption a surrogate may have based on birth relationship. This often involves obtaining a court order and updating the birth certificate, a process that will be guided by the attorneys based on the specific legal requirements in the relevant state (most often where the baby is born).


It's essential for all parties involved to adhere to the legal requirements throughout the gestational surrogacy process to ensure a smooth and legally sound arrangement. This process serves to protect the interests of both the intended parents and surrogates.  Here at Collective Surrogacy, we are well versed in helping to guide both our surrogates and our intended parents through this complicated and, at times, overwhelming process.


Once both the medical and legal clearances are given, the journey can then enter the phase of actively pursuing a fetal embryo transfer. Since all of our journey coordinators are previous surrogates themselves, they are all well versed in this process and are equipped to help surrogates navigate each new and exciting step along the way.




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