There is a lot of testing, emotional investment, and physical considerations to think about before you suggest the idea to your loved one. Here’s what you need to know about being a gestational carrier for a friend or family member. In addition, it’s important to note that people often use the word “surrogate,” but the phrase “gestational carrier” is more accurate. Technically speaking, a surrogate is a woman who not only carries the pregnancy but who is also the egg donor. This involves further legal implications and is rarely done. More commonly, the intended mother’s eggs are used (if available), or an egg donor is used. The term for a woman who carries a pregnancy and who has no genetic relation to the baby is a gestational carrier. (This is what the following information will be discussing.)

Qualifications

Not just anyone can be a gestational carrier. Some people are under the impression that the guidelines for gestational carriers apply primarily to compensated gestational surrogacy (which refers to those who are paid strangers for this service), and wouldn’t apply to a friend or family member. This isn’t true. Even friends and family members who want to carry a pregnancy for an infertile couple need to meet certain requirements.

What’s Involved in the Process?

Being a gestational carrier for someone is not the same as being pregnant with your own child. There are significantly more medical procedures, along with legal contracts, psychological screenings, and counseling. You will need to attend numerous healthcare appointments—more than those you may have attended during prenatal care with your own child—which also may mean taking time off work.

Must be older than 21 and younger than 37 years oldMust have already had at least one child of their ownMust have carried at least one pregnancy to termHas a record of uncomplicated and generally healthy pregnancies and birthsMust be in generally good healthCannot be obese nor underweightNot on any government assistance programsDoesn’t smoke, abuse alcohol, or use any street drugsIf the person is married, their partner must also agree to the arrangementMust be cleared by their OB/GYN to be a gestational carrier

Also, you will need to remember that the baby you are carrying isn’t yours. This means that prenatal care and some aspects of the pregnancy and birth process will not be at your full discretion. The intended parent or parents may feel strongly about issues that you might not have taken into consideration when you were carrying your baby. While coming to agreements on things like prenatal care are important, with a compensated arrangement (that’s when intended parents hire someone to carry the baby), navigating these differences can be harder when you have an established relationship with the intended parents. Do extensive research into what medical procedures will be required of you as a gestational carrier. Besides regular prenatal care, some of the procedures that you may not be as familiar with, but you need to be aware of and ready for. For instance, you may need multiple blood tests (more than what occurs during a regular pregnancy) and multiple transvaginal ultrasounds (are not painful but can be uncomfortable and invasive). You also need to prepare for the embryo transfer (where the embryo/embryos will be transferred to your uterus via a catheter that goes into your cervix) as well as injections of hormonal drugs, including daily progesterone injections, which can be painful. It’s helpful to learn more about all aspects of being a gestational carrier and also to read more about IVF treatment. There are additional legal and emotional aspects to the process aside from the medical procedures as well.

Before You Make the Offer

Before you even mention the idea to your loved one, consider the following six items first.

Is Gestational Carrying an Option for Your Friend?

If your friend is having trouble getting pregnant, be careful with assuming that getting a gestational carrier is something that applies to the situation or if it is even something they are considering. There are many kinds of infertility, and a very small percentage of infertile couples need a surrogate to have a baby. Also, not every infertile couple is comfortable with the idea of a gestational carrier. Another extremely relevant issue is the cost. Having a gestational carrier is extremely expensive, even when the carrier is someone they know (and hence may cost much less than compensated surrogacy arrangements).

Get Medical Clearance First

To be a gestational carrier, you’ll need to be cleared by your OB/GYN at some point. To avoid any feelings of disappointment early in the game, make an appointment with your healthcare provider for a pap smear and to discuss your wish to carry for your friend. Do this before you talk to your friend. It needs to happen regardless, and it also shows you are serious. It’ll also give you an opportunity to talk about the reality of carrying a pregnancy for your friend with your healthcare provider without any perceived social pressure and “promises” that have already been made.

Be Absolutely Sure You Understand Everything Involved

Don’t offer your friend the idea of carrying for them, and then really look into what’s involved. First, research every aspect you can on being a gestational carrier before you make any offers or suggestions of an offer. Otherwise, you may find yourself learning about aspects of the process that don’t feel right for you and you may want to rescind the offer.

Talk to Your Support System Before You Offer

You will need the support of those around you. Speak with your significant other, your children, your friends, and any close family. Being a gestational carrier is an emotionally and physically trying process. You want to be surrounded by positivity. If your primary support system isn’t on board, then this is probably not a good option for you.

Find and Talk to Other Surrogates

One of the best ways to know what it’s like being a gestational carrier is to talk to people who have already done it. This way, you can learn about the reality of the day-to-day as well as any hardships that you could face. You can start by looking at online forums like those on Facebook.

Be Absolutely Sure That You Are Ready to Follow Through 

Before you even mention the idea of being a gestational carreir to your friend, be sure you are ready to go through with it. This is why seeing your healthcare provider for that initial evaluation, and doing as much research before you make that offer, is vital. “You are approaching someone with something that is not only life-changing and amazing, but it’s something that, although you can back out, the ramifications, emotionally and to your relationship, if you do, are astronomical," says Candace Wohl, a writer, family building advocate, and public speaker. Wohl recounts when her own gestational carrier backed out and how it was an extremely emotional and “soul-crushing” situation. Wohl’s story among countless others are testimonies to the fact that offering to be anyone’s (especially a loved one’s) gestational carrier is a matter that shouldn’t be taken lightly. “What many people do not realize is that even if you do have a gestational carrier matched, nothing is guaranteed,” she adds. “The transfers can fail, miscarriages happen, and more often than you would think, even after a surrogacy agreement is signed, gestational carriers have backed out last minute.”

Difficult Ethical and Emotional Factors

Being a gestational carrier for a stranger comes with ethical and emotional hurdles you’ll need to consider and deal with. Being a gestational carrier for a friend can be even more complicated. With a friend, your conflict can become more personal due to your relationship. Consider the following challenges that may arise.

Dealing With Difficult Decisions.

Probably one of the most controversial and difficult decisions that a gestational carrier and intended parent may need to consider is selective embryo reduction. This may be an issue if multiple embryos successfully implant themselves into the uterus, resulting in a high order pregnancy. High order pregnancies pose a risk to the mother and the babies. With surrogacy, the babies’ health and fate belong to the intended parent(s). The intended parents may want to carry out a selective reduction procedure to increase the odds of survival and health for the other fetuses. Depending on how the gestational carrier feels about selective reduction, this can be a very complicated issue to address. It can be even more emotional when the gestational carrier and intended parents are friends, especially if they disagree. 

How You Take Care of Yourself During the Pregnancy

You probably know how many differences of opinion exist in the pregnancy and parenting world. The baby you’re going to be carrying is the child of your friend and the intended parent. They are going to want what’s best for the baby, and you may or may not automatically agree with what that looks like. “Before ink hits the paper, and before you go through a lot of the testing, ask questions, questions, and more questions,” says Wohl. “Topics like selective reduction, how do they feel about prenatal care, are [you] willing to take all the prenatal screening tests, what does the birth plan look like—[all need to discussed beforehand.]" Surrogacy is all about compromise, she says. For instance, will you be OK with them being in the room or at the transfer? “All these logistics—What does your diet look like? Will [you] take vitamins? There are just so many questions that arise that a lot of people don’t think about it,” Wohl adds

Privacy at Prenatal Exams and the Birth

You and the intended parent will need to discuss how you all feel about the intended parents attending doctor and ultrasound appointments together with you. The intended parent (your friend) will want to know what’s happening with the baby, be there to hear or see the heartbeat for the first time—all those amazing milestones that come with pregnancy. They also will likely want to be there for the birth of the baby. But, these healthcare appointments are your personal medical appointments as well. The baby may be destined to be theirs, but your body is carrying it and, eventually, birthing it. Coming to agreements on these topics can be easier—or trickier—when the gestational carrier and intended parents already have a relationship. It’s hard to say which way things will go.

Medical Decisions That Affect the Baby and Gestational Carrier

The concept of “It’s your body, but their baby,” is key here. There can be ethical and emotional struggles over medical decisions that affect you and the baby.

Becoming a gestational carrier requires legal guidance, contracts, and considerations. The laws vary from state to state (and country to country). Some states are considered “surrogacy friendly,” while others are not.

Invasive prenatal testing (such as amniocentesis) Vaccinations of the mother during pregnancy Method of birth (C-section, vaginal, or VBAC? Natural or with an epidural?) All the other complicated birthing questions (such as fetal monitoring, interventions like induction, and many more)

When the gestational carrier is a friend, it may seem “too formal” to have a legal contract—but this is a must. You cannot be a gestational carrier for a friend without having a legally binding contract in place. This is to protect you and your friend. 

Financial Issues

While compensated surrogacy is an arrangement where the gestational carrier is a “stranger” who carries the intended parent’s child in return for financial compensation, with compassionate surrogacy, things are different. There is an assumption that with compassionate surrogacy, no money goes to the gestational carrier except what is needed to cover expenses like lost work for medical care, health insurance co-pays and expenses, and so on. While a compassionate surrogacy arrangement won’t involve paying tens of thousands of dollars to the gestational carrier, some financial remuneration can be a good thing. You might feel like you shouldn’t take any money from your friend because you are friends, but allowing your friend to reward you in at least a small way can be good for your relationship. “It looks different for many people, but I do think there should always be some form of compensation because it’s just very difficult,” says Wohl. “We need to make sure our gestational carrier has something so she feels like she feels appreciated and kind of rewarded accordingly.” Wohl gives an example of paying for the gestational carrier’s family vacation or giving money toward the carrier’s own child’s college fund if it is not simply an exchange of the money itself—there are ways to figure out what works for each individual relationship.

Your Future Relationship

A big question you need to ask yourself is whether your relationship can withstand the stress of surrogacy. You might be quick to say, “Yes!” but it’s rarely that simple. For some, surrogacy will bring them closer together. For others, it may drive them apart. “When it comes to having a friend or family member carry for you, think about the impact it’s going to have on your relationship,” says Wohl. “There are a lot of hard topics that can arise throughout the pregnancy that may not have been hashed out in the surrogacy agreement. If all parties do not agree (which happens), and you do not find a way to compromise a solution, it can really impact your relationship. This is why communication is key in a successful surrogacy.” Wohl advises that going to therapy sessions at least once each trimester may help to ensure that all parties involved in the birth are on the same page.

The Etiquette of Making the Offer

I you’ve decided after all your research that this is for you, and you’ve been cleared by your healthcare provider, you’re ready to let your friend know you’d be willing to be a gestational carrier for them. Here’s the etiquette of asking.

Make It Clear That You Are Serious

Your friend has likely had empty offers in the past. Let them you’re your offer is different and that you’ve looked into everything involved in the process. Talk them through why you’ve made the offer to them, everything you’ve researched, and assure them that you are confident in your offer.

Give Them Time and Space to Consider the Offer

Don’t expect or insist on an immediate answer. You might assume they’d jump at any offer, but it’s way more complex. Your friend needs time and space to think about your offer and whether they think it’d be a good idea to get into a surrogacy arrangement with you. There may be many reasons they might decide not to want to pursue a surrogacy arrangement with you. One of those reasons may be they are too afraid to risk your relationship with them.

Don’t Ask in Public

This goes right along with giving your friend or family member space and time to consider your offer. Making the offer in public can be uncomfortable and awkward for all involved. Make the request privately.

A Word From Verywell

Being a gestational carrier is a beautiful gift to a family who can’t carry a pregnancy themselves. That said, it’s also a very involved and invasive process. If you considered being a gestational carrier, but decide after doing some more research that it’s not for you, don’t feel bad. It’s better that you decide not to make the offer than to agree to it and have it harm your relationship or, worse, back out in the middle of the arrangement and cause your friend tremendous heartbreak and financial loss. If you do decide that being a gestational carrier is right for you, approach the situation and your friend with care, compassion, and careful consideration.