i. IMA ART Surrogate Application

Surrogates also adhere to the American Society for Reproductive Medicine (ASRM) guidelines:-

Resides in a state where surrogacy is legal, and where parental rights are protected — see our Surrogacy Law map
Has had at least one full-term uncomplicated pregnancy and delivery
Is raising her own child/children
Between the ages of 21 and 42 with a healthy BMI
Financially secure and is not on government assistance
Not being treated for/is not on medication for depression or anxiety
Is not a smoker
No current use or history of drug or alcohol abuse
Agrees to defer to the Parents’ decisions on the important pregnancy issues
No felony convictions
Have transportation to and from surrogacy appointments

IMA ART Fertility Surrogacy candidate questions goes into tremendous detail about a candidate’s life. We include questions related to their medical history, family, education, opinions and views on pregnancy and surrogacy.

We ask difficult pregnancy questions, including terminating a pregnancy due to genetic abnormalities or selective reduction. The answer to all of these questions are an integral part of a successful matching process.

ii. IMA ART Surrogate’s OBGYN Form and Medical Records

For candidates who respond favorably to all the questions in pre-screening, the next critical step is submitting their detailed pregnancy and delivery records from their OBGYN. The physician’s report specifies past complications or anything important to note in the candidate’s history, such as gestational diabetes managed without medications, or an abnormal pap smear result. The OBGYN form also indicates whether she followed through with appointments and OBGYN recommendations during her own pregnancies or previous surrogate pregnancies.

In addition to the past pregnancy records, we ask the candidate’s OBGYN for their opinion on whether their patient may be a good fit to serve as a gestational carrier (surrogate). Previous attending OBGYNs are invited to talk about the candidate’s medical records as well as anything else the Doctor feels is pertinent. The written document is sent directly to IMA ART by the OBGYN.

All gestational carrier candidates will undergo a second medical screening by the attending IVF specialist, as well as a clinical psychological review by IMA ART’s PhD. This is done prior to the execution of the Surrogacy Agreement.

iii. Agreement and Waiver

IMA ART asks the applicant (and her significant other if she has one) to electronically sign an agreement and waiver, acknowledging that should she match with an IMA ART client, IMA ART will facilitate her surrogacy journey, although we are not her legal counsel.

At this point, the candidate can also choose to opt into our IMA ART Fertility Exclusivity Program, meaning that she would forgo working with other surrogacy agencies and exist exclusively on our surrogate roster for your selection.

iv. Surrogate Criminal Records Check

Criminal records check is completed for every gestational carrier candidate and for any adults living in her home.

v. Surrogate Reference Checks

Gestational Carrier candidates are required to provide contact details for 5 references, who are willing to receive video calls from IMA ART.

Family — 1 reference
Personal Friend — 2 references
Professional — 2 references

IMA ART Senior Management makes video contact with the references, and asks a number of questions concerning the candidate. IMA ART asks about her support system, her home environment, and her reasons for pursuing this opportunity. We also reach out to a professional reference, who can share more about the surrogate candidate’s responsibility, trustworthiness and stability.

vi. Surrogate Home Visit

A critical last pre-approval step. We look at the physical conditions inside and outside the home. We meet the people living with your future surrogate to understand whether they have a strong support network to help them throughout the pregnancy.

We ask many of the same questions we previously asked, and cross-check the answers for consistency. We ask the candidate what she hopes for from the parents during the pregnancy, and how much she wants you involved.

We then begin discussing the next part of the process with the candidate, including medical and psychological screening.

At the conclusion of the home visit a report is written and pictures are taken.

vii. Curated Surrogate Proposal

Surrogate portfolios are created by IMA ART. Portfolios contain the references, home visit report, and a profile about the candidate. We also ask for an initial green light from the designated IVF clinic. (Please note this is not a guarantee she will pass medical screening, but it is an initial approval to move forward, based on the fact that there are no disqualifying medical flags in her application or medical history.)

Parents may decide if they would like to move forward with the surrogate candidate, and then write a personalized letter under IMA ART’s guidance.

viii. Personalised Letter to the Surrogate

Parents are requested to prepare a personalized letter to the gestational carrier candidate. This is an important letter, as it gives the gestational carrier candidate an opportunity to learn about you as the parents. This letter should be friendly, personal, warm and include family photos. It should introduce yourself, your immediate family and why you have chosen to seek a gestational carrier to help you build your family. Please include a paragraph about your hopes for the future baby and what life will be like for him or her.

The surrogate candidate reads the personalized letter from the parent(s) before deciding whether to move forward with the video introductory meeting with them and their case manager.

ix. The Introduction

You are introduced to your pre-selected surrogate via Zoom, Skype or Facetime. Assuming both parties are interested in moving forward, your surrogate will undergo Medical Screening (refer to section x. below) and parents will speak with our clinical psychologist.

If one of the parties is not comfortable with the other party, IMA ART Senior Management will endeavor to understand why so we can match you with a candidate that better aligns with your wants and needs.

x. Surrogate Medical Screening

Following the introduction video call, your surrogate undergoes medical screening at the selected IVF Clinic. This screening will check the surrogate’s uterus to ensure she can carry the baby. Your surrogate will also undergo bloodwork to ensure good health in the lead-up to the embryo transfer. IMA ART Senior management will coordinate between the parties, keeping each side fully informed of the progress.

The entire process from the introductory video call to embryo transfer is approximately 4-6 months.

xi. Surrogate Psychological Assessment

IMA ART Fertility’s dedicated clinical psychologist interviews the surrogate and administers either the Personality Assessment Inventory (PAI) or the Minnesota Multiphasic Personality Inventory (MMPI) assessment. The Inventory (PAI or MMPI) is the most widely employed and researched clinical assessment tool used by mental health professionals to diagnose mental health disorders. This scored personality index and the interview are used to understand the surrogate candidate’s personality.

Depending on where the surrogate resides, interviews and PAI or MMPI may be done in person or through a HIPAA compliant telectronic platform.

Evaluations in line with ASRM (American Society for Reproductive Medicine), SEEDS (Society for Ethics in Egg Donation and Surrogacy) and APA (American Psychological Association) guidelines in terms of administration, scope and content typically take a couple of hours. The clinical psychologist will spend a few hours reviewing notes and analysing the assessment.

At the conclusion of the interview and PAI or MMPI, the clinical psychologist will make a final recommendation on whether your and your preferred surrogate should move forward together.

xii. Parent Psychological Preparation

Parents undergo psychological preparation for the journey. This is usually done through a video meeting with IMA ART Fertility’s clinical psychologist. Areas of discussion include the relationship with your gestational carrier and your expectations during the pregnancy.

Our Fertility Governance protocol also includes a one-hour professional joint consultation between you and your surrogate, conducted by our experienced clinical psychologist. This joint consultation talks about important psychological issues involved in forging this new and unique relationship. It endeavors to put together the various pieces of this complex puzzle and to ensure that everyone is on the same page.

xiii. Insurance Plan Overview

Medical insurance is not mandated by the federal government of the United States. However, certain states, including the state of California do mandate medical insurance.

For protection of our parents, the surrogate and the newborn, IMA ART Fertility requires 3 different types of insurance; to cover the surrogate’s pregnancy and delivery, surrogate’s accidental death insurance and insurance to cover the new-born baby. IMA ART Fertility’s insurance expert will review the policies with you and any necessary details will be added into the Surrogacy Agreement.

xiv. Surrogacy Agreement Drafting & Final Execution

The Surrogacy Agreement is drafted by a lawyer specializing in Reproductive Law. If you don’t already have a lawyer, we can refer you to our network of carefully curated lawyers working at the forefront of reproductive law. This lawyer represents you and is critical to ensuring a smooth journey and understanding of the roles and responsibilities between parent and surrogate. This Surrogacy Agreement states that you, the parents, shall be considered the legal parents for all purposes and that the surrogate is not the parent of the child and does not have any legal claim to or financial responsibility for the child.

Parents are advised to consider any requests they might have throughout the pregnancy and delivery in advance, as these requests will be included into the Surrogacy Agreement.

The Surrogacy Agreement is extremely detailed and articulates in clear terms each of the party’s roles and responsibilities before and during the pregnancy, as well as at birth.

IMA ART Fertility will coordinate closely with you and your lawyer during drafting, questions and execution.

Upon completing the draft Surrogacy Agreement, your lawyer will send a copy to the lawyer representing the surrogate.

xv. Embryo Transfer and Preparation

Prior to the embryo transfer, your surrogate will consult with your selected fertility specialist. These consultations include blood tests and ultrasounds. Your surrogate will start taking prescribed medications to prepare her uterus to receive the embryo. The fertility specialist will transfer the embryo at the moment the uterus wall has reached the correct thickness and blood test results are optimal.

xvi. Pregnancy

Your surrogate usually consults her personal OBGYN during pregnancy. If mutually agreed and entered into the Surrogacy Agreement, other arrangements may be made.

The Surrogacy Agreement may include terms governing your right to attend certain OBGYN visits — such as ultrasounds — and to be kept fully informed on the development of the pregnancy.

In cases where the single embryo splits into 2 embryos, a second medical doctor will be added to the team. This second doctor is a specialist in high risk pregnancies, including in the case of twins.

When there is a confirmed pregnancy, IMA ART Fertility coordinates with the insurance company to underwrite the newborn policy.

xvii. Perinatologist

A perinatologist, also known as a Maternal-Fetal Medicine specialist, is an obstetrician who specializes in prenatal care of women who are at high risk of having a complicated pregnancy.

According to the Society for Maternal-Fetal Medicine (SMFM), “A Maternal-Fetal Medicine (MFM) specialist is an OB/GYN physician who has completed an additional two to three years of education and training. MFM specialists are high-risk pregnancy experts. For pregnant women with chronic health problems, MFM specialists work to keep the woman as healthy as possible while her body changes and her baby grows.

xviii. Pre-Birth Order

The legal process commences during the second trimester of your surrogate’s pregnancy. This is when we begin implementing the legal parentage strategy. The objective is to ensure you are declared the sole legal parents of your child.

This protects your surrogate as well, because she wants you to have all of the legal responsibilities for your child. The Surrogacy Agreement will specifically relieve her of any putative responsibilities.

xix. Pre-Birth Preparation

Prior to the gestational carrier giving birth to your baby, we will contact the hospital staff and introduce the parties and procedures for the delivery and hospital stay. The objective of this preparation is to ensure the hospital medical and administrative staff understand the parents are legally recognized as the legal parents. With this legal recognition, you have the right to make medical decisions for your baby.

xx. Birth

Congratulations on the birth of your child! With this, you’ve completed the last steps of the surrogacy journey. In the days and weeks ahead, IMA ART Fertility will assist the parents in applying for the Birth Certificate and Passport.