For some couples to achieve pregnancy, the use of a surrogate is required. Fortunately, these are the minority of cases. Many women are confused about when surrogacy is required. If a woman has poor egg quality, a surrogate is not going to be helpful for her to achieve a pregnancy. For women with poor egg quality, a surrogate is not the appropriate treatment. The use of donor eggs is the appropriate treatment in that case.
But in women who have a very poor uterus; for example, ones who've either undergone a hysterectomy and have no uterus or in cases in which the uterus has very significant tumors that are benign but not allowing for implantation, or in cases where there's terrible scar tissue in the uterus, surrogacy can be very useful.
Surrogacy has to be separated into two different types. One is called true surrogacy in which both the surrogate woman's eggs and uterus are being used and then there is what's called a "gestational carrier". A gestational carrier is a case in which the woman who needs the surrogate uses her own eggs and those eggs are fertilized by the husband's sperm, and the embryos are transferred into the gestational carrier.
This type of surrogacy has significant legal limitations in certain states. For example, in New York State where I practice, paid surrogacy is not allowed by law. Compassionate surrogacy is allowed. What that means is that someone can choose to be a carrier for another person as long as no money changes hands. In other states, those limitations do not exist.
In order to achieve a pregnancy by surrogacy, of course, the first thing is to choose the surrogate. It's a very difficult process in the sense that many women are not interested in being surrogates and those who are interested do require significant compensation to do so. The most important step is to first speak to a reproductive attorney.
That attorney will then work to create a contract between the couple and the surrogate so that the chances of the surrogate in the future desiring to keep a child or making pregnancy decisions without the input of the recipient couple is avoided or minimized. Surrogacy is an important part of fertility care for some couples. Speak to your fertility physician about the role of surrogacy in your case.