Health & Fitness

How the Covid Pandemic Created a Surrogate Shortage in the U.S.

Charlie Lee and his husband want to have a baby.

But they are facing a major hurdle: They have 12 viable embryos, but no one to carry one.

The couple has spent a little over a year searching for a surrogate. They were originally told by their surrogacy agency that they would be matched with one in six months at the most. That was in January 2021; 15 months later, they are still waiting.

Before the pandemic, surrogate mothers were typically paid about $35,000 (fees are unregulated and usually determined by the surrogates and their agencies, if they work with one) and wait times for a match tended to be about three to six months.

Now, Mr. Lee, 31, and his husband, who conceived their embryos using donor eggs, have increased their offer to $50,000 plus medical fees and other compensation, such as maternity clothing and transportation costs.

“We are anxious and we are just waiting,” said Mr. Lee, who lives in Madison, Wis., and is a student in an M.B.A. program. “There’s nothing else I can do at this point,” he said.

Mr. Lee and his husband are contending with the same issue as thousands of other aspiring parents — most often same-sex couples or couples who are facing fertility issues — in the United States: an approximately 60 percent decrease in potential surrogates, according to the 10 agencies The New York Times spoke to, along with doubled wait times and significantly higher fees.

According to Jeff Hu, a founder and the director of SurrogateFirst in Los Angeles, Covid-19 vaccination is one issue spurring the surrogacy shortage. A number of potential surrogates, Mr. Hu said, don’t want to get vaccinated. Many intended parents, however, are requiring their surrogates to, Mr. Hu said, as research shows a mother will pass the antibodies to the babies in utero. Additionally, recent studies show that Covid poses many risks to the pregnancy itself.

“You can see where there will be a disconnect in the matching market,” Mr. Hu said. “There are now terms in the legal contract about vaccination,” he added, as well as certain Covid protocols, such as agreeing “to not attend large groups or large public gatherings” for the entirety of their pregnancy.

Vaccine disagreements are only one issue. Many surrogates are themselves mothers, and — like so many of us — have been struggling with pandemic parenting and all it entails, including erratic child care.

Consequently, many potential surrogates — many of whom are military wives who are unemployed and use surrogacy to boost the family’s income — are reluctant to make any other commitments at the moment, said Dr. Deepika Garg, an assistant professor of obstetrics, gynecology and reproductive sciences at Yale University School of Medicine. (In other words, they are exhausted.)

And, Dr. Garg said, surrogacy contracts require a commitment of nine months to a year, and this limits travel. As travel bookings pick back up, many surrogates may be hesitant to continue restricting their travel after two years of various lockdowns.

Surrogacy is also often prohibitively expensive, which is among the reasons some American couples turn to surrogates abroad, often for significantly lower fees. But while some surrogates are available abroad, the process can be very complicated, and may take many months, including preparing an egg retrieval, undergoing fertility treatments, transferring an embryo and confirming a healthy pregnancy.

Furthermore, many foreign countries ban surrogacy arrangements with same-sex couples. As a result, having a surrogate who lives closer to home is preferable — or the only option — for some.

And nowhere has the challenge of international surrogacy been highlighted more than currently in Ukraine, which allows foreign surrogacy arrangements and which, by some estimates, is the largest surrogate hub in the world. The war there has created a gut-wrenching crisis: terrified, pregnant surrogates in fear for their safety and parents unable to reach their newborns. The Times recently reported on nearly two dozen surrogate-born babies in hiding with nannies in a Kyiv basement, their fate unknown.

Mirjam Johns, who lives in Ludowici, Ga., was a surrogate for a single mother in China. She gave birth in January 2021, and cared for the baby for an additional seven months due pandemic challenges.
Credit…Anna Ottum for The New York Times

For American surrogates working with parents abroad, there can also be extreme challenges.

Mirjam Johns, 37, an intake coordinator at SurrogateFirst, was a surrogate for a single mother who lives in China, where surrogacy is illegal — though Chinese citizens may hire foreign surrogates legally. The baby girl was born on Jan. 27, 2021.

The pregnancy went smoothly; it was only after Ms. Johns, who lives in Ludowici, Ga., gave birth that the real Covid complications occurred. Because of the pandemic, a partial shutdown at U.S. passport services and worker shortages, the necessary paperwork from the Chinese Embassy to get the baby to her mother was delayed, Ms. Johns said.

Ms. Johns was given full power of attorney over the child so she could take her home from the hospital. Then, Ms. Johns applied for the baby’s passport, and then needed to file for a Chinese visa, as the baby couldn’t get a Chinese passport until physically arriving in China.

Ms. Johns ended up taking care of the baby for seven months, until the baby could be with her mother. Ms. Johns took the child to all her pediatrician appointments — and even took her along on two vacations with her husband and three sons: to a mountain getaway in Helen, Ga., and, a few months later, on a vacation in Atlanta.

“She went everywhere I did,” Ms. Johns said. “We just included her as if she was ours. It was the best experience.”

When the paperwork was finally completed and the baby was cleared to leave the United States, a nanny whom the intended mother hired took her to China, where the newborn and the nanny tested positive for Covid. (Ms. Johns, who is vaccinated, and her family were negative.)

The baby continued to test positive for six weeks. Once she finally tested negative, she was released back into mandatory quarantine in Shanghai and 10 days later, her mother (the father is a sperm donor) was allowed to pick up her daughter. This was in October 2021, nine months after the child was born.

“I cried, but I was happy she got to finally go home and meet her mom,” Ms. Johns said. “But of course it was hard to watch her leave.”

Eran Amir, right, and his husband, Mike Gowen, have used surrogates twice and are now beginning their third process with one.
Credit…Yehyun Kim for The New York Times

There is intense demand to recruit more surrogates, said Eran Amir, 44, the founder of GoStork, a fertility marketplace where intended parents may find, compare and connect with fertility providers, including surrogacy agencies.

He started the agency so others could have more transparency about the surrogacy process.

Mr. Amir and his husband, Mike Gowen, have used surrogates twice and are now beginning their third process with one.

They paid about $200,000 total for their first surrogacy in 2017: $35,000 for egg donor screening fees, an egg donation, egg donor insurance, the egg donor agency fee, travel expenses and legal fees; $35,000 for I.V.F., which included the egg retrieval, creating the embryos and transferring the embryo; and more than $120,000 for the surrogacy process, which included a $35,000 compensation for the surrogate, plus the surrogate agency fee, surrogate insurance, legal fees, screening, travel expenses and other miscellaneous fees. The second time, in September 2020, they paid $150,000, using a different agency.

Mr. Amir, who lives in New Haven, Conn., said his relationship with his surrogates has always been very important to him. “We FaceTime a lot and talked on the phone as much as we could,” he said. “But because of distance” — the first surrogate lived in Ohio; the second in Tennessee — “and Covid on the second journey, we only met for the first time in person when our babies were born.”

And because surrogacy is not allowed for same-sex couples in many foreign countries that otherwise allow it, helping a gay couple is a calling for some.

Shea Eschman, a photographer who lives in Yukon, Okla., is due July 4 with twins for a gay couple who live in Italy. Ms. Eschman, who has a 4-year-old daughter, had spent time on social media talking to others about potential surrogacy when she was having trouble conceiving her daughter. Now, she said, she wants to help people who aren’t able to have kids on their own.

“I’m excited to give them their dream family,” Ms. Eschman said. “They wanted twins, and it’s exactly what they are getting.”

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