When a family member offers to serve as surrogate, it may seem like a dream come true. Thousands of dollars in agency fees can be saved, and it is comforting to have personal knowledge of the surrogate's medical history and background. However, the closeness of the family relationship can lead to other areas of difficulty. It is important to carefully evaluate the situation and to consider the following issues before proceeding.

Surrogate Fee and Expense Reimbursement:
While the surrogate may view her participation as an *act of love* and adamantly refuse any financial compensation, the intended parents may feel uncomfortable with this *imbalance*. Alternatives to a surrogate fee include making a contribution to her children's college fund or sending the family on a deluxe vacation after the birth. Similarly, the surrogate may deny reimbursement for out-of-pocket expenses including childcare, maternity clothes, lost wages and transportation. While the surrogate may not want to realize a profit, accumulated expenses can be substantial and place a financial burden on her family. Making regular deposits (i.e. $200/month) to the surrogate's checking account, can eliminate dealing with receipts and reimbursements. If the surrogate is employed, securing a pregnancy disability policy may provide coverage for lost wages in case of a prolonged absence from work. (Note that this insurance is not available for all occupations or income levels.)

Psychological Evaluation:
It may seem absurd to schedule a psychological evaluation for your sister, aunt, cousin or niece. However, an experienced mental health professional will be able to provide an independent assessment and help the surrogate take a careful look at whether this is an appropriate choice for her and her family. Most evaluations involve an oral interview as well as written psychological testing. Factors that will be considered include the surrogate's motivation, her concerns regarding medical procedures, her ability to separate emotionally from the child post-birth, moral and religious attitudes regarding surrogacy, support from family and friends, comprehension and acceptance of medical risks, and emotional maturity. A referral to an experienced mental health professional can be obtained through Resolve, OPTS or your treating physician.

Independent Legal Counsel:
Family members may prefer to keep their dealings on an informal level, but it must be remembered that surrogacy involves an important legal transaction. The surrogate is placing herself at risk both physically and financially. While she may want to waive her right to independent counsel in order to avoid legal fees, her attorney will serve several crucial functions. An experienced attorney can educate the surrogate about the legal process involved, review the agreement with her best interests in mind, and bring up issues that may be difficult for the parties to discuss directly (such as financial compensation, disability coverage, expense reimbursement and life insurance). Rather than depending on a verbal understanding, all terms should be explicitly stated in the written agreement to avoid misunderstandings that may jeopardize the relationship.

Guardianship:
A provision for guardianship of the child should be set forth in the surrogate agreement as well as in the intended parents' will before embryo transfer or insemination. This will clearly state the parties' intentions and offer the surrogate protection in case the intended parents predecease the child. The surrogate may have an expectation of being named guardian or godparent of the child. If your surrogate does not live close by, you may prefer to select someone who does. This issue, though often difficult to discuss, should be resolved before the surrogacy agreement is executed.

Counseling Facilitation:
Using a family member as surrogate usually eliminates the need for agency involvement. It also eliminates a third party to act as a "support" or "buffer" between the parties. Counseling before commencement of cycle will help family members voice their expectations and concerns. Is everyone in agreement regarding selective reduction and therapeutic abortion? How many cycles will be attempted? How will the obstetrician be selected? Will the surrogate be expected to make lifestyle changes (diet, exercise, alcohol consumption, etc.)? Who will be present at the birth? As in any assisted reproductive cycle, the parties will no doubt ride the roller coaster of emotional ups and downs. Unresolved family issues may surface during these stressful times. After a failed pregnancy attempt, the surrogate may blame herself for not resting enough, for picking up her toddler a few times, or for not eating right. The intended mother may hide her feelings of loss, while trying to take care of others. Counseling can help the parties move through the grieving process and decide on a next step.

When there are unresolved family issues or motivation based on obligation, using a family member as surrogate can result in difficulties throughout the pregnancy and beyond. The above topics can provide a starting point for initial discussions. Professional guidance can help to determine whether surrogacy is an appropriate choice for those involved. With adequate preparation and careful thought, using a family member as a surrogate can be a rewarding experience for all.

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