Mary Beth Whitehead was a traditional surrogate. She was inseminated with William Stern's sperm, but her own eggs were used, and she was the child's biological mother.

The Benefits of Agencies
How do intended parents and surrogates meet each other? What kinds of screenings take place? What sorts of agreements are signed?

Brooks says that surrogacy agencies offer services such as medical exams, legal representation and matching couples and surrogates. "Each surrogate is screened psychologically and financially before any insemination or IVF transfers take place," he says. Although his agency does place advertisements geared toward both potential surrogates and intended parents, he says that "word of mouth" is the way most surrogates and intended parents choose his agency.

Brooks estimates that clients of his agency, who use a traditional surrogate, pay between $22,500 and $33,000. Those who use a gestational surrogate pay $30,800 to $50,000, and those who utilize both a gestational surrogate and egg donor pay $38,300 to $53,000. Expenses vary according to travel expenses, additional medical procedure fees and the surrogate's lost wages if she is not covered by a disability policy.

Lucy, 27, of Riverside, Calif., was a surrogate for a Russian couple. She met the couple through a surrogacy agency and chose to become their surrogate after studying their profile which was prepared by the agency. Lucy, who endured painful shots, had to stay on bed rest and missed out on family activities for the sake of her surrogate pregnancy, says, "I was paid $15,000 in a year-and-a-half period. I could make $30,000 a year working in an office with a lot less to lose."

Going It Alone
While Lucy and the intended parents she worked with were very comfortable with the idea of working with a surrogacy agency, this isn't for everyone. Money was the reason that Kim and her husband didn't work with a surrogacy agency. "That's easy," says Kim, 36, of Alisa Viejo, Calif. "Simply, they charge too much for what we could do. I did all the work. I already had the embryos and a doctor."

Kim recently entered into an independent gestational surrogacy relationship with a former co-worker. Kim had frozen embryos leftover after a failed IVF, and those were used for the pregnancy that resulted. This is not Kim's first attempt at surrogacy, however. Kim and her husband negotiated with a neighbor for a full year. They were unable to come to an agreement, and Kim's husband was frustrated because "he felt (the potential surrogate's) husband was in it for the money," Kim says. While an agency might have screened out the failed surrogate and streamlined the process, Kim felt she could work things out on her own.

During the year that Kim and her husband were negotiating with their potential surrogate, a co-worker of Kim's approached her and offered to be a surrogate if the first arrangement didn't work out. When the negotiations stalled, Kim approached the co-worker, who had three children, and asked if she was still interested. The co-worker discussed it with her partner. "A week later, she called me and said yes!" says Kim. "Within three months, she saw her doctor and was cleared, did the lab tests necessary, saw the psychologist, saw my reproductive endocrinologist and signed the contract. We did an FET (frozen embryo transfer), and she got pregnant." The surrogate is pregnant with twin boys and due in June. Kim and her husband couldn't be happier.

The experience is in contrast to their first attempt at surrogacy: The surrogate's partner is supportive, and Kim's husband "gets along great" with the surrogate. "He is very involved and goes to most appointments," she says. "He is so relieved we are with her now, as opposed to our last arrangement."

Kim has ample evidence that their current surrogate isn't motivated by money, and this has smoothed the relationship between the two couples. "She offered to do it for free, but I couldn't do that. Although we couldn't pay her the fee that agency surrogates get ... we make sure that she is not out any money of her own." Kim and her husband cover the surrogate's time away from work, so that she doesn't need to use vacation time or sick time; they pay for mileage, maternity clothes, insurance and an agreed-upon fee. "She feels we treat her with respect," says Kim.

Battling the Cost
For some, the cost of even an independent gestational surrogacy arrangement is overwhelming. Lynn, 39, of Chesapeake, Va., and her husband struggled with the financial implications of the IVF required for a gestational surrogacy arrangement. Since being genetically related to the child was not important to Lynn, they decided to try traditional surrogacy, which is much less expensive. "Our daughter is genetically related to my husband and our surrogate," she says.

Linda, 39, of Oak Lawn, Ill., is the mother of 7-month-old twins through an independent gestational surrogacy agreement. Although things turned out happily in the end – "I have cherished every day with them since their birth," Linda says – her experience with her surrogate was decidedly mixed.

"We did not know our surrogate before," says Linda. "It was a little rocky at points because she was clearly doing this for financial gain instead of compassionate reasons. Sometimes the relationship was strained because she tried a couple times to push me on the financial issues. For this reason, I highly recommend using an escrow or trust account even in an independent relationship so that financial issues don't come into play in the surrogacy relationship."

Because of Linda's infertility, an egg donor was used. The surrogate became pregnant through IVF on the first try. Because of the tension, Linda occasionally worried throughout the pregnancy that the surrogate might change her mind about giving up the babies. Happily, her fears proved unfounded.

Brooks maintains that surrogate mothers are not motivated by financial gain. "The women who become surrogates are special, loving individuals who have a true desire to help others become parents," he says.

While the surrogates who helped Susie and Lynn become parents were certainly motivated by loving kindness, as was Kim's second surrogate, this isn't always the case, as evidenced by the experiences of Linda and Kim with her first surrogate. And on the flip side, it is certainly possible that potential parents could take advantage of a surrogate. Understanding each other's motives and having a clear agreement about finances and expectations are key factors in making surrogacy work for everyone involved.

In part two of this series, we'll share more of the stories of both surrogates and intended parents and explore the questions of what happens after the babies are born and what surrogates take away from their experience.

Want to see more?

• Gift-giver: Profile of a Surrogate Mother
• Dollars and Sense of Infertility Treatment
• Choosing Assisted Reproduction: Social, Emotional and Ethical Considerations
• Talk about it!