Things to Consider:

1. 85% of miscarriages happen in the first trimester. If the physician stated that you
and your partner were advised to abstain from having sex for extended periods of
time. Is this a commitment you can both agree with?

If you are single, do you understand that once you enter into a surrogate
agreement with Intended Parents that any sexual partner you plan on
having intercourse with will have to be tested for infectious diseases
before you proceed with intercourse?

2. The surrogacy journey is a long one (each journey’s timeline is different but the
journey is usually around 18 months); in addition to all of the wonderful aspects
of a surrogacy journey, there will be many sacrifices you’ll have to make, are you
ready for that?
a. Some of these sacrifices include:
i. Abstinence for prolonged periods of time
ii. More doctor appointments than a normal pregnancy.
iii. Lots of medications
iv. May have to pay costs upfront.
v. Loss of some privacy, i.e agency, and intended parents
vi. Travel restrictions

3. Is there a reason you would need to stop the surrogacy process before the FET?

Your Responsibilities:

Now that we know you have a giving heart and a desire to help another family realize
their dreams of having children, we want to reiterate that serving as a surrogate can be
complicated and sometimes trying. Being a surrogate is for women who have a true
and strong desire to help other families in their journeys to Parenthood.

Intended Parents often spend their life savings to bring this baby into the world.
Therefore, we have listed the following responsibilities you will be required to fulfill so
you have a clear understanding of what is expected of you, and determine if you are
ready to commit to fulfilling each one.

Surrogate Responsibilities:
1. Your will disclose any medical history

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 2. You will adhere to a healthy lifestyle, including:
a. Following a healthy diet that consists of healthy nutrition
b. Taking daily vitamins
c. Exercising on a regular basis
d. Limiting caffeine and artificial sweeteners
e. Abstaining from consuming any tobacco products or any alcohol
throughout the pregnancy
f. Abstaining from sexual activities for a time period deemed necessary by
the doctor. Normally 6-8 weeks starting at medication up to the heartbeat
confirmation.
3. You will not partake in any dangerous activities, and you will avoid being in any
surroundings that contain any harmful environmental chemicals before and
during your pregnancy.
4. You will strictly follow and comply with all medical instructions given by the IVF
Physician and/or the Obstetrician.
a. You will take all medications and injections in a timely manner.
b. You will ensure that you are following protocol and taking the proper dose.
5. You will attend all OB visit appointments and attend on time; you will then update
your Intended Parents immediately following the appointment.
6. You will update your Intended Parents once a week throughout the pregnancy.
7. You will do your best to deliver in the hospital that is part of your in-network
insurance plan at the time of delivery
a. This means that around the middle to end of your 2nd trimester your
contract may state you are not allowed to be further than 100 miles from
your designated hospital.

I have read and fully understand the above responsibilities of being a surrogate. I agree
that I can meet these expectations.

Signature: _______________________

Date: ___________________________

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