GESTATIONAL SURROGATE APPLICATION

Gestational surrogacy is a four step process.  First, the intended mother or
egg donor will take medications to stimulate her ovaries to produce multiple
eggs.  Step two involves retrieving the eggs from ovaries.  Once the eggs have
been retrieved, the next step is the fertilization of the eggs and culture of the
embryos in the IVF laboratory.  The next step involves placing the embryos into
the uterus of the surrogate for implantation, called an embryo transfer.  The
embryo transfer may take place on day 3 or day 5, depending on the grade
and quality of the embryos.  Following the embryo transfer, the surrogate
should be prepared to be  on strict bed rest for  the next 4 days after transfer.  
During this time, the embryos have the best chance of implantation.

We are looking for women to be an acceptable surrogate for our program . We
only accept applicants that are interested in Gestational Surrogacy Some of
the determining factors are as follows:

Must have given birth to at least one child and be raising that child.
Must be between the ages of 21 and 40.  (If the surrogate is between the ages
of 37-40, she must have delivered a child in the last 2 years, and be able to
provide a physician’s clearance.
Must be a non-smoker.
May not be receiving any government assistance.
No complication during pregnancy and delivery.
No pre-term deliveries before 36 weeks (unless in the event of multiples)
Must be able to provide previous delivery records
Must be willing to  undergo a psychological evaluation and written test.
Must be willing to be medically tested, as well as the husband/partner.
No criminal history of any kind.
Must have a stable residence and not be planning to move out of the county in
which you reside, from the time you submit the application until after the
delivery of the child(ren).
Name
Phone number
Address
Email address
Yes
No
Have you ever been a surrogate
before?
Age 21-37
Number of children
Ethnic origin
Height
Weight
Yes
No
Do you have health insurance?
What is your current marital status?
Any complication with previous
pregnancies?
Yes
No
Do you smoke?
Method of birth control?
Do you or have you had any
medical problems?
Blood type and RH?
Are you currently taking any
medication?