Defenders examine business side of surrogacy, donors

The compensation paid to surrogates and donors who help otherwise childless couples conceive is often not set by state or federal law.

Instead, it is left to fertility clinics and surrogacy agencies to determine.

Geography and cost of living influence the pay a surrogate can receive, while the American Society of Reproductive Medicine sets guidelines for how much money a donor should receive.

“I’m often their final hope, their final resource,” said Cori Smelker, who runs Surrogate Angels of San Antonio.

Smelker has given birth to six children as a surrogate and five children of her own.

"A first-time surrogate could get as little at $15,000 or possibly as much as $25,000 to $30,000, depending on the agency and what she’s asking for and the couple she's carrying for,” she said.

Surrogacy agencies will likely pay more for multiple births or lost wages if the surrogate is employed and must go on bed-rest.

A sperm-donor can make, on average, $4,000 over six months.

Compensation for egg-donation can also vary, according to Dr. Summer James, reproductive endocrinology & infertility specialist atTexas Fertility Center.

"Per ASRM guidelines, somewhere around $5,000 to $10,000,” James said. “We tend to offer egg-donors between $5,000 and $6,000 in our program.”

Most clinics self-govern, James said, by following the guidelines of the ASRM, which also sets guidelines on who can donate and how donors should be screened and selected.

The FDA has its own regulations.

ASRM recommends a woman not donate eggs more than six times.

James says violating ASRM guidelines doesn’t always come with a penalty, but such were the circumstances in the infamous “Octomom” case.

Dr. Randal Robinson, reproductive endocrinologist and infertility specialist at UT Medicine San Antonio, agrees that the majority of fertility clinics follow the same guidelines.

“I think that's the thing we always have the concern about is to make sure we're not inducing people that really don't have that altruistic spirit,” Robinson said. “I think that, if anything, clinics are probably more conservative and follow the rules to an ever greater degree because of the concern that if something unusual happened, what negative publicity that would provide to the specialty and the clinic itself.”

The majority of donors contribute eggs anonymously, Robinson added.

“I really feel like its regulated well. It's working medically. It's working legally,” James said.

Those within the fertility field believe it is unlikely one could make a living off of the compensation surrogates or donors receive.

“The compensation is really going to be for time off work, for discomfort, for the surgical procedure she will have to undergo to have eggs removed,” said James.

Surrogates could through months of testing and treatments without payment, says Smelker. If they do not get pregnant, they do not get paid.

Smelker works with three to 12 potential surrogates, or carriers, each year.

“They’re married. They have had their children. They’re very often nurses, teachers,” she said. “They’re in some kind of service administration -- something that helps people.”

Surrogate Angels of San Antonio helps match between 10 and 12 couples with carriers annually.

Smelker says she follows the rules of the fertility clinics she works with.

“Some clinics say they don’t want to work with a woman over the age of 37 even if she’s a carrier and it's not her egg, they just don’t want to work with an older woman,” Smelker said. “Others say 40 and others say we'll go higher than age 40 as long as she's had a baby in the last year or two years.”

In the state of Texas, only gestational surrogacy is recognized.

Dr. Pepe Lee Chang, UTSA ethics professor, believes the idea of compensation to create children can raise challenges in a cross section of medical and business ethics.

“If you think of it as a product, then it's subject to the free market and it's worth as much as somebody is willing to pay for it,” Chang said.

But on the flip side, families are intrinsically valuable, she says, and a case can be made for why a set price should not become the standard.

Stricter regulations on compensation could exclude a number of people outside a certain income bracket.

“That might prevent market forces from jacking up the prices. But then is that really fair? Because for somebody who is renting out her womb, if there's competition for it, doesn’t she have the right to sell it to the highest bidder?” Chang asked.

Supporters of surrogacy say the critical notion that a woman "renting her womb" is misleading and puts the practice in a false light.

For Smelker, there is only one payout that matters.

"When they look at their family, to know that you helped create that -- there’s no words to describe the joy that you feel,” she said.