What Professionals Are Involved in a Child’s Journey to Birth?
Third-party reproduction is often understood as an arrangement between intended parents, egg donors, or surrogates, but a complete treatment cycle actually requires the multi-party collaboration of reproductive medicine, embryology laboratories, psychological counseling, legal services, insurance, and case management.
The American Society for Reproductive Medicine (ASRM) states that third-party reproduction involves complex medical, psychological, and legal issues and should therefore be evaluated and executed by a multidisciplinary team with relevant experience. The professional roles listed by ASRM include physicians, third-party reproduction nurse coordinators, mental health professionals, and independent legal counsel.
Below is a summary of common professional roles and their main tasks in third-party reproductive treatments.
I. Intended Parents: The Core Decision-Makers of the Treatment
Intending parents need to discuss their health status, fertility goals, and acceptable treatment plans with the medical team.
Important decisions may include:
- Whether to use your own eggs and sperm
- Do you need egg donation, sperm donation, or a surrogate mother?
- Embryo generation and testing methods
- Acceptable Number of Treatment Sessions
- Expectations for prenatal checkups and pregnancy management
- Timeline and Budget Planning for Cross-Border Medical Treatments
Intended parents need to fully understand the treatment information and associated risks in order to make informed decisions at different stages.
2. Reproductive Endocrinologist: Evaluation and Treatment Planning
Fertility specialists are responsible for evaluating the medical conditions of intended parents, donors, and gestational carriers, and planning appropriate fertility treatments.
Job duties typically include:
- Assess the condition of ovaries, sperm, and uterus
- Plan the controlled ovarian hyperstimulation, egg retrieval, and embryo transfer cycle
- Review past medical records and test results
- Assessing the Medical Condition of Donors or Surrogate Mothers
- Explain the risks of the treatment and the chances of success.
- Determine the appropriate embryo transfer method
ASRM recommends that surrogate pregnancy treatments undergo comprehensive medical screening, infectious disease testing, and risk assessment, and that necessary legal and informed consent documents be completed prior to treatment.
III. Embryo Laboratory: Handling Eggs, Sperm, and Embryos
Embryologists and embryology lab staff are responsible for critical laboratory procedures during the treatment process, including:
- Processing of eggs and sperm
- Conventional Insemination or Intracytoplasmic Sperm Injection
- Embryo culture and grading
- Embryo biopsy and chromosome testing submission
- Cryopreservation of Eggs, Sperm, and Embryos
- Embryo thawing and preparation for transfer
- Confirmation of technical data for inter-clinic embryo transport
The work of the embryology laboratory directly affects treatment scheduling, so prospective parents should also confirm whether the clinic has comprehensive laboratory management and embryo preservation systems.
4. Egg donor or sperm donor: providing reproductive cells
Gestational surrogacy helps intended parents complete pregnancy and childbirth through embryo transfer and has no genetic relationship with the baby carried.
Surrogate mothers will participate in:
- Medical and medical record review
- Psychological Assessment
- Independent legal consultation
- Contract negotiation
- embryo implantation
- treatment pregnancy prenatal checkups and childbirth
- Postpartum health care
Surrogates retain the right to make their own decisions regarding their medical care. The ASRM states that surrogates are the sole decision-makers regarding their medical care, from embryo transfer and prenatal care through delivery to postpartum care.
5. Surrogate mother: Assisting with pregnancy and childbirth
When prospective parents are unable or unsuited to use their own eggs or sperm, the involvement of an egg or sperm donor may be required in the treatment process. Donors are generally required to undergo:
- Personal and family medical history review
- infectious disease testing
- Genetic disease or carrier screening
- Fertility assessment
- Psychological and Donation Motivation Assessment
- informed consent procedure
ASRM recommends that donors undergo psychological education and evaluation conducted by a mental health professional with experience in third-party reproduction, covering motivations for donation, family medical history, and potential future psychological and social impacts.
6. Mental health professionals: Assess psychological readiness and communication expectations
The role of mental health professionals is not limited to judging whether participants are "suitable," but also includes helping all parties understand the emotional, familial, and interpersonal impacts the treatment may bring.
Common consultation topics include:
- past experiences with infertility or building a family
- Motivation for participating in the treatment program
- Expectations for the treatment and our relationship
- Privacy and Social Media Boundaries
- Communication methods during pregnancy
- Prenatal checkups and major medical decisions
- Do you stay in touch after the baby is born?
- How to explain the birth process to children in the future
Per ASRM recommendations, surrogate mothers and their partners should first undergo psychological evaluation, and intended parents should also receive independent psychoeducational counseling. Before starting the treatment cycle, a joint session should be arranged for both parties to confirm a mutual understanding of the treatment and communication methods.
7. Reproductive Lawyer: Protecting the Rights and Interests of All Parties
Third-party reproduction involves contracts, medical decisions, financial responsibilities, and parental rights procedures, and therefore requires the involvement of lawyers with experience in reproductive law.
Lawyers typically assist with:
- Rights and Obligations of All Parties
- Medical and pregnancy management agreed fees
- Compensation and Expense Arrangements
- Insurance and Medical Expense Liability
- Number of embryo implantations and related restrictions
- Custody and birth certificate procedures
- Interstate or transnational legal application issues
ASRM clearly recommends that surrogacy agencies and intended parents be represented by different independent attorneys, and that the attorneys must be licensed to practice in the applicable state. The complete contract and legal confirmation documents should be finalized before the medical procedures begin.
8. Insurance, Trusts, and Financial Management
Third-party reproduction may involve multiple medical and non-medical expenses, so it is necessary to clarify insurance coverage and fund management methods in advance.
Relevant professionals may assist:
- Reviewing surrogate mothers' existing health insurance
- Check if the policy excludes surrogacy pregnancy evaluations.
- Is additional medical or life insurance needed
- Establish a trust or third-party account
- Pay compensation and related fees in accordance with the contract
- Save expense and payment records
These arrangements can reduce disputes arising from cost determination or insurance claims during the treatment period.
IX. Case Management and Cross-Border Coordination Personnel
When intended parents live outside the United States, they also need to deal with time zone differences, language barriers, paperwork, embryo shipping, and travel arrangements to the US.
Case management personnel are usually responsible for:
- Consolidate contact windows from all parties to track medical care
- Psychology and Legal Progress
- Arrange communication between intended parents and surrogate mother
- Help organize the documents requested by the clinic
- Coordinate embryo or germ cell transport tracking
- Insurance, Trust, and Fee Progress
- Arrange the procedures for intended parents to travel to the US and after the baby's birth
- Assist with local communication during emergencies
ASRM points out that cross-border surrogacy arrangements increase legal, ethical, and logistical challenges, making the involvement of a professional team familiar with third-party reproduction and cross-border processes even more necessary.
One-minute summary
Third-party reproduction is a journey composed of multiple professional stages.
Reproductive physicians and embryologists handle the medical treatment; mental health professionals help all parties reach a consensus; lawyers ensure the completeness of contracts and parental rights procedures; while insurance, trust, and case management personnel are responsible for seamlessly connecting the different stages.
Clearly understanding the responsibilities of each role also helps intended parents judge whether their current service arrangements are complete, and confirm whether there are any unaddressed aspects before the treatment begins.
Source:
- American Society for Reproductive Medicine, Gamete and Embryo Donation Guidance, 2024.
- American Society for Reproductive Medicine, Recommendations for Practices Using Gestational Carriers: A Committee Opinion, 2022.
- American Society for Reproductive Medicine, Consideration of the Gestational Carrier: An Ethics Committee Opinion, 2023.
💡 The content of this article is intended to be an educational description of experiences, systems, and processes; actual medical diagnosis and treatment must be evaluated and performed by a licensed physician.
