(IVF Cycle with the Intended Parent’s eggs and sperms, Embryo Transfer to Surrogate.)
(1) Information provided by the client
We ask the client to inform our staff of the client's information by e-mail or telephone.
・Why the client wishes to have a surrogate mother
・Client's name, age (date of birth), occupation, address, telephone number, etc.
・Composition of the family
・Does anyone in the family know about surrogacy other than you?
・Medical history, treatment history, etc.
*If you have any questions about surrogacy, we will try to answer them as clearly as possible.
We will try to answer your questions as clearly as possible.
Optional Plan for Surrogacy
In order to respond flexibly to surrogacy in the midst of the global corona crisis or/and with any personal reasons, PMI offers IVF services at the clinics in Japan, the transportation of fertilized embryos to the U.S., and the embryo transfer to surrogate mothers in the U.S.
For those who are unable to travel to the U.S., our experienced staff can guide you through the process of IVF in Japan and transport embryos to the U.S.. For IVF in Japan, we can refer you to the clinics in Japan.
For patients who would like to have IVF in Japan and wish to have the embryos shipped to the U.S., please contact our staff for the different schedule below.
Preimplantation genetic testing (PGT)
PMI can perform preimplantation genetic testing (PGT) upon client request.
Preimplantation genetic testing (PGT) is a state-of-the-art procedure used to identify genetic abnormalities in embryos created through in vitro fertilization (IVF).
The goal of PGT is to allow physicians to select and transfer embryos that are predicted to be free of certain genetic conditions and chromosomal abnormalities.
Approximate Schedule for Surrogacy
*(3)Depending on the tiiming, we can send you a profile of the surrogate mother at first.
(1)Telephone (or Skype) consultation with the doctor.
(1) Initial trip to the U.S. after the doctor determines that surrogacy is applicable.
(Necessary tests, sperm collection and freezing)
* When frozen embryos are to be transported to the U.S., the embryos must be tested for infectious diseases as required by the FDA at a designated laboratory in the U.S. For details of the tests, please contact us separately.
(2) Contract with PMI and make arrangements for surrogacy.
Set up an escrow account. Remittance. → We will send you a PMI Service Agreement and ask you to remit the money after setting up an escrow account.
(3) Introduction of the surrogate mother → We will send a profile.
(Profile of the surrogate mother to the client, profile of the client to the surrogate mother)
If both parties mutually agree to proceed, we will conduct the screening of the surrogate mother. After receiving Medical Clearance, we proceed to the contract stage.
(4)The client's attorney drafts the surrogate mother agreement, and the surrogate mother's attorney reviews the draft with the surrogate, makes changes if needed, and finally concludes the surrogate mother agreement.
(5) Once the surrogate mother contract is signed, the legal clearance is issued, the frozen embryo transfer cycle can begin.
(6) Meeting with the surrogate mother.
(This will be done via video phone. If desired, this can be done at the time of ③)
(7) Pregnancy confirmation after the embryo transfer.
(8) If the client wishes, you will travel to the U.S. to participate in the surrogate mother's ultrasound examination at approximately 20 weeks gestation. If the client does not come to the U.S. and request, our staff can go to the ultrasound examination appointment
(9) After the birth of the child, the baby will return to Japan after the child's passport is obtained.
*After obtaining a Birth Certificate, we will apply for a U.S. passport.
Consultation with Doctor
Request for the client to fill out the questionnaire
*The client will be asked to fill out a questionnaire about surrogacy, as well as a questionnaire to be submitted to the clinic. You will be asked to return the form with a photograph of yours.
*We will translate the surrogacy questionnaire into English and give it to the surrogate mother with the surrogate mother's photo as a profile of the client.
*We will translate the questions to be submitted to the clinic into English and give it to the doctor prior to the consultation with the doctor.
Initial visit to the U.S.
At the clinic, the client (male) undergoes a blood test (for infectious diseases), urinalysis, sperm analysis, and sperm collection for sperm freezing. The client (female) will undergo blood tests (for infectious diseases), urinalysis, etc.
When performing IVF
If you wish to use fresh sperm for IVF, the client (male) will need to travel to the U.S. to coincide with the egg retrieval date. For those who cannot make the schedule, frozen sperm is usually used, but some clients want to use fresh sperm.
*We can also transport frozen sperm to the U.S. Please contact us separately.
(There is no need to consider the success rate when deciding whether to use frozen or fresh sperm.)
If frozen sperm is used, ICSI (Intra-Cytoplasmic Sperm Injection) is always used.
If frozen sperm is stored for IVF, frozen sperm can be used, so the client (male) does not need to travel to the U.S. again for IVF.
It is recommended that the sperm be discharged 4-7 days prior to the client's arrival in the U.S. This is to ensure the best possible conditions for sperm testing and sperm collection for freezing.
The U.S. Government's Food and Drug Administration (FDA) requires that the client's (male or female) blood and urine samples (for infectious diseases, etc.) be tested at a designated laboratory in the U.S. Before the IVF procedure begins, we recommend that the client's blood and urine be tested at a designated laboratory in the U.S. Before IVF begins, the client's (male/female) blood work must be clear. The surrogate mother contract can be signed only after the blood and urine tests are completed.
Both male and female
HIV 1 & 2 (HIV I, HIV II)
HTLV 1 & 2 (may not be available in Japan) (human T lymphotropic virus types I and II)
Hepatitis C antibody
Hepatitis B surface antigen
Hepatitis B core antibody (IgG / IgM) (antibody hepatitis B - immunoglobulin G / immunoglobulin M)
Syphilis/RPR/VDRL (syphilis/syphilis antibody screening test/syphilis antibody screening test)
CMV IgG / IgM (Cytomegalovirus - immunoglobulin G / immunoglobulin M)
Gonorrhea / Chlamydia (Gonorrhea / Chlamydia)
1st visit to the U.S. - blood and urine tests, sperm analysis, sperm freezing, ultrasound.
(completed in 1 day)
2nd visit to the U.S. - stay about 1 week out of IVF cycle, including the day of egg retrieval.
(Another visit to the U.S. – Visiting the ultrasound testing with the surrogate mother at about 20 weeks of pregnancy (only if requested)).
(If desired, our staff will attend the ultrasound with the surrogate mother.)
3rd visit to the U.S. - at the time of delivery
(The length of stay depends on the situation before and after the birth, but after the birth, the minimum stay is about 3 weeks)
(2) Consultation with the doctor via videophone
After the doctor determines that surrogacy is applicable and you have decided to use a surrogate, you come to the U.S.
*Duration: 1 to 3 days
(*For those who have limited time, we can accommodate your request in a flexible manner.
Interview with a doctor
Interview with psychologist (if necessary)
Significance of the interview
・To deepen the friendship and understanding between the client and PMI.
・Confirmation of schedule for the visit to the U.S.
・To determine if the client is suitable for surrogacy. (The Initial Consultation has already taken place.) ∙
・Blood and urine tests necessary for surrogacy.
・Other tests (if necessary).
・Confirmation of the client's understanding of the surrogacy process.
・Confirmation that the surrogate is emotionally ready to accept the surrogacy.
・Provide emotional support and care.
・Explain the legalities of surrogacy.
・If there are any questions, it will be explained to the client.
*Points to note
Please inform us of your medical history and treatment history in Japan in advance.
If you have a history of infertility treatment, it would be very helpful to have the information
Upon arrival at the Los Angeles airport, our staff will pick you up upon your request.
Our staff will accompany you to the clinic and provide interpretation.
We will refer a doctor and a lawyer but we will consult with you if you have other requests.
(3) Contract with PMI
Once the surrogacy is decided, a contract will be signed between the client and PMI.
a. Delivery of the prospective surrogate mother's profile
The profile includes a photograph of the potential surrogate mother and a detailed description in English of her age, occupation, family structure, medical history, and why she wants to be a surrogate mother.
We will send you the profile with her answers in English, along with a photograph.
b. Interview appointment with the surrogate mother
If you like the prospective surrogate mother's profile, please let PMI know.
PMI will arrange a meeting with the surrogate mother (video phone call).
Some cases we can introduce you to a surrogate mother immediately, while other cases may take a little longer.
We cannot promise how long you will have to wait, but please allow approximately 2 to 3 months.
We do not translate profiles, but if you have any questions, our staff will be happy to answer them in detail.
We will provide you with the profiles of the current available surrogate mother candidates and ask you to choose one of them who is suitable for you.
(4) Interview with prospective surrogate mother
The meeting with the surrogate mother is usually conducted via video phone.
*About the surrogate mother
・The surrogate mother will be selected from women between the ages of 21 and 38 who reside in California and have experienced pregnancy and childbirth at least once.
・Most of the surrogate mothers are married women, but some are single mothers.
・Single mothers will be selected who have family and friends who can support them emotionally and physically.
・We look for candidates from all over the state of California, so they do not necessarily have to live in Los Angeles.
(5) Determination of the surrogate mother
A surrogate mother cannot be bound until a contract is signed. Therefore, it is important to make a decision as soon as possible.
If both parties (client and surrogate mother) agree, we proceed to the next step, screening.
(6) Background check of the surrogate mother
PMI will request a specialized agency to conduct a background check on the surrogate mother.
The background check will check the surrogate mother's criminal record, address history, etc. The results will be available in approximately 3 to 7 days.
(7) Psychological Evaluation of the surrogate mother
After passing the background check, a psychological evaluation is conducted by the psychologist.
The psychologist will check the surrogate mother's understanding of surrogacy and her suitability mentally as a surrogate mother.
(8) Physical Check of the Surrogate Mother (Medical Review)
After passing the psychological evaluation, a physical check of the surrogate mother is conducted.
The doctor will examine the surrogate mother directly to determine if she is physically fit to be a surrogate mother.
Blood and urine tests (surrogate mother and her partner (husband)) are also performed at the same time.
The client will be responsible for the surrogate mother and her partner (husband)’s transportation, lodging, and meals to tip to Los Angeles.
Fees will depend on the location of the surrogate mother.
PMI will arrange for the processes (7) and (8) to take place on the same day, if possible.
(9) Final determination of surrogate mother
After (8) is completed, the surrogate mother will be officially selected. (including blood test)
(10) Contract with the surrogate mother
After the surrogate mother has been selected, a surrogacy contract will be drafted by an attorney.
*Process to exchange a contract with the surrogate mother
a. The client and the attorney (A) conclude a Retainer Agreement (attorney request to prepare a surrogate mother contract).
b. PMI sends necessary information to the attorney (A) for the preparation of the agreement.
c. The attorney (A) prepares a draft agreement, which is translated into Japanese by a translator.
d. The client reviews the draft agreement alongwith the Japanese translation.
e. The client, the attorney (A), and the interpreter will hold a conference call by international telephone.
At this time, the client will receive a detailed explanation of the contents of the draft contract from the attorney (A), and the attorney (A) will answer the client's questions and discuss the draft contract with the client.
f. Attorney (A) sends the draft agreement to the surrogate mother's attorney (B).
g. The surrogate mother's attorney (B) and the surrogate mother discuss the draft agreement.
h. The attorney for the surrogate mother (B) discusses with the attorney (A) and makes an offer to change the contents if desired.
i. The client, attorney (A), and interpreter confirm the contents by e-mail.
j. Attorney (A) drafts the final Agreement and sends it to the client.
k. The client reviews the Agreement, signs it if there are no problems, and sends it back to the attorney.
l. The attorney (A) sends the final Agreement to the surrogate's attorney (B).
The attorney for the surrogate mother (B) reviews it, signs it if there are no problems, and sends it back to the attorney (A).
m. The attorney for the surrogate mother (B) reviews it, signs it, and sends it back to the attorney (A).
n. The attorney (A) checks this agreement signed by the client and the surrogate mother and issues a Legal Clearance.
o. This concludes the conclusion of the surrogacy contract.
(10') Obtaining medical insurance for the surrogate mother
Medical insurance (medical expenses) includes insurance premiums and deductibles (co-payments).
Not only the client, but also the surrogate mother and the agency are taking on the risk of surrogacy. We ask that you fully understand the risks and proceed with the surrogacy process without fear of the risks. Medical insurance will be explained in detail during the initial video phone consultation between the client and PMI.
If the surrogate mother has medical insurance through her or her husband's company, it may be possible to use that insurance as the surrogate mother's medical insurance for the pregnancy and delivery.
（If this is the case (with the consent of the surrogate mother), you will need to have an insurance agency specialist verify that the policy does not exclude the surrogate mother's coverage.
PMI recommends that the client consult with an insurance agency specialist to discuss medical insurance considerations.
(11) Escrow Account Opening and Deposit
All payments to the surrogate mother, including remuneration, medical expenses, attorney fees, and necessary expenses, will be made by the professional representative through the Escrow Account.
For this purpose, you are required to open an account and make a deposit. The amount of the deposit will be in accordance with the Surrogacy Service Agreement between the client and PMI and the Surrogacy Agreement between the client and the surrogate mother.
(12) IVF and Egg Transfer
The client, the doctor's office, and PMI will communicate with each other to prepare for IVF. When IVF is ready and egg retrieval is scheduled, the client will come to Los Angeles (second trip to the U.S.).
Stay for about one week of the IVF cycle, including the day of egg retrieval.
(12‛) After the surrogacy contract is signed, PMI will stay in contact with the doctor's office and surrogate mother to prepare for the Embryo Transfer cycle.
(13) Post-Embryo Transfer care
a. After the embryo transfer, the surrogate mother rests in a hotel near the doctor's office for one or two days.
b. Approximately 10 days later, a pregnancy test (blood test) is performed.
c. After a positive result (pregnancy) is obtained, the surrogate mother will undergo ultrasound, blood tests, and other tests as instructed by the doctor.
d. When a heartbeat is confirmed, the pregnancy is confirmed.
e. Since the client is in Japan during this period, PMI will be communicating with the client, the surrogate mother, and the doctor.
PMI will also keep the client informed of the surrogate mother's living situation.
f. When the surrogate mother reaches about 12 weeks of pregnancy, she will be transferred to an obstetrician/gynecologist.
(14) Commencement of payment of remuneration to the surrogate mother
Compensation to the surrogate mother usually begins when the pregnancy is confirmed and is paid in 10 monthly installments of a fixed monthly amount.
(14') Life insurance for the surrogate mother
Once the pregnancy is confirmed, life insurance for the surrogate mother is obtained.
(15') Surrogate Mother's Obstetric Doctor Examination
Upon the client's request, PMI staff will accompany the surrogate mother to her doctor's examination (ultrasound, blood test, etc.). We will send photos and videos of the ultrasound, etc. to the client.
The client can also accompany the surrogate mother to the doctor's examination.
・As with all surrogate mothers, they would like to build a good relationship with the client.
・We recommend that you ask the surrogate mother to keep you updated on her pregnancy as much as possible, and to be involved in the pregnancy as much as possible, by asking her how the baby is doing in the womb and giving her tapes of the client's voice.
・It is also a good idea to accompany the client during ultrasound examinations. The surrogate mother will understand if you are unable to go because of the long distance.
・The surrogate mother will be happy to interact with the client after the birth.
・Some people prefer to avoid interaction after the birth as much as possible, but even in such cases, the surrogate mother will want to be kept up to date with updates through photos of the child, Christmas cards, and the like.
(16) Legal Procedures Before the Birth
*Process of Legal Proceedings (Pre-Birth Order)
a. The client's attorney (A) prepares the documents to be submitted to the court and has them confirmed by the surrogate's attorney.
b. After confirmation, both the client and the surrogate mother sign the documents.
c. The attorney (A) goes to the California State Court and submits the documents to the judge.
d. The judge receives the documents, reviews them, and then issues a Pre-Birth Order, which is a Court Order.
e. The client receives the Court Order from the attorney (A) prior to the birth.
f. The client's attorney sends the Court Order to the administrative staff of the hospital where the surrogate mother will give birth.
g. The legal parents of the child determined according to the court document.
The hospital in charge will submit the birth document of the baby according to the Court Order to the local (county) government office.
The legal process is handled entirely by the attorney (A), so the client does not need to visit the court.
When a baby is born in the U.S., the hospital where the baby was born issues a birth document and submits it to the local (county) government office. The local government office will issue a Birth Certificate in accordance with the birth document. This certificate has a column for the names of the parents. In California, the parent's name is the client's name, not the birth surrogate's name. This is because the attorney will go through the process of having a California State Court Judge issue an Order to that effect in advance. You give that document (Pre-Birth Order) to your OB/GYN (hospital) at the time of the birth (often before the birth). The hospital writes the birth document and submits it to the county office, in accordance with the judge's order. The client then has the county office issue an official Birth Certificate for the child. In this respect, California is a state with well-established laws regarding surrogacy. The Japanese client will then go to the ward or city office in Japan to register the birth of the child along with the birth certificate. The child can then be placed in his or her own family register. Therefore, adoption is not necessary.
(17) Attendance at the birth
It is best to come to the U.S. about one week before the expected date of birth if possible.
(Third trip to the U.S.)
The client may be present at the birth, and PMI staff will accompany the client to the birth. PMI staff will accompany the client and the surrogate mother to the U.S. We will plan the birth of the baby according to the best needs of both the client and the surrogate mother.
2 to 4 weeks
(18) Baby's return home
After the baby is delivered, if there are no problems, the baby is usually discharged from the hospital within 2 days.
Once the baby is discharged from the hospital, we will apply for a U.S. passport.
In order to do this, a birth certificate must be issued by the county of birth.
This process usually takes two to four weeks, but the baby can return to Japan with the client as early as two weeks after the birth. (In some cases, it may take longer, depending on the circumstances at the time.)
PMI will help you with the various procedures and arrangements until you return to Japan.
Until your return to Japan, you will stay in a hotel with a kitchen or in a condominium for a short stay. On the day of your return, PMI staff will take you to the airport.