Surrogacy is one of the many paths to parenthood. Yet the surrogacy journey is fraught with obstacles, from the astronomical costs to the mountains of paperwork to the overwhelming and complicated processes intended parents and surrogates are forced to navigate.
It also often surprises people to learn that surrogacy actually isn’t legal or protected in all 50 states. While California is considered a surrogacy friendly state, Nebraska, Louisiana and Michigan still classify gestational surrogacy contracts as illegal. If an intended parent in Michigan wants to have a child via surrogacy, they must work with one who resides elsewhere. Even New York State updated their surrogacy laws with the Child Parent Security Act (CPSA) as recently as 2021.
Barriers aside, surrogacy is the preferred option for many parents looking to start or grow families. That’s why fertility doctor Brian Levine created Nodal, a company that aims to guide people through the process. With the hire of Brianna Buck, a former surrogate herself, as the company’s head of community, Nodal wants to also create a space where surrogates can connect, share information, exchange resources and access mental health support.
The experience mimics that of Bumble’s dating app, giving the surrogates the ability to reach out to families themselves, which flips the usual model of having families reach out to a surrogate once they find a desired match.
Nodal is backed by a list of investors that includes Kate Ryder of Maven Clinic. I spoke to Brian and Brianna about the work they’re doing to destigmatize and add more transparency to the surrogacy industry.
Brianna Buck, Head of Community at Nodal
Amy Shoenthal: Tell me about your background and why you felt the need to create Nodal.
Brian Levine: I'm a practicing reproductive endocrinology and infertility specialist which is codeword for fertility doctor. There’s still a lot of mystery around surrogacy. It’s time prohibitive, cost prohibitive, and emotionally exhausting. It is especially heartbreaking for patients who say things like, we're two guys, we don't have a uterus, this is our only option but we can’t afford it.
As the pricing has escalated from $75,000 to ranges as high as $250,000, the actual compensation to the surrogate really hasn't changed. These astronomical costs are actually hidden in the brokerage of the partnership. In many cases, that has become the most profitable part of the deal.
I wanted to make the matching part of the process affordable, accessible, and transparent, so I built a digital offering that's easy to navigate.
Shoenthal: So what is that process? How do you remove the brokerage part and make it accessible and affordable for people?
Levine: To go through surrogacy, there's a structured series of steps. First, you need embryos. So if you're a gay male couple or a single father or a woman who needs to use donor eggs, you may have already worked with a traditional agency to acquire those eggs. Once you have eggs, you make them into embryos. The next thing you need to do is to match with a surrogate. That’s where we come in.
We want people to understand what surrogacy entails. We reach out to women who potentially want to be a surrogate, and we help them build a profile on our platform. We actually let them say what they want out of the relationship, for example, one or two embryos, an open or closed surrogacy relationship, Covid vaccination or not, travel or not, and more. The last question we ask them is to name their ideal compensation. Part of my reason for starting Nodal was seeing surrogates become a target for unfair compensation.
We do the Bumble model by allowing the surrogate to make the first move. When an intended parent finds out that a woman wants to help them start or grow a family, it is just incredible. But more importantly, that surrogate has options, agency and choice. It strengthens the relationship on both ends.
Shoenthal: So have you completely removed the brokers and agencies from the mix?
Levine: We're not actually competing with agencies. We just make the match and then make sure our families get to the right place for the next step. If you want to go to a traditional agency because you want the case management and all the services, for example if you want your surrogate to be sent avocado socks and pineapple t-shirts and someone to text her for every appointment, we can find that. But if you're like my daughter’s teacher and his husband who can't afford to go through surrogacy on a high touch platform, we can help guide them through an independent journey with just a lawyer. We match you and guide you through next steps.
Shoenthal: Brianna, talk to me about your experience of becoming a surrogate and how you eventually ended up at Nodal.
Brianna Buck: My husband and I were so lucky that I got pregnant with my first within six weeks of trying. My first child was three months old when I found out I was pregnant with my second. Just as I was coming out of the haze of having two tiny humans to take care of, I came to know so many other people who were trying to start their families but couldn't. I thought about how this was something that came to me easily, so perhaps I might be able to offer it to others who weren’t having such an easy experience.
I did research for a full year before I was ready to pull the trigger. I went with one of the larger agencies, and was surprised that it was really hard to find any clear, transparent information. Through a long and drawn-out process, I found myself answering very intense questions about my family, my relationship, my medical history, and more. My husband and I both did three-hour psych evaluations, but I couldn’t get any of my own questions answered. The hardest thing was not knowing any other surrogates. I didn't have anybody to speak to about whether or not my experience was normal. I also wanted to compare compensation. But the agency had no support resources.
Nodal reached out to me while they were in their research phase, and during the interview they asked if I’d like to be part of their team.
Shoenthal: Since Roe v Wade was overturned, it seems all aspects of fertility from IVF to surrogacy could potentially be impacted. Has that started to creep into the process yet?
Levine: It's impressive that you brought that up because so few people think of that being related at all. There’s a lot of misunderstanding around what the actual decisions mean. Many people have extrapolated that if life begins at a certain place, that means embryos are at risk, which means surrogates are at risk. But you can't use the laws of syllogism to link A to B and B to C. The important thing to remember is that we haven't seen any personhood laws passed yet.
We have seen many of the trigger states talk about when you can terminate or not, if there needs to be a heartbeat or not. But the personhood laws that are related specifically to embryos have not been passed, which means no state has banned IVF yet. However, many people are making reactionary statements to try to preempt what could happen down the road.
It does give me great concern for a woman using an untested embryo. If you're unaware of the genetic status of that embryo, there's a bigger chance it could end in a miscarriage or a chromosomal defect, so you end up putting that surrogate at a greater risk. An optimistic take is that a very bizarre unintended consequence of Dobbs could be better quality IVF if people only transfer genetically tested embryos to reduce these risks. There may be more steps taken to protect the safety of that surrogate and not put her in harm's way.
Shoenthal: But obviously, miscarriage or unviable pregnancies can happen even with all the genetic testing in the world.
Levine: What I always advise people is that surrogacy is about partnership. Through strong partnerships with an open dialogue, we can probably handle almost anything. That’s why people rushing their contracts poses such a risk. Anecdotally, I'm hearing from both patients and my colleagues in the field that intended parents are scared to ask questions right now because they don't want to lose their opportunity to have that kid.
Shoenthal: Meanwhile, surrogacy isn’t even legal or protected in all 50 states. New York State just updated their surrogacy laws with the Child Parent Security Act (CPSA) and this is still illegal in a few states. Are you doing anything to fight for better protections and legislation around this issue?
Levine: I love living and working in New York City. But surrogacy wasn’t even legalized in New York State until February 2021. When that happened, all of a sudden, there was lots of interest and lots of demand. As the demand continued to increase, the supply was staying pretty constant.
Dobbs has set a baseline anxiety to everything reproductive almost everywhere below the Mason-Dixon Line. While New York State was the most recent to legalize surrogacy, it’s also the largest IVF market in the United States. The island of Manhattan does more IVF than any other place in America. And surrogacy is still new and novel here.
Shoenthal: How does Nodal help protect the interests of parents and of the surrogates?
Levine: The big question families always ask are, how do we make sure she won't take the baby? But from the surrogate's mind, she wants to know, how do I know they're going to take the baby? The answer to both is a legally binding contract.
Shoenthal: How does Nodal make money?
Levine: Today we make money through a subscription based service. Intended parents pay $500 a month to be on our platform. And if they match with a surrogate, a match costs $6,000 total. That monthly fee goes towards that total, so if it takes them longer to find a match, they’ve invested more money towards that match.
Shoenthal: Brianna, what do you think is missing from the surrogate point of view that Nodal is trying to solve for?
Buck: I love that I get to create all of these resources I didn’t have during my surrogacy experience. I’m building a landing page for people who are not quite ready to fill out an application but just want to learn about surrogacy. We offer a surrogacy 101 webinar that people attend through Facebook. You don't have to fill out an application, you can just come to learn about what the requirements are.
Once surrogates are on our platform, they're assigned a mentor who was a previous surrogate herself. She works with them throughout their entire journey, from before they match all the way through to the fourth trimester.
Levine: This is a part of healthcare. We need to help people understand that. This is the path toward parenthood for so many people who either don't have the biological capabilities, weren’t born with the right assets, or it wasn’t part of their original plan, but it is their plan today.
Surrogates almost always start with the same ubiquitous story, which is, I love my own kids so much and I have the ability to help other people. Can I help someone else have the same joy?
