Gestational Surrogacy

To be a surrogate means to be a substitute. In regards to human reproduction, surrogates are women who carry a baby for a couple who cannot carry their own child. There are two types of gestational surrogacy: traditional surrogacy and gestational surrogacy.

A traditional surrogate is genetically related to the baby meaning that the baby is created from her egg and she also carries the baby in her uterus. As you can imagine, this arrangement can lead to significant legal and parental rights complications and this form of surrogacy is no longer practiced by most centers, including CFS. The second type of surrogacy is gestational surrogacy. This is where a woman (gestational carrier) carries and delivers a baby for an infertile couple and is not genetically related to the child. The egg would be from the intended mother or from a separate egg donor.

Since pregnancy is not a benign condition and there can be risks to a woman during pregnancy or delivery, the American Society for Reproductive Medicine recommends that this approach be used only when there are compelling medical reasons for doing so.

Medical reasons for Gestational Surrogacy

Gestational carriers “may be used when a true medical condition precludes the intended parent from carrying a pregnancy or would pose a significant risk of death or harm to the woman or the fetus.” Examples of medical reasons include:

• Problems with the uterus or absent uterus
• The intended mother has a serious medical condition that makes pregnancy unsafe for her health

How does a Gestational Surrogacy treatment work?

With assisted reproduction, we need three things to achieve a successful pregnancy: sperm, eggs and a functional uterus. In this day and time, each of the components may be “borrowed” from appropriately selected and screened sources. In a gestational surrogacy cycle, the uterus is being “borrowed”.

At its most basic level, a gestational surrogacy treatment involves an in vitro fertilization treatment for the woman providing the eggs and preparation of the uterine lining of the gestational carrier. In the in vitro fertilization cycle, the ovaries are stimulated to produce several eggs and these are retrieved from the ovary. The eggs are then combined with sperm in the laboratory and embryos develop over 3 to 5 days. During this time, the uterine lining of the gestational carrier is prepared so that it will be receptive when the embryos are ready to transfer. Typically one embryo is transferred into the uterus of the gestational carrier. A pregnancy test is done 10-14 days after the embryo transfer.

What type of testing is necessary for Gestational Surrogacy treatments?

There is a great deal of work to do before the Gestational Surrogacy treatment can be undertaken. These include:

• Psychosocial education of the intended parents and the gestational carrier with our third party reproduction team and with a qualified mental health provider.
• Screening and testing of the genetic parents. This can include complete medical screening, testing for infectious diseases, semen analysis and quarantine of the sperm, and ovarian reserve screening of the egg provider.
• Finding an appropriate gestational carrier.
  – Age: 21-42 years old
  – Prior pregnancy experience: 1-5 uncomplicated pregnancies (3 or less if she had previous cesarean sections)
  – Stable family environment
  – Passes infectious screening, medical screening, and psychosocial evaluation.
• Legal agreements and informed consent of all parties
  – Both the couple and the carrier should have independent legal representation in this process.
  – Both will need to be represented in the state where the baby will be delivered.
  – We frequently work with Stephanie Brinkley on reproductive legal issues. Her web site address is: www.brinkleylawfirmllc.com

How successful are Gestational Surrogacy treatments?

The first three days of human embryonic development is almost entirely an egg driven process. Thus, the quality of the eggs used in the gestational surrogacy treatment are the primary determinants of the outcome. Ovarian reserve testing is done on the individual providing the oocytes to assess the ovarian function so that we can get a feel for the prognosis prior to treatment. This also helps us design a protocol to optimize outcomes with the ovarian function we are working with. When dealing with good oocyte quality, pregnancy rates can be quite high (50-70%), but these can drop significantly as ovarian function wanes.

The process of implantation is extremely complex, but it appears that the lining of the uterus tends to be “permissive” meaning it will usually work if we provide a normal embryo for implantation. Nonetheless, it is possible that an endometrium may not work which is why extensive evaluation of the gestational carrier is done to make sure that, to the best of our ability, the uterus is in good shape and will accept and nourish a pregnancy.