A “surrogate” or gestational surrogate is an older term for what we now refer to as a “gestational carrier”. A gestational carrier (GC) is a woman who accepts to bear (or be pregnant with) the child of another woman who is incapable of becoming pregnant using her own uterus. The gestational carrier provides a host uterus for the offspring, and does not contribute genetic material, i.e. the carrier is not the egg source. The offspring’s genetic material may come from the egg and the sperm provided solely by the aspiring couple (referred to as the “intended parents” or IP) or in combination with donor egg and/or donor sperm depending on the needs of the intended parents.
Patients who need gestational carriers include those who:
- do not have a uterus (including gay male couples and single men)
- have a very abnormal uterine cavity
- have had several recurrent miscarriages, not due to embryo issues
- have had recurrent failed IVF cycles and the embryos are not suspected to be the problem
- have medical issues for which pregnancy is not advised
Choosing a gestational carrier is crucial first step in the process of conceiving with a carrier. This is, after all, the woman that will be an important part of the intended parents’ life for a year or more, and may even continue to be a part of the family beyond that, if so desired. The gestational carrier may be provided by an agency or could be a friend or a family member. If you select a GC from an agency, they will provide all necessary information and arrange the required contracts and agreements. If you plan to use a gestational carrier you personally select, an agent must be contracted to work with the gestational carrier and the intended parents. Please see the article in this issue discussing Gestational Carrier Agencies. In short, the agent acts as an intermediary and facilitates the acquisition/completion of the items below:
- A psychological evaluation of the gestational carrier (and spouse) by a licensed professional including counseling for the prospective GC and her partner as well as psychological testing
- Medical insurance for the gestational carrier, to cover all aspects of pregnancy
- A legal contract drawn up by an attorney, with separate legal representation for both the intended parents and the gestational carrier
- Any necessary coordination for the duration of the pregnancy
Upon completion of all requirements listed above, the gestational carrier begins her screening appointments. The screening for the carrier includes medical records review, physical and ultrasound uterine assessment by a PFC physician. Appropriate blood tests for the gestational carrier and her spouse, if applicable, are also performed. Should the physician find any problem or should any of the laboratory tests be abnormal, it is possible the cycle may be delayed or the GC may not be medically approved to proceed.
Pacific Fertility Center follows some basic guidelines for selection and approval of prospective gestational carriers. Currently, the American Society for Reproductive Medicine, a national medical society to which we belong, is working on the establishment of standard guidelines for physicians and IVF clinics working with patients that need gestational carriers. First and foremost, there must be a legitimate medical reason that a man, woman or couple needs to use a gestational carrier. That is, just not wanting to be pregnant is not a sufficient reason for another woman to assume the risks of pregnancy. If the prospective GC is a friend or family member, there must not be any dependent relationship or evidence of any coercion. These are some of the basic requirements for gestational carriers:
- Age: 21- 40. We do prefer GCs to be less than 40 prior to embryo transfer but will make exceptions up to age 45 for healthy candidates that have had successful delivery within the last 5 years.
- The current recommendation is that a gestational carrier’s maximum weight/BMI should be restricted to < 32.
- Carriers must have had at least one full term birth and having living child/children at home is the norm.
- No more than 5 natural births/deliveries and no more than 3 C-section deliveries.
- The gestational carrier must have no significant chronic illness. Specific medications which may have the potential to interfere with fertility medications or which are not recommended for use in pregnancy (e.g. antidepressants) are not permitted.
- Potential carriers must not use tobacco, illicit drugs, and agree to not drink any alcohol during pregnancy. We recommend that carriers not consume caffeine during pregnancy. Carriers should agree to taking daily prenatal vitamins and if applicable, thyroid hormone supplementation during pregnancy.
- Last birth of the gestational carrier should be less than 5 years, but is contingent upon request. A gestational carrier can become matched as a carrier 6 months after her last delivery.
- All prior medical, prenatal and delivery records for each pregnancy are required for the initial screening process.
Some other recommendations:
- We recommend that the Intended Parents meet the GC at least once and attend as many medical visits as feasible. Visiting the GC’s home is also a good idea, if possible.
- Complete agreement between the IPs and GC is mandatory on several issues such as the number of embryos to transfer. We do, in general, recommend no more than 2 embryos but, with egg donor egg source, we recommend only one embryo be transferred. In general, the legal contracts will have language specifying these issues.
- It is important that the GC be in a stable home-life situation without recent or anticipated changes in marital status, evidence of financial distress or having legal disputes. A supportive home environment is best for the health of all involved parties.
While undergoing IVF with a gestational carrier can seem a daunting endeavor, this can be a positive experience for everyone. Careful matching of intended parents to their gestational carrier and her family is essential to getting the process started off on the right foot. Exacting attention to detail by the agency and fertility clinic are critical to a successful establishment of the pregnancy. Flexible attitudes and compassionate behaviors are important characteristics and will help lead to a successful outcome for everyone.