Gestational Carriers and Surrogates
Third-Party Reproduction Solutions For Your Growing Family
Sometimes, it requires the help of another person in order to make your family complete. This is called third-party reproduction and it can take a range of forms, depending on your infertility diagnosis and preferences. NCFMC is committed to providing the highest-quality fertility care, using innovative assisted reproductive technology, to help our patients start or grow their families.
If you’ve received an infertility diagnosis that requires third-party reproductive solutions, one of the following options can significantly increase your chances of bringing a healthy newborn into the world.
- Donor Sperm. Donor sperm can be used in a variety of scenarios, from assisting couples with a diagnosis of male infertility factor to helping LGBTQIA families.
- Donor Eggs. Similarly, women over 38-years of age, couples with female infertility factor, carriers for certain genetic disorders and the LGBTQIA community can opt to use IVF with donor eggs to increase their chances of in vitro fertilization (IVF) success rates.
- Donor Embryos. In cases where fertilized embryos are not a possibility, embryos are not viable, or embryos test positive for genetic disorders, couples can opt to use donor embryos. These embryos can be transferred to the mother or a gestational carrier via IVF.
- IVF using a Gestational Carrier, also called Gestational Surrogate. Sometimes a woman is not able to carry a baby to term, whether it be for anatomical or medical reasons. The Intended Parent(s) can opt to undergo egg retrieval and IVF with a partner’s or donor’s sperm, after which a gestational carrier will undergo the Embryo Transfer procedure and carry the baby for her.
- Traditional surrogacy. With traditional surrogacy, the surrogate is also the egg donor and intrauterine insemination (IUI) is used to inseminate the surrogate with the father’s sperm, or donor sperm, depending on the situation.
Medical Screening of Surrogates
Prior to beginning treatment, surrogates must be fully screened to ensure that there are no conditions present that could trigger complication during pregnancy. The range of tests she must undergo includes:
- A careful medical and family history
- A thorough physical examination
- A psychological evaluation
- Specific blood tests to exclude HIV, hepatitis B and C, and other diseases
- Cervical cultures for organisms such as chlamydia and urea plasma that might interfere with a successful outcome
- An evaluation of the uterus by hysteroscopy (in which a thin, telescope-like instrument is introduced into the uterus) to determine if anything might interfere with implantation
- Blood tests for prolactin and thyroid stimulating hormone
- Blood testing of the surrogate’s partner for HIV, hepatitis, and other transmittable diseases
The intended parents may also be required to undergo tests if it has not already been confirmed that the woman has an adequate ovarian reserve and that there are no unidentified problems with sperm quality that could hinder success.
Due to the legal complexities of a surrogate pregnancy, it is absolutely imperative to draft a contract that both parties can agree on before beginning the IVF process. The contract should be specific and thorough, addressing all aspects of the surrogacy process in detail, especially the matter of who the intended parents of the child are to be. It is necessary for the couple and the surrogate to be represented by separate attorneys, as their interests are inherently different.
Potential Scenarios to Discuss with Your Surrogate
Carla: Dr. Thompson delivered my three children. He even delivered me! I trust him completely and consider him a part of my family. Dr. Thompson is a family practice physician and has delivered thousands of babies over the years. I never had a problem with my previous pregnancies and I don’t need a specialist for this one. I couldn’t imagine going through a pregnancy without him. Why can’t Laurie and Mike trust me to know what is best?
Laurie and Mike: After months of research, we have identified an experienced high risk OB/GYN with an office twenty minutes from Carla. We have spent nine years trying to have a baby on our own and will spend over $50,000 on this surrogacy. This baby is so precious to us and we’re so worried something will go wrong. We’ve heard horror stories of tragedies that could have been prevented. We want Carla, and our baby, to have the best care possible. After all we’ve been through, this doesn’t seem like too much to ask.
Solution: After much discussion, the parties agreed that Dr. Thompson will continue as Carla’s primary physician. Her care will be overseen by the high risk OB/GYN who will review records and make periodic examinations.
Jan: I lift free weights regularly to relieve stress and keep in shape. In the summer my family and I love to water ski with our new jet boat. During my last pregnancy I was skiing through my eighth month. You should have seen the stares! I think exercise helps maintain a healthy pregnancy and builds endurance for the labor process. I would never do anything to hurt the baby. I agreed to have a baby for Steve and Sara, but I didn’t agree to give up my whole life.
Steve and Sara: Sara stayed in bed for ten weeks trying to hold on to her last pregnancy. We think Jan should not take any unnecessary risks. Walking and swimming in moderation is OK, but what if she falls while skiing, or drops a weight? This is only a temporary restriction. Jan can get back to all her activities after the delivery. Taking care of the pregnancy should be the number one priority.
Solution: It is certainly in everyone’s best interests for Jan to maintain good health and a positive attitude throughout the pregnancy. Jan agreed to consult with the IVF physician as well as her OB/GYN and to follow medical advice regarding activity restriction. Steve and Sara will let the physician set these parameters.
Stephanie: When I agreed to be a surrogate, I had no idea of the time it would require — doctor’s appointments, meetings with the lawyer, support group meetings. I already had a busy life. I work full time, take care of my two children, and volunteer for the crisis hotline. On top of all this, Patricia calls me every other day wanting to know how I’m feeling. Then she tells me all about her life! I don’t want to be rude, but I don’t have time for this! The relationship is beginning to feel intrusive. Sometimes I don’t answer the phone just to avoid her.
Patricia: How do you think it feels to have my baby growing in someone else’s uterus over 2000 miles away? I get so worried when I don’t hear from Stephanie. Hearing her voice makes me feel more secure. Even though I’d like to, I don’t call every day. I want to experience this pregnancy as much as possible. I don’t think it’s asking too much to stay in touch with each other.
Solution: Stephanie and Patricia agreed to communicate largely by email, which feels less intrusive to Stephanie. The doctor’s office has agreed to fax summaries of OB/GYN visits directly to the intended parents. Stephanie promised to notify Patricia of any change in her condition. The parties acknowledged that they had different needs and that they would try to be sensitive to each other.
It is likely that the previously described conflicts could have been avoided if, before proceeding with a surrogate pregnancy, the parties had thoroughly discussed relevant issues and set forth all verbal understandings in the written surrogacy contract. A counselor can be quite helpful in facilitating this dialogue. With sufficient commitment to the process of communication, an agreement that supports the needs of all parties can usually be reached.
Special Considerations for Using a Family Member as a Surrogate
Although it can be a relief and a blessing to have someone who is already close to you offer to be your surrogate, it is important to realize that navigating this journey with a family member or close friend can actually complicate matters unless the proper steps are taken to ensure the best interests of everyone involved are met.
First and foremost, it is absolutely necessary to perform all of the same pre-treatment steps as if you were undergoing IVF surrogacy with a stranger. While many people may be tempted to keep things informal while dealing with a family member, setting up the proper legal arrangements and conducting the necessary medical and psychological evaluations ahead of time will ultimately prove worthwhile.
Although the surrogate may see her participation as an “act of love,” it must be recognized that the financial, physical, and emotional burdens of pregnancy are significant and that the responsibilities of both parties should be realistically and clearly addressed prior to the IVF process.
Finally, without the help of a surrogate agency to mediate between parties, the conflicts that can and do arise during this process may be extremely difficult to resolve. At Northern California Fertility Medical Center, we recommend the both parties participate in a counseling program before and during the surrogacy to help prevent or resolve any issues that may threaten the relationship.