Gestational Surrogacy is indicated when a woman can produce viable embryos, but cannot carry a pregnancy. “Traditional surrogacy” refers to artificial insemination of a surrogate mother with the semen of the intended father. In contrast, gestational surrogacy involves the production of embryos through IVF, using the eggs and sperm of the intended parents, and transferring the embryos to the uterus of the surrogate. At NCCRM, we only do gestational surrogacy.
Examples include:
- Previous hysterectomy
- Congenital absence of the uterus
- Congenital malformations of the uterus
- DES uterus
- Uterine pathology such as fibroids or scarring of the cavity
- Maternal disease that makes pregnancy dangerous, such as severe diabetes, renal failure, lupus, or rheumatoid arthritis
- Rh Isoimmunization
- Some breast cancers
- Multiple failed IVF procedures with good embryo quality
Surrogate mothers should have at least one biological child that they have raised. Compared to egg donors, surrogate mothers undergo a much more intensive psychological assessment. Most applicants are rejected following this initial evaluation. After completing the psychological evaluation, the candidate undergoes a medical evaluation, similar to the one performed on egg donor recipients. A good contract between the gestational surrogate and her couple is critical.
Examples of covered issues are:
- How many embryos can be transferred?
- What happens if there is a multiple pregnancy?
- Will the surrogate permit a termination if an abnormal fetus is discovered?
- Health insurance, life insurance, clothing allowances are discussed.
- Agreements regarding nutrition, smoking, travel, and other behaviors may be covered.
The couple and the surrogate remain in contact throughout the pregnancy. Surrogacy is about relationships, and this aspect can be very rewarding to all parties involved. Results In general, results with gestational surrogacy are excellent, but vary according to the age of the egg provider. In a given age group, results with surrogacy tend to be higher than with routine IVF. This is largely due to patient selection.
Proper selection of candidates implies that these women could have children on their own, if it were not for the medical problem that lead them to surrogacy. Good embryos placed into a well-prepared, proven uterus theoretically optimizes the IVF process. How the Process Works In reality, egg donation and gestational surrogacy are similar techniques. The only difference is who goes home with the baby! In general terms there is an egg provider, and a recipient.
The cycles of the two women are synchronized using a combination of birth control pills and Lupron. Upon stopping the pills, the egg provider begins using one of the brands of injectable gonadotropins to stimulate multiple egg production. The use of these drugs requires several office visits for blood and ultrasound monitoring to determine how many eggs are being produced and when they are likely to be mature. When the follicles seem large enough, a single injection of hCG is given. The transvaginal ultrasound guided egg retrieval is timed to this injection.
Most centers perform this procedure with conscious sedation, especially with egg donors. While the egg provider is taking her injections, the recipient begins twice weekly injections of estrogen. Around the time of the retrieval, the recipient adds some combination of vaginal and injectable progesterone, thus creating an artificial cycle timed to the egg provider’s cycle. The eggs are combined with the sperm from the intended father, and three days later a small number of embryos is transferred to the recipient’s uterus. Since success rates are rather high, we discourage transferring large numbers of embryos, and in many of our egg donor cycles, or surrogacy cycles with young eggs, we often transfer two embryos with excellent results.
Extra embryos can be frozen for future use. As with any medical procedure, there is a small potential for risk. For the egg provider, the retrieval procedure can cause internal bleeding or infection. We give prophylactic antibiotics to greatly reduce the risk of infection. Occasionally, the egg provider experiences the complication of hyperstimulation syndrome. This results from an overabundant response to the stimulation drugs. When this occurs, women experience significant abdominal distension and pain. Since these women will not be pregnant, the symptoms quickly recede with the menses, and most of these women can be managed successfully on an outpatient basis. In contrast, egg donor recipients and surrogates face few risks from their procedures.
The main risks are associated with pregnancy itself, and multiple births is an important issue. That is why it is important to use caution when deciding how many embryos to transfer in these often optimal situations.
NCCRM has started a Gestational Surrogacy Group for women seeking the opportunity to carry a child for another couple. This is also a group for couples seeking to meet gestational surrogates. If you are interested in joining this NCCRM Gestational Surrogacy Group, click here. This is where you can connect with other people. This group is moderated by the staff of NCCRM. Please refrain from publishing private health information.
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