COVID-19 Information

Eight Things You Should Know About Gestational Surrogacy

Written By: Dr. Carol A. Wheeler on April 12, 2017


photo-toddler-with-book-webGestational surrogacy is a truly exciting aspect of infertility treatment, as it grants individuals and couples the ability to have biological offspring in situations where it would have been impossible just a few decades ago. The most rewarding part of my job is helping people achieve their goals of starting a family, and sometimes the best way to meet the goal is through the use of a gestational carrier.

So, how does gestational surrogacy work? When is it used? What should you consider if you’re thinking about pursuing this sort of treatment? This blog addresses some of these important questions, offering eight things to consider in the process.

1. The difference between traditional surrogacy and gestational surrogacy

Surrogate pregnancies have been with us for a very long time. One of the oldest recorded examples is found in Genesis, the first book of the Bible. In this instance, Abraham’s barren wife Sarah offers her servant Hagar to Abraham that she might bear a son on her behalf. Of course, Ishmael, the child born to Hagar, has no genetic relation to Sarah. Biologically speaking, Sarah is Ishmael’s mother by title alone. This is an example of traditional surrogacy.

Today, advances in assisted reproductive technology (ART) have made another sort of surrogacy possible: Gestational surrogacy. This is when a woman carries and delivers a child with whom she has no genetic relation. An egg and sperm are fertilized outside of the womb with in vitro fertilization (IVF) and the resulting embryo is transferred to the gestational carrier, who will carry the baby to term on behalf of the intended parents (the ones going home with the baby).

2. Gestational surrogacy can involve complicated parenting combinations

Put simply, gestational surrogacy is complicated. That is not to say that the process is necessarily unpleasant or stressful, but it’s important that all parties involved are aware of the relational dynamics at play.

In the most complex cases, five parent relationships exist: The gestational carrier, the egg donor, the sperm donor, and the two intended parents, who in this scenario most likely do not have healthy sperm or eggs to contribute. Granted, such a circumstance is rare.

In most cases, one or both of the intended parents are also the egg and/or sperm donor, as the mother may contribute the eggs but not be able to carry a pregnancy. But it is technically possible to have up to five separate individuals involved in the birth of one baby.

3. Gestational surrogacy for medical reasons, social reasons or both

First, there are a host of medical reasons that a woman may be unable to get pregnant or carry a pregnancy to term. We’ll often identify these after a patient has had a series of failed embryo transfers or a history of miscarriages. Other times, the underlying reason that a patient can’t deliver a baby is more obvious, such as when a woman has had a hysterectomy, or is transgender and has undergone a sex reassignment surgery.

Second, there are social reasons that an individual or couple may seek to have a child using gestational surrogacy. Gay couples or single men may opt to use a surrogate carrier and an egg donor to have children. Lesbian women may choose to undergo reciprocal IVF, a process in which one woman donates her eggs and the other carries the baby to term, each playing a role in the pregnancy.

4. All parties go through screening, some FDA regulated

Each person involved in the gestational surrogacy will undergo some type of screening, the most rigorously screened member being the carrier herself. A couple may choose to use a surrogate carrier who they know personally, such as a sister or close friend. Other times, a surrogate will be provided via an outside organization. In either case she will be thoroughly evaluated for physical, emotional and psychological health to ensure the best possible odds of a successful pregnancy.

Additionally, the FDA has strict testing guidelines in place for egg and sperm donors using a gestational carrier. These guidelines are to prevent the spread of disease and minimize risk to the surrogate. We also can conduct genetic testing on the embryos produced from the donated egg and sperm to increase the odds that the transferred embryo will be free of chromosomal disorders.

Whether or not the intended parent(s) donate the eggs or sperm, they will undergo psychosocial education and counseling. This counseling helps the intended parents understand the impact that the pregnancy will have on relational and community dynamics, as well as develop a plan regarding future contact with the gestational carrier. Oftentimes this counseling can be coordinated in-house via our Women & Infants Social Services team.

I’ve included a video below featuring one of our experienced nurses, which should give you an idea of what the screening processes described above look like here at the Fertility Center.



5. Legal and financial counseling are critical

In nearly all gestational surrogacies, a woman will give birth to a baby over which she will have no legal claim. The child’s intended parents, who are usually but not always biologically related, will instead be the legal guardians. As you might imagine, this all must be clearly laid out in a contract written by a lawyer and signed by all involved parties in advance of the pregnancy.

On a related note, the cost associated with gestational surrogacy should be thoroughly evaluated. In Rhode Island we are fortunate in that a good chunk of IVF costs are covered by many insurance providers. However, with gestational surrogacy, additional costs will be incurred that will almost certainly not be covered by medical insurance. These include legal fees, compensation paid to the gestational carrier, and costs associated with screening and testing.

6. The gestational carrier will have an embryo transfer and the egg donor (often the intended mother) will have an egg retrieval

Because a gestational carrier receives an embryo made from donated sperm and egg, she must undergo some of what’s involved in the normal IVF treatment process. The key difference here is that the carrier’s own eggs will not be collected, so she will not receive the same sort of ovulation stimulation medicines that a woman gets when undergoing IVF using her own eggs. A gestational carrier will usually receive hormones in order to properly synchronize her cycle for the embryo transfer. The egg donor, who may be the intended mother, will undergo hormone shots and an egg retrieval in order to obtain the eggs.

7. Gestational surrogacy has a relatively high success rate

The success rate of gestational surrogacy pregnancies and births is relatively high compared with other fertility treatments, but largely depends on the age of the egg donor. The most recent data published by the Society for Assisted Reproductive Technology (SART) indicates that live birth success rates were 50.5 percent in 2014 when donor eggs originated from women under the age of 35. In women over the age of 42, this number dropped to 9.2 percent.

8. Ethical concerns around financial or emotional coercion

As with many advanced reproductive treatment options, gestational surrogacy has some ethical considerations. The most important is that of emotional and financial coercion of the carrier. We take extensive measures to ensure that the selected carrier is not motivated by fear, obligation or financial bribery.

As you might imagine, this can be particularly challenging, especially in cases where the carrier is closely related to one of the intended parents. But this is far and away the most important moral and ethical aspect of gestational surrogacy, as we want to ensure that all parties involved are providing fully informed consent.