Eight Things You Should Know About Gestational Surrogacy

Originally published March 2022

Gestational surrogacy is one of the most exciting developments in infertility treatment. It gives individuals and couples the chance to have biological children in situations where that wasn’t possible just a few decades ago.

Helping people build their families is the most rewarding part of my work, and sometimes, the best path forward includes a gestational carrier.

So, how does it work? When is it used? And what should you know before considering it? Here are 8 key things to keep in mind:

1. Traditional vs. Gestational Surrogacy

Surrogacy has been around for centuries – there’s even a reference to it in the Bible. In that example, Sarah has her servant Hagar bear a child for her. This is known as traditional surrogacy, where the carrier is also the genetic mother.

Today, most surrogacy cases use gestational surrogacy, where the carrier has no genetic connection to the baby. Instead, an embryo created via in vitro fertilization (IVF) is transferred to the uterus of the gestational carrier. The egg and sperm usually come from the intended parents or donors, making the surrogate simply the one who carries the pregnancy.

2. It Can Involve Multiple Parenting Roles

Gestational surrogacy can be complex. In rare cases, up to five people could be involved: the gestational carrier, an egg donor, a sperm donor, and the two intended parents.

More commonly, one or both intended parents also contribute their own egg or sperm. For example, the mother may use her eggs but need someone else to carry the pregnancy. Still, it’s important to understand the potential complexity of the relationships involved.

3. Used for Medical and Social Reasons

There are many reasons someone might need or choose gestational surrogacy.

• Repeated failed embryo transfers
• History of miscarriage
• Having had a hysterectomy
• Being transgender and having undergone gender-affirming surgery

Social reasons include:

• Same-sex male couples or single men using a surrogate and egg donor
• Lesbian couples opting for reciprocal IVF (one provides the egg, the other carries the pregnancy)

4. Everyone Involved Goes Through Screening

Every person involved, especially the gestational carrier, undergoes screening. Whether the carrier is a close friend, family member, or matched through an agency, she’ll be evaluated for her physical, emotional, and psychological readiness.

The FDA also regulates screening for egg and sperm donors to reduce disease transmission risks. Genetic testing of embryos may be recommended to check for chromosomal issues.

The intended parents receive psychosocial counseling as well. This helps them prepare emotionally and consider their future relationship with the carrier. At Women & Infants Hospital, we often coordinate this through our in-house Social Services team.

5. Legal and Financial Guidance Is Essential

In most cases, the gestational carrier will have no legal claim to the child she delivers. A legal contract, drawn up and signed before the pregnancy, outlines all rights and responsibilities.

It’s also important to understand the financial side. While IVF costs may be covered by insurance in Rhode Island, many surrogacy-related expenses are not.

These may include:

• Legal fees
• Carrier compensation
• Screening and testing costs

6. IVF Involves Two Separate Roles

Both the egg donor and the gestational carrier go through parts of the IVF process:

• The egg donor (often the intended mother) takes hormone shots and undergoes egg retrieval.
• The carrier receives hormone therapy to prepare her uterus for the embryo transfer but doesn’t need ovulation medications.

7. Success Rates Are Generally High

Gestational surrogacy tends to have strong success rates, especially when younger donor eggs are used. According to the Society for Assisted Reproductive Technology (SART), the live birth rate in 2014 was:

• 5% using donor eggs from women under 35
• 2% using donor eggs from women over 42

8. Ethical Considerations Are Part of the Process

One of the biggest concerns in surrogacy is ensuring that the carrier is fully consenting, without pressure or coercion, emotional or financial. This is especially important when the carrier is related to one of the intended parents.

At our center, we take extensive steps to ensure all parties understand the process and participate freely and ethically. Informed consent is non-negotiable.

In Summary

Gestational surrogacy offers incredible opportunities for people to grow their families. But it’s a complex process that involves emotional, medical, legal, and ethical considerations. With the right support team and guidance, it can be a deeply meaningful path to parenthood.

Disclaimer: While I am a doctor, I am not your doctor.  The content in this blog is for informational and educational purposes only and should not serve as medical advice, consultation, or diagnosis.  If you have a medical concern, please consult your healthcare provider or seek immediate medical treatment.