Surrogacy Using a Gestational Carrier

Surrogacy using a gestational carrier at a glance

  • Surrogacy using a gestational carrier (GC), a woman who carries and delivers a child on behalf of another couple, is the preferred type of surrogate used in assisted reproduction.
  • A gestational carrier is often favored over a traditional surrogate because her eggs are not used to achieve pregnancy, which avoids a genetic relationship between the GC and the child.
  • A surrogate is used when a couple or individual wants to have a child but is not able to carry a pregnancy because of problems with the woman’s uterus or in cases of male partners who wish to become parents.
  • Surrogacy involves several health and legal considerations for both the intended parents and the surrogate. 

What is surrogacy using a gestational carrier?

A gestational carrier is a woman who carries and delivers a baby on behalf of a couple. Surrogacy involves creating an embryo through IVF using sperm from the recipient father and an egg from the intended mother (or using donated sperm or eggs) and implanting the embryo in the surrogate’s uterus for pregnancy.

By using a gestational carrier, the recipient partners are genetically related to the child because the genes from the father’s sperm and genes from the mother’s retrieved eggs are used to create the embryo. This is preferred over traditional surrogacy in which the surrogate uses her own eggs with the intended father’s sperm through IVF or intrauterine insemination (IUI) to create a pregnancy, and thus would be genetically related to the child.

When to use a surrogate

A doctor will recommend that an individual or couple use a gestational carrier surrogate when they want to have a child but cannot safely carry a pregnancy. There are various reasons for this including:

  • Previous unsuccessful attempts at getting pregnant using IVF.
  • Absence of a female partner, such as a single male or a gay couple who want a child genetically related to them.
  • Medical conditions that make carrying a pregnancy difficult, such as recurrent miscarriage (a condition in which a woman has two or more consecutive miscarriages).
  • Women who do not have a uterus or have uterine abnormalities that may make pregnancy risky.

Gestational carriers can be contacted through a fertility clinic or an agency, or the intended parents can work with a known surrogate, usually a family member or a close friend.

In most cases a surrogate is compensated for her effort, expenses and time. This payment is generally discussed and agreed upon before starting treatment. The payment methods and frequency should also be discussed and noted in a legal contract between the surrogate and the recipient couple.

Selecting a surrogate

Several tests and screenings are used in evaluating and choosing a healthy and viable gestational carrier for surrogacy. The general criteria for a surrogate include:

  • A woman who is between the ages of 21 and 45.
  • A woman who has had at least one successful pregnancy.
  • A woman who is supported by family or friends who are willing to help her manage the pressures of pregnancy.
  • A woman who has had less than five vaginal deliveries and/or less than two cesarean deliveries.
  • A woman who has fully reviewed with a medical professional the risks of pregnancy and details of being a surrogate.

A gestational carrier will be examined for the risk of any sexually transmitted infections (STIs) that could be passed along to the child including HIV, gonorrhea, cytomegalovirus (CMV), syphilis, hepatitis and chlamydia. In addition, the surrogate will need to discuss her comprehensive medical history with a doctor and undergo a physical exam to make sure she can safely carry a pregnancy.

It is recommended that a surrogate undergo a mental health interview with a psychologist or counselor. The interview should detail the process of surrogacy including how to manage interactions with her children, her partner, her employer and the recipient couple, as well as detail the associated risks of the procedure(s).

Screening intended parents

The couple having a child through surrogacy should follow a similar process including completing a medical history and physical exam to determine their health and ability to participate in IVF procedures. They should also be screened for genetic disorders related to their ethnicity, such as sickle cell anemia in African Americans.

The Food & Drug Administration (FDA) requires that the intended parents of the child carried by the surrogate be screened for disease that can be passed on within seven days of sperm collection and 30 days of egg retrieval. In some instances, the embryo may be frozen and quarantined for 180 days to retest the recipient couple.

A session with a psychologist or counselor is also recommended for the recipient parents. The mental health professional will evaluate the recipient parents for untreated or unresolved mental illnesses, abuse or addiction issues.

It is also important that the session cover the intended parents’ anticipations, particularly regarding their relationship with the surrogate and her family, plans to inform the child of the use of a gestational carrier at a later time, and plans for continuing (or not continuing) the relationship with the gestational carrier after the child is born.

Surrogacy legal considerations

Every state’s laws on gestational carriers are different so it’s important that both the gestational carrier and the recipient parents are represented by legal professionals experienced in third-party reproduction issues.

These professionals should ideally practice within the state where both parties live and where the baby will be delivered, as well as in the state where the surrogate plans on attending regular prenatal visits with an OB-GYN or midwife. There are many elements the legal contract between the two parties should consider, including how regularly the fetus will be tested, a plan in the event that there are any irregular test results during the pregnancy, and details of the birth plan.