An Alternative Approach to Parenthood

Is a Gestational Carrier Right for You?

A gestational carrier (GC), also called a gestational surrogate, is a woman who carries and delivers a child for another couple or person (intended parent[s]). When using a GC, the eggs used to make the embryos do not come from the carrier. Because the eggs will be retrieved from one woman and implanted in another, this technique requires the use of in vitro fertilization (IVF). IVF is when eggs are fertilized in the laboratory and a limited number of resulting embryo(s) are transferred into the uterus of the gestational carrier. 

A Big Decision
Deciding to use any kind of third party reproduction, such as surrogate parenting, is a big decision. Making a decision like this can be an overwhelming process. Often, couples say they don’t know how to begin the decision making process.

·      Where do we find a surrogate?

·      Where do we get information about the legal aspect of surrogate parenting?

·      What do we need to know about the medical part of the process?

·      How do we handle the emotional aspects?

In this general overview, all of these topics will be discussed. Additionally, it is always recommended that you seek individualized answers to questions from your physician, a therapist specializing in infertility, and an attorney with experience in third party reproduction issues. 

A Brief History
If you are looking into surrogate parenting you may feel very alone. Chances are you don’t personally know anyone who has utilized a surrogate carrier. Although various types of surrogate parenting have been around since biblical times, surrogate parenting became a more viable option for couples as IVF progressed. Since approximately 1985, several thousand couples have created their families via the use of a gestational surrogate.

Two Types of Surrogate
When we use the term “surrogate,” what are we really talking about? There are two kinds of surrogates: traditional surrogates and gestational carriers. There are different legal and medical ramifications for each types, thus you should be very clear about your particular needs, and the special circumstances associated with both types. 

Due to various legal and emotional aspects of traditional surrogacy, at CT Fertility we only work with gestational surrogates. Therefore, with the exception of a brief definition, the remainder of this overview will focus primarily on gestational surrogacy.

Traditional Surrogate
In traditional surrogacy, the surrogate mother is inseminated with the sperm of the intended father or sperm donor. The surrogate’s own egg is used, thus she is the genetic mother of the resulting child. This form of surrogacy is sometimes used when the intended mother is in need of donor eggs, or when the intended couple cannot afford in vitro fertilization, and wants to utilize a less expensive option such as intra uterine insemination. This type of surrogacy can require the parents to legally adopt the child following birth.

Gestational Surrogate
In gestational surrogacy, the surrogate (or gestational carrier, or GC) carries a child conceived of the egg and sperm of two other individuals. Specifically, the sperm of the intended father or a sperm donor, as well as the egg from the intended mom or an egg donor are fertilized and transferred, via IVF, into the gestational carrier. Typically, depending on the location, intended mothers are able to have their name on their child’s birth certificate, without having to adopt their child.

A gestational carrier (surrogate) is used when an intended parent wants to have a child and either does not have a uterus or has a medical condition that would prevent carrying a pregnancy safely. Also, a GC may be considered for women who have a history that suggests a problem with her uterus such as recurrent miscarriage or IVF failure or when a female partner is absent (single male or gay couple).

Who can be a gestational carrier?
The ideal GC is a healthy woman between the ages of 21 and 45 who has had a successful term pregnancy and has a supportive family environment to help her cope with the added stress of pregnancy. The carrier should have no more than five previous vaginal deliveries or two previous cesarean deliveries. Prior to becoming pregnant, the GC should talk about the risks of pregnancy with her healthcare provider.

What type of medical tests does a gestational carrier need to undergo?
The GC should have a complete history and physical examination performed to ensure that there are no reasons for her to avoid pregnancy. This examination also will identify patients at risk for sexually transmitted diseases. The American Society for Reproductive Medicine (ASRM) recommends that all carriers be tested for viral infections, including HIV, hepatitis, gonorrhea, chlamydia, syphilis, and cytomegalovirus.  

Does the gestational carrier have to undergo psychological testing?
A GC and her partner (if appropriate) should have a clinical interview with a mental health professional. This and subsequent interviews will cover the potential psychological risks associated with the process, including managing relationships with her partner, her children, her employer, and the intended parents. Psychological testing may be performed at the discretion of the counselor. 

Are the intended parents screened for sexually transmitted diseases?
The intended parents are screened for infectious diseases that can be passed to the carrier. This screening is done by questionnaires, physical examination, and blood tests. Testing is required by the Food and Drug Administration (FDA) within 30 days of the egg retrieval and within seven days of the sperm collection. While these tests do not eliminate the risk of transmission, they greatly minimize them.

Should the intended parents have a psychological evaluation?
As for the GC, counseling with a mental health professional is recommended for the intended parents. The counselor should evaluate the couple for any unresolved or untreated addiction, abuse, or mental illness. The evaluation also should include an exploration of the couple’s expectations and relationship with the carrier and her family, plans for any relationship with the carrier after delivery, and plans to disclose the use of a carrier to the child that is born.

What are the legal implications of using a gestational carrier?
The laws regarding GCs vary for each state in the United States. It is recommended that the GC and the intended parents have independent representation by lawyers experienced with GC contracts in the states where the parties live, intend to receive obstetrical care, and intend to deliver. The contract may address issues regarding the number of embryos to be transferred, testing of the fetus during pregnancy, and contingency plans for abnormal test results. Of course, these decisions should be made after appropriate counseling with the infertility specialist and/or obstetrician. 

Are gestational carriers compensated?
A GC is generally compensated for the time and effort involved in fulfilling this role. Compensation to the GC should be agreed upon before any treatment begins. The amount of compensation can be prorated based on the procedures performed. The compensation agreement should be documented in the contract between the carrier and the intended parents. 

Get more information on whether or not a gestational carrier is the best option for growing your family. Call 1 203.373.1200 or 1 855.CFABABY (Toll Free) to schedule an appointment with us. We look forward to hearing from you.