The use of a gestational surrogate (carrier) is useful for situations where a woman is unable to carry a pregnancy herself.
Examples of this would be in situations where her uterus is severely damaged or absent, where she is medically unable to carry a pregnancy for some reason or where it has proven difficult to get the lining of the uterus to respond to hormonal stimulation.
We work with a number of agencies that recruit and screen potential gestational surrogates and follow the treatment of the surrogate from start to delivery. Ideally, the gestational surrogates have been pregnant in the past without complication, are in good health and are under the age of 40. The screening process begins with a detailed examination of the potential surrogate’s medical history and all of the pregnancies that she has had. This is followed by a thorough physical examination and a procedure to visualize the interior of her uterus such as a hysteroscopy.
A panel of infectious disease testing (including sexually transmitted diseases) is then performed along with some basic hormone screening tests for thyroid disease and prolactin and an illegal drug screening panel. Then the potential surrogate has a psychological evaluation. Once all of the testing has been completed, the surrogate is made available for selection by the intended parents.
There is a considerable legal component associated with gestational surrogacy and the agencies coordinate this as well. A comprehensive contract between the intended parents and the surrogate is drawn up. If the surrogate is to deliver the baby in the state of California then the attorney will submit documents so that the intended parent’s names will be on the birth certificate. In some states, the surrogate’s name is placed on the birth certificate and the intended parents have to adopt the baby after birth.
Once the treatment cycle has been initiated, a representative from the agency will accompany the surrogate to all of her doctor appointments and is available for assistance during the entire process. The first step in treatment is to coordinate the menstrual cycle of the surrogate with that of the women from whom the eggs are coming from, either the intended mother or an egg donor. This is easily accomplished within about two weeks. Then the gestational surrogate is given medication to cause the lining of her uterus to develop as it would in an ideal natural cycle. Once the eggs have been fertilized, the surrogate has one or two embryos transferred into her uterus when they are five days old. She is then placed on restricted physical activity for one week and the pregnancy test is performed 10 days after the embryo transfer.
We have been working with gestational surrogates for over 20 years and have had tremendous success during that time. When used in conjunction with egg donors, the pregnancy rate has been greater than 90%. When the intended mother’s eggs are used, we have had success that is comparable to the IVF pregnancy rates for women of the same age.