Gestational surrogacy, also known as third-party reproduction, uses the assistance of a surrogate to carry a pregnancy to term. A surrogate is a woman who is implanted with a fertilized egg using in vitro fertilization, or IVF, on behalf of another individual or couple. Unlike classic surrogacy where a surrogate is inseminated with the sperm from the male and her own egg is used, carrying the baby to term on the couple's behalf, the gestational surrogate has no genetic link to the child. In gestational surrogacy, an embryo may be produced entirely by the genetic parents, or from a combination of donated or genetic egg and sperm. The embryo is then placed into the uterus of the surrogate and carried to term. Gestational surrogacy is considered legally less risky than classic surrogacy and is the most common type of surrogacy chosen by couples or intended parents.
Reasons for Gestational Surrogacy
Gestational surrogacy is often considered by women who may have difficulty getting pregnant or carrying a pregnancy to term. This difficulty may be caused by the following conditions:
- A prior hysterectomy
- A history of infertility
- A history of pregnancy loss
- Medical problems of the uterus
- Advanced age
A number of other medical conditions that may cause problems with pregnancy and may also lead to the use of gestational surrogacy may include severe diabetes, heart problems, cancer or kidney disease.
The Gestational Surrogacy Process
The gestational surrogacy process is physically and emotionally complex process that should be carefully considered by all involved parties. Prior to the procedure, the surrogate and the intended parent(s) go through counseling to ensure a clear understanding of the legal, financial, psychological, physical, and ethical issues related to the pregnancy and the surrogacy process. There are several stages to the surrogacy process.
Selection of the Surrogate
Gestational surrogates may be relatives or friends, or they may not have met the couple before. The ideal candidates are highly committed women between ages 21 and 40 with proven fertility and at least one healthy child. Potential surrogates will undergo a complete screening of their overall medical and psychological health and are advised to seek legal counseling before the process. Potential surrogates should also receive a complete screening for infectious diseases, including HIV, syphilis, gonorrhea, and hepatitis B and C.
Evaluation of the Recipient Couple
The recipient couple will be screened for the IVF procedure. The female recipient will receive a pelvic exam and be evaluated for infertility issues and viability of pregnancy. The male partner's sperm will also receive a genetic screening.
Selection of Egg Donor
If necessary, an egg donor may be selected to provide the eggs to create multiple embryos. Donors and recipients may remain anonymous or they may choose to meet. If the intended parent(s) chooses to use an egg bank, they may be able to select eggs from donors based on a number of qualities, including physical appearance, medical history, ethnicity, and education. Donors will be screened extensively for diseases such as HIV, hepatitis B and C, gonorrhea, chlamydia and syphilis, and for cystic fibrosis.
Preparation of the Surrogate
To prepare the surrogate's uterus and the uterine lining for the embryo implantation, hormones are injected so her body is prepared and synchronized with the egg donor's reproductive cycle. Progesterone supplements are often used prior to the procedure to make the lining of the uterus more receptive to implantation
Egg Retrieval and Fertilization
After menstrual synchronization, the donor eggs are retrieved from the donor. The eggs are fertilized in the laboratory, using the IVF process, with the male partner or donor's sperm. The fertilized eggs will remain in the laboratory for a period of three to five days.
Surrogate Intrauterine Insemination
The successful embryos will be transferred into the surrogate's uterus using a catheter. One or more embryos are transferred to the surrogate using intrauterine insemination. The surrogate will likely continue to receive hormone treatments and testing until pregnancy is achieved. The surrogate carries the fetus to term if implantation is successful and pregnancy results. Any unused embryos may be frozen.
Considerations for Gestational Surrogacy
There are a number of issues which should be considered before choosing gestational surrogacy. The surrogate and recipient parent(s) should be advised of the health risks involved in the gestational surrogacy process. Risk factors for gestational surrogacy are similar to those of IVF procedures, which includes the rare occurrences of birth defects, multiple births, and ovarian hyperstimulation syndrome. Some of the factors that cause infertility may be genetic and passed on to the offspring as adults. Medical complications of medications used for ovulation induction are mild. Side effects of hormonal medications may include hot flashes, nausea, bloating, headache, and blurred vision.
The gestational surrogacy process can be physically, financially, and emotionally stressful. Many of the treatments associated with gestational surrogacy are costly and may not be covered by insurance. This can be a factor in the selection of fertility treatments. Gestational surrogacy may also include moral and legal issues which should be discussed by all involved parties. Ethical and legal concerns of IVF may also accompany gestational surrogacy.