Definition & Overview

A gestational carrier, more commonly known as a surrogate, is a woman who carries and delivers a baby for someone else under an agreement. The individuals who will receive the baby after birth is called the “intended parents” and will be involved every step of the way from pregnancy to childbirth.

The term “gestational surrogate” is used to refer to women who become pregnant after a successful assisted reproduction procedure, more commonly an in vitro fertilization (IVF) procedure. This is to distinguish them from women who are called “traditional surrogates” who are artificially inseminated with the sperm of either the intended father or a sperm donor. While a traditional surrogate is considered as the biological mother of the baby, a gestational surrogate is not biologically related to the baby she carries aside from being the “birth mother”. The biological mother is still the woman from whom the fertilized egg was harvested. In recent years, gestational surrogacy has become the more ideal arrangement because of the genetic ties between the intended parents to the baby.

Who Should Undergo & Expected Results

Gestational surrogacy is now very common; especially as in vitro fertilization technology further improves. Every year, about 750 babies are born through this method.

Women who choose to use a gestational surrogate are those who:

  • Have medical problems with their uterus
  • Have had their uterus removed through a hysterectomy as a form of therapy for a disease
  • Have severe heart disease or lung problem that makes it dangerous for them to become pregnant or to give birth
  • May have tried and failed to get pregnant through IVF techniques
  • Are unable to adopt a child due to their age, marital status, or sexual orientation

The surrogate, on the other hand, can be a friend, family member, or a gestational surrogate hired through a surrogacy agency. Each type of arrangement has unique challenges. According to the American Society for Reproductive Medicine, surrogacy using first-degree family members or relatives is discouraged since the child will carry the same genes as if he/she was born of incest. While having a friend or family member become the surrogate may be less costly and less complex in legal terms, it has its own complications. Thus, many people choose to hire through a surrogacy agency, where intended parents can go for help to find a suitable surrogate. The agency arranges the agreement, collects and passes on fees, and deals directly with the surrogate to avoid personal conflicts between the two parties.

Hiring a gestational carrier can also be expensive. Costs are influenced by several factors but generally include:

  • Agency fee
  • Gestational carrier compensation
  • Health insurance
  • Non-medical expenses
  • Legal fees
  • Counseling fees
  • In vitro fertilization process

Surrogacy can be expensive not just financially as it also requires emotional and psychological investments. Thus, intended parents are advised to consider it carefully before making any decisions.

How Does the Procedure Work?

The intended parents can initiate the gestational surrogacy process by seeking fertility counseling to fully evaluate the pros and cons of using a gestational carrier. Once they are fully decided on the issue, the next step is to find a surrogate. Surrogates have to meet the following specific criteria:

  • She should be least 21 years old. (Her age will have an effect on the likelihood of successful pregnancy.)
  • She must have previously given birth to at least one healthy baby and is familiar with the medical and emotional effects of pregnancy and childbirth.
  • Her family should be supportive or consensual regarding the issue.
  • She must be healthy both physically and emotionally.

All parties then undergo separate screenings, but surrogates are screened both psychologically and physically. A written contract will then be prepared to outline all aspects of the arrangement. The contract must cover:

  • Individual roles and responsibilities of each party
  • Actions to ensure that the baby receives good prenatal care
  • Parental rights and legal custody of the child
  • Compensation for the surrogate
  • Location of delivery
  • Future contact between the two parties
  • Medical bills during the whole process
  • The gestational carrier’s insurance coverage from pregnancy until birth
  • All possible outcomes, such as the unexpected birth of twins or triplets

Once a suitable surrogate has been found and the arrangement has been sealed through a binding legal contract, the in vitro fertilization process will be initiated. This begins by syncing the cycles of the gestational surrogate and the intended mother using medications; this is to ensure that the gestational carrier’s uterus is able to support an embryo when the eggs are retrieved and fertilized from the intended mother. Once in sync with the surrogate, the intended mother will take medications to encourage the production of multiple eggs. When the eggs are ready for fertilization, they will be retrieved through a minor operation; at the same time, the intended father will produce a sperm sample. The eggs and sperm are then fertilized in a lab dish. Once fertilization is successful, the embryos will be transferred to the gestational carrier’s uterus.

Possible Complications and Risks

Emotional aspect. The whole surrogacy process can be long and complex; intended parents must understand, prior to initiating the process, what they can expect from the procedure. Sometimes, it takes couples months or even years to find a surrogate they will feel comfortable working with. And not all IVF cycles lead to successful pregnancies, so they may have to go through the same process three to four times. This may take up to several months since each IVF cycle takes at least four to six weeks.

Success rates. Successful pregnancy is not guaranteed, especially if the intended mother’s eggs will be used. This is because the mother’s chances of producing high-quality eggs will depend on her age.

Side effects. Fertility medications used during the process will have some side effects for the intended mother and the gestational carrier. The surrogate will also experience all the side effects that go with a normal pregnancy.

Legal complications. There is a long list of factors that can get in the way of a successful surrogacy. There is a possibility that the surrogate will back out and decide not to carry the baby, or that she might change her mind at the last minute and decide not to give the baby up.

Parental rights. Possibly the biggest complication in using a gestational surrogate is the legal aspect, which is complicated by the fact that state laws in different locations tend to vary on this issue. In some places, the intended parents are still required to pass adoption proceedings in order to be granted legal custody, whereas in other locations, a simple procedure called “declaration of parentage” can be undertaken prior to birth so that an adoption process is no longer necessary. It is important for birth parents to understand the whole surrogacy process and laws in the place they live in, so they can protect their rights to being the legal parents.

Medical and health concerns. Prior to the procedure, a gestational surrogate will first undergo a psychological screening to make sure she will not have any problems giving the baby up after birth, as well as a medical screening to check for the risks of certain health problems.

References:

  • American Society for Reproductive Medicine: "Third Party Reproduction."
  • The Ethics Committee. Fertility and Sterility, November 2003; vol 80: pp 1124-1130.
  • The National Infertility Association: "Surrogacy," "Myths about Surrogates."
  • Sreenivas, K. and Campo-Engelstein, L. Cancer Treatment and Research, 2010; vol 156: pp 135-152. Saul, S. The New York Times, Dec. 13, 2009.
  • American College of Obstetricians and Gynecologists: "ACOG Committee Opinion, February 2008: 'Surrogate Motherhood.'"
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