Gestational Carriers & Surrogacy

Gestational Carriers Also Known as Gestational Surrogates Carry Children for Women with Damaged or Absent Uterus

Women who have normally functioning ovaries but who cannot carry a pregnancy can consider the use of a gestational carrier.  This can include patients who were born without a uterus or who have had a hysterectomy, patients who have a misshapen uterus and resulting infertility or repeat pregnancy loss, or patients who have a medical contraindication to pregnancy (e.g. severe heart disease, severe diabetes mellitus, breast cancer, etc.)

A gestational carrier is a woman who has an embryo derived from the sperm and oocyte from another couple (the intended parents) transferwho red into her uterus.  A donated egg and/or donated sperm may also be used in conjunction with a gestational carrier in the event that the female partner cannot produce her own eggs or the male partner cannot produce sperm.

Some people tend to confuse the term “gestational carrier” and “surrogate.”

A true surrogate is a woman who not only carries the pregnancy for a couple but uses her own egg as the genetic material.  In these cases the fetus is genetically linked to the surrogate.  True surrogacy is not legally permitted in the state of Texas.

A couple may choose to use a known gestational carrier (typically a relative or friend) or an anonymous gestational carrier from an agency that specializes in recruiting such women.  The gestational carrier should be at least 21 years old and have previously delivered a live born child at term.  Gestational carriers who are older have a higher chance of obstetric complications (e.g. high blood pressure, diabetes, need for c-section, etc.) and should be carefully evaluated before being considered.

A comprehensive evaluation of the intended parents and the gestational carrier needs to be performed before proceeding with fertility treatment.  The intended parents need to have a complete medical history performed, and the female partner will also need a physical examination and ultrasound.  The gestational carrier will also need a complete medical history, ultrasound, and evaluation of her uterine cavity.  All parties involved will also need to do blood work, including infectious disease screening.

Pre-treatment counseling is required for both the gestational carrier and the intended parents.

Counseling for the gestational carrier is performed so that she has a clear understanding of the psychological issues related to the process of gestational carriage, including managing a relationship with the expectant parents, coping with attachment issues to the pregnancy, and dealing with the impact of the gestational carriage on her own personal and professional life.  Counseling for the expectant parents can be helpful to structure and manage their respectful relationship with the gestational carrier.  In addition, it is important to discuss as a team the expectations for pregnancy, including a discussion on embryo transfer number, potentially invasive prenatal testing, fetal reduction, etc.

Legal counseling is critical to the gestational carriage process.  It is important to define the obligations and rights of all parties involved.  Contracts can be helpful to outline financial obligations of pregnancy care, expected behavior of the gestational carrier to optimize chances for a healthy pregnancy, anticipated prenatal testing, and agreements regarding fetal reduction or abortion in the case of multiple pregnancies or identification of a fetal anomaly.  It is critical that this counseling be done with an attorney who is knowledgeable about these issues and familiar with Texas laws.

To achieve pregnancy using a gestational carrier, in vitro fertilization (IVF) is required.  All the steps of a regular IVF treatment cycle are performed except the embryos are transferred into the gestational carrier.  Once pregnant, the gestational carrier carries the fetus throughout the pregnancy and delivers the child for the intended parents.  Despite the fact that she carries and delivers the baby, a gestational carrier has no genetic link to the fetus she is carrying.