Fertility doctors are pretty popular at cocktail parties (or so I hear since I really don’t get out much). Between OctoMom and the latest Hollywood star announcing that they are pregnant with twins using a surrogate, there is always some interesting aspect of reproductive gymnastics to be discussed.
In the past month I have discussed the use of a gestational carrier with a wide range of patients. Some have had previous uterine surgery that has made pregnancy problematic. Another has a history of severe medical problems that make her a risk for pregnancy and yet she and her husband do not want to consider adoption. Finally, another patient has experienced multiple unexplained pregnancy losses in the mid-trimester. All of these are valid reasons to consider this alternative pathway to family-building.
When a couple chooses to use a gestational carrier I ask them to arrange for me to interview her as one of the first steps. A few years ago, a couple found a gestational carrier through an agency and asked me to meet her. She lived in the Mid-West so I asked her to fax me a patient questionnaire. She never did (first red flag). One afternoon she appeared in person for an appointment. I asked her about her previous pregnancies. She looked away but said that everything ended up fine by the end (second red flag). Upon further discussion, it turned out that she was incredibly sick every pregnancy with hyperemesis (killer morning sickness) and required multiple hospital admissions and even intravenous feedings at home! Yikes! She didn’t (or wouldn’t) understand that the risk to her was real in terms of pregnancy complications and that the cost of any hospital admissions may be the responsibility of my patients. She called me several times that day on the way back to the airport but I remained steadfast that she should not be a gestational carrier.
So here is one of the few remaining questions from our book 100 Questions and Answers about Infertility…
85. What is a gestational carrier, and when should you consider using one?
Fertility doctors sometimes recommend the use of a third- party gestational carrier if the infertile couple wants to have their own biological child. Many medical conditions necessitate the use of a gestational carrier, including the absence of a uterus in the would-be mother, either because of a congenital (at birth) condition or when a disease necessitated its surgical removal. A gestational carrier may also be the best option when a woman has a systemic disease that may affect either her own or her baby’s health, such as advanced heart disease, severe diabetes, or multiple sclerosis. Likewise, a woman with a history of poor pregnancy outcome—including repetitive pregnancy losses, preterm labor, incompetent cervix, or severe preeclampsia—may be a good candidate for IVF using a gestational carrier.
Prior to the IVF treatment, thorough screening of the gestational carrier is routinely performed using ASRM guidelines. Gestational carriers are usually well known to the couple and may be relatives or friends. In addition, agencies exist that introduce gestational carriers to prospective patients. In such arrangements, the gestational carrier is usually compensated for her time and energy (especially if the pregnancy proves successful).
When using a gestational carrier, IVF is performed by combining the infertile couple’s sperm and eggs to produce their own genetic embryos. However, unlike in standard IVF, these embryos are then transferred into the uterus of the gestational carrier. This process resembles donor-egg IVF in that the process requires synchronization of two patients: the egg donor (genetic parent) and the recipient (gestational carrier). Pregnancy proceeds normally just as if the gestational carrier had become spontaneously pregnant. The major factor in determining the success rate is the age of the woman whose eggs are donated. The ideal gestational carrier is a woman who has had a previous uncomplicated pregnancy and delivery.