Using a Gestational Carrier (Surrogate)

Using a gestational carrier (surrogate) at a glance

  • A gestational carrier (GC) is a form of surrogacy in which a woman becomes pregnant using an embryo created through in vitro fertilization (IVF) by a couple or individual who are unable to carry a pregnancy or carry a pregnancy safely to term.
  • Intended parents use their own sperm and eggs (or donated sperm and eggs) to create an embryo that is transferred to the GC’s uterus. The resulting child is genetically related to the intended parents (or donors) and is not genetically related to the gestational carrier.
  • Legal documents will be signed in advance identifying the intended parent(s) as the legal parents of the child.
  • A GC is an option for a woman who has a medical condition prohibiting her from carrying a pregnancy or fertility issues such as a uterine abnormality, recurrent miscarriage or previously failed IVF.
  • A GC, as well as an egg donor, is also used to assist single men or gay male couples wanting to build a family.
  • According to the American Society for Reproductive Medicine (ASRM), an ideal gestational carrier is a healthy woman, 21-45 years old, who has already had a successful, uneventful pregnancy and has gone through extensive medical tests, including evaluation of the uterus and her general health.

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What is a gestational carrier?

In fertility treatment, using a gestational carrier or (surrogate) is an option for individuals or couples who are unable to carry a pregnancy to term, including single male patients or gay couples.

A GC is a woman who enters into a legal agreement to have an embryo(s) created through IVF transferred into her uterus, and to carry and deliver the resulting child(ren) on behalf of the couple or individual who cannot carry a pregnancy – known as the intended parent(s).

In this arrangement, the GC is not genetically related to the resulting child(ren). Intended parents who need a gestational carrier can use their own sperm and eggs in IVF or use a donated egg, sperm or embryos.

Gestational carrier surrogate vs. traditional surrogate

In the United States, gestational carriers (who don’t use their own eggs) are the preferred option as opposed to traditional surrogacy (in which the woman uses her own eggs), since the legal arrangements are more straightforward.

Traditional surrogacy is a legal arrangement in which a woman will be inseminated with sperm from the intended parent to attempt to become pregnant on behalf of the intended parent(s). The surrogate’s own egg(s) are fertilized, and therefore the surrogate is biologically and genetically related to the baby she carries.

According to ASRM, this type of surrogacy carries a higher legal risk due to the potential for conflict over the nature of binding agreements signed prior to the surrogacy process or at birth, since the surrogate is genetically involved.

Psychological & legal counseling

Fertility Specialists Medical Group requires that in any gestational carrier arrangement, the intended parent(s) and the GC seek counseling from a mental health professional familiar with the complex psychological and emotional issues related to a gestational carrier arrangement.

We also require legal counsel for both parties before the medical process begins to ensure all parties are in agreement regarding parenting rights and compensation.

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Benefits of using a gestational carrier surrogate

  • A GC allows those who would otherwise be unable to carry a pregnancy to have (potentially) biological children and experience parenthood from the earliest stages.
  • In most cases, using a gestational carrier allows one or both parents to be biologically/genetically related to their child.
  • Often when using a gestational carrier, the intended parents are able to be involved and present during prenatal visits, ultrasounds and at the delivery.

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Who needs to use a GC?

Many factors come into play when deciding to use a GC. Women who are unable to safely carry a pregnancy to term may opt to use a gestational carrier, often due to conditions such as:

  • Congenital anomalies of the uterus
  • Having experienced recurrent miscarriage
  • Uterine fibroids
  • Severe Asherman’s syndrome (intra-uterine adhesions)
  • After hysterectomy, such as for uterine/cervical cancer
  • Other medical condition(s) that make pregnancy dangerous for the mother or baby

Other candidates for using a gestational carrier include:

  • LGBTQIA couples or individuals who do not have a uterus to achieve pregnancy, such as a gay male couple or transgender woman
  • Single men
  • Women of advanced maternal age who carry high obstetric risks
  • Those who have experienced several unsuccessful cycles of IVF due to likely uterine factor or other circumstances

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Gestational carrier sitting on bed | Fertility Specialists Medical Group | San Diego, CA

Finding a GC surrogate

The gestational carrier is compensated for the risk she assumes and the service she provides by carrying a pregnancy.

Some patients choose to have a friend or family member be their GC, which can reduce costs significantly. Our doctors can screen and test friends or family members who consider being gestational carriers.

Gestational carrier agencies around the country offer programs for intended parents to meet potential GCs. Agencies typically recruit, screen (basic) and legally represent all potential GC candidates.

Steps to a gestational carrier pregnancy

  • Each GC agency program is typically directed by a licensed social worker and represented by legal counsel.
  • Once a potential gestational carrier completes an extensive application, she is briefly screened for any significant medical contraindications to be a GC. She is also evaluated by a licensed psychologist for evaluation before being admitted into a program.
  • Intended parents must also complete an application, and once invited into a program, they are matched with a potential GC.
  • Both the GC and intended parents must have a legal agreement before treatment can begin.
  • The potential GC is evaluated here at Fertility Specialists Medical Group for medical clearance and, if appropriate, can then proceed with embryo transfer.

Gestational carrier agencies in San Diego County

There are a number of agencies in the San Diego area. Please click on the links below to learn more about each agency. Other agencies can be found via the internet.

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Risks & considerations of using a gestational carrier

Both the intended parents and the gestational carrier undergo physical examinations to make sure they are healthy enough for their respective procedures.

  • If an intended parent is using her own eggs, she must undergo IVF up to the point of embryo transfer, which carries minimal surgical risk.
  • During the egg retrieval process there is a minimal risk of damage to the bladder or bowel, internal bleeding or infection.
  • The risks posed to the gestational carriers are the same for a woman undergoing pregnancy. This includes increased risks to the GC if more than one embryo is transferred and results in twins.

Single embryo transfer: avoiding the risk of multiples

According to the Centers for Disease Control and Prevention (CDC), gestational carriers have a higher rate of multiple birth (twins or more) and preterm labor when compared with non-gestational carrier pregnancies. This is largely due to transferring more than one embryo per IVF cycle.

For the safety and health of both the woman and resulting child(ren), the physicians at Fertility Specialists Medical Group recommend transferring only one embryo when possible for all IVF cycles (including for gestational carriers), which is known as elective single embryo transfer (eSET).

Legal, emotional & financial concerns of surrogacy

Partnering with a gestational carrier involves considerable legal issues and potential risks. Those wishing to have a child using a gestational carrier should seek advice from lawyers who are experienced in third-party reproduction.

Traditional surrogacy carries even more of a legal risk than using a gestational carrier because the surrogate is genetically related to the child. Many states have outlawed the use of traditional surrogates. While traditional surrogacy is still legal in the state of California, due to the legal complexity, gestational carriers are still preferred, and used exclusively at FSMG.

Using a gestational carrier can be emotionally and psychologically challenging for both the intended parents and the woman carrying their child(ren). Counseling by professionals who are experienced in providing support can be very beneficial.

While not a medical risk, the cost of using a gestational carrier can be daunting for some. We recommend patients talk to our financial counselors if they are considering using a gestational carrier.

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