When it comes to becoming a parent, the process can certainly be rife with challenges for many people. However, for most obstacles to building your family, there are solutions that can help. 

For many couples, difficulty conceiving a child naturally can lead down a path where you have to consider starting your family using a gestational carrier or “surrogate”.

Q: What’s the difference between a gestational carrier and a surrogate? 

A: While many people may be more familiar with the term “surrogate,” there are key differences between the two. Technically speaking, a “true” surrogate is someone who chooses to become pregnant and carry a pregnancy for an intended couple by being inseminated with the intended parent’s sperm in order to fertilize their own egg (not the egg of the intended parent). This process results in the surrogate being the biological parent of the baby that is delivered and is considered illegal in most states and no longer offered as an option.  However, most people still colloquially call their gestational carrier their “surrogate”.

A gestational carrier has no blood or DNA relation with the child she carries and delivers. This is accomplished through in vitro fertilization (or IVF), which involves gathering the eggs and sperm of the intended parents, combining them in the laboratory thus creating embryos, and then transferring one or two of the resulting best quality embryos into the carrier. When necessary, embryos can also be created using donor eggs or donor sperm as well.

Q: Who may need to consider a gestational carrier? 

A: There are many reasons for someone to need to use a gestational carrier. Some of the most common reasons include :

  • Women who have had a hysterectomy (for any reason)
  • Women whose medical conditions make it unsafe or life-threatening for her to get pregnant
  • Couples where one partner does not have a uterus
  • Congenital or other abnormalities of the intended parent’s uterus that make carrying a pregnancy to term problematic or impossible

Q: What is the process like when utilizing a gestational carrier?

A: Often, a couple has a friend or family member who offers to carry their baby for them. Other times, they use a professional gestational carrier they found online or through an agency. In either circumstance, there are details and legal issues that need to be worked out. Contracts and payment agreements are chief among the important details. Because of the complexity involved, many intended parents choose to work with an agency to help guide them through the entire process, including finding the best match for them on their parenting journey. This is obviously more expensive than having someone you know carry for you. 

Once a potential carrier is identified, she needs to undergo health screening to make sure she is a suitable candidate for pregnancy. This will involve physical exams, blood tests, and procedures to make sure her uterus is normal. Partners of the gestational carriers also need to be screened for infectious diseases. A psychological evaluation is also performed, often with both the GC and the intended parents together to discuss the upcoming pregnancy. 

To create the embryos, the woman undergoes stimulation of her ovaries that takes about two weeks and then a short procedure to harvest the eggs. Other times, the eggs have been collected from an egg donor using the same process. They are then fertilized in the laboratory with sperm. Over the course of 5-6 days, the embryos that are created are cared for and observed. Many of the embryos that start out don’t continue to develop. The embryos that do continue to develop are then available for what is called an “embryo transfer”. Sometimes the embryos are frozen (“cryopreserved”) prior to transfer, for example when the couple creates the embryos before they have found a gestational carrier or before they know they need to use one. 

The gestational carrier also undergoes a process to prepare her uterus for implantation. There are many different ways this can be accomplished. There are protocols that don’t involve many medications (“natural” cycles). However, most of the time, the GC will need to be first on a form of estrogen (patches, pills, vaginal pills, injections) followed by progesterone (injections, vaginal creams or pills). The transfer of the embryos to the uterus would not feel much different than a pap smear. The big decision is how many embryos to transfer. Most of the time, it is recommended to only transfer one embryo to minimize the risks of getting pregnant with multiples. These protocols typically give really good pregnancy rates. Once pregnant, the gestational carrier would be treated just as anyone else who got pregnant without assistance. The intended parents will then have full legal custody once the child is born.

Q: How much does a gestational carrier typically cost?

A: The price of utilizing a gestational carrier will vary widely based on the situation and from person to person, and agency to agency. If your family member or friend carries the pregnancy, the main costs will be the cost of the IVF to create the embryos. You would of course decide how to compensate them.  If you need to use a professional gestational carrier, you can expect to pay anywhere from $50,000 – $150,000. This typically includes an agency’s fees, the carrier’s fee, the cost of IVF, counseling, support, medical fees, etc. There are a number of different potential costs that should be thoroughly weighed before actually entering into a contract with a carrier or agency.

Q: Who can become a gestational carrier?

A: Most agencies or clinics have their own guidelines for who would be a good candidate to become a gestational carrier. While these can vary, some of the requirements often include:

  • Being generally healthy
  • A healthy BMI
  • Being between the age of 21 and 40
  • No past major pregnancy complications
  • Not currently taking antidepressants or antianxiety medications
  • No prior drug or alcohol abuse
  • Having been successfully pregnant before is not an absolute requirement but is preferred

Q: What rights does a gestational carrier have? 

A: In short, typically, no parental rights whatsoever. While every gestational carrier-intended parent relationship is individually assessed and has its own individual contract, this is something that’s ensured from the very start. Many times, even professional gestational carriers and the new parents maintain contact after she has delivered since she has been such an important part of their lives. Other times, there is no contact with the GC after delivery.

Summary:

If you are considering using or for sure need to use a gestational carrier, you’re bound to have a number of questions and concerns. The good news is that using a gestational carrier is not unusual or rare. It is something that fertility clinics should be very prepared for and able to help you with. Agencies can also be a great resource and help you navigate the process.  Remember to do your research, read reviews, and look for agencies that have impeccable recommendations. Use a fertility clinic that handles gestational carrier situations frequently.  Not only will this help you to have the smoothest experience possible, but it will also ensure that your path to becoming a parent starts off in the best way possible. 

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