Pregnancy requires three important components: a sperm, an egg and a uterus. When a woman does not have an ideal uterus for pregnancy (for reasons such as hysterectomy, fibroids that prohibit uterine growth with pregnancy, congenital abnormalities of the uterus and severe pelvic adhesions) or does not have the eggs and uterus for a successful pregnancy, she and her partner may turn to surrogacy or a gestational carrier.
Surrogacy is what many people recognize as “traditional” surrogacy. Traditional surrogacy relies on the surrogate (the woman carrying the pregnancy) to provide both the egg and the uterus. Typically, artificial insemination is used to fertilize the surrogate's eggs with the client husband's sperm. In some cases, natural insemination may be used.
As a result of this genetic pairing, the conceived child is biologically linked to the surrogate and the client husband. After the child is born, the client family will undergo an adoption process in order to make the client wife the legal mother of the child. A gestational carrier is used when the client family can provide their own sperm and egg (either their own or from a donor). The client wife's eggs (or donor eggs) are fertilized with the client husband's sperm (or donor sperm) through IVF and the resulting embryos are implanted into the surrogate, who is called the gestational carrier. Unlike a surrogate, the gestational carrier is not genetically related to the child she is hired to carry for the client couple.
It is important to note that utilizing a gestational carrier is more complicated and expensive than using a surrogate. Egg retrieval and IVF are necessary with gestational carriers but not necessarily with surrogates. Gestational carriers require hormone injections to prime and time the uterus so that it is ready when the eggs from the client wife (or egg donor) are harvested and fertilized.
Since both eggs and uterus are needed in a traditional surrogate, it is best to find a woman who is under the age of 30, in an established monogamous relationship, has children of her own and has a history of healthy pregnancies with vaginal deliveries. Some of these requirements are to ensure the healthiest pregnancy and delivery possible. A surrogate in a healthy stable relationship with children of her own is less likely to refuse to give the child to the client parents. A sister or close friend is a better choice for a surrogate if such a person is available.
Best candidates for gestational carriers are similar to that of traditional surrogates. However, the age of a gestational carrier is not as critical as a surrogate since there is no genetic contribution from the gestational carrier.
Both surrogate and gestational carrier should be screened for infectious or transmissible diseases and have a uterine cavity assessment done. Surrogates, who are using their own eggs, should also undergo ovarian reserve testing.
In addition to being an emotionally intense arrangement, traditional and gestational surrogacy is legally complex. Some states do not legally permit surrogacy arrangements and some laws apply only to gestational carriers and not surrogates. Seek legal counsel should you be unsure of the details and nuances of these arrangements. Where it is legal, hiring an attorney to establish the parental rights and responsibilities as early as possible would prevent legal controversy in the future, should it happen.
If you are wondering if surrogacy or a gestational carrier is right for you, spend time with a trained professional who knows and understands the medical implications and the emotional process that accompanies this important decision. ART sometimes involves an egg donor and/or sperm donor or previously frozen embryos. Donor eggs may be used if a woman has impaired ovaries or has a genetic disease that could be passed on to her baby. And if a woman does not have any eggs, or her eggs are not good enough quality to produce a pregnancy, she and her partner might want to consider employing a surrogate. A surrogate is a woman who agrees to become pregnant using the man's sperm and her own egg. The child will be genetically related to the surrogate and the male partner, but the surrogate will give the baby to the couple at birth.
A gestational carrier might be an option for a woman without a uterus due to hysterectomy, but who still has her ovaries. Other women who shouldn't become pregnant are those with serious health problems. Once the sperm fertilizes the woman's eggs, we place the resulting embryo inside the gestational carrier's uterus. In this case, the carrier will not be related to the baby and will give the baby to the parents at birth.
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