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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 which 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.

Gestational Carriers

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.

Best Candidates

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.

Legal Considerations

In addition to being an emotionally intense arrangement, traditional and gestational surrogacy are 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 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.


“It is difficult to write reviews for fertility clinics since there is so much inherent bias in terms of whether or not one receives a positive outcome. My wife and I, both physicians, understand that online reviews are largely skewed in this regard and tend to focus on things like "customer service" and factors that are somewhat irrelevant to the quality of the medical care received. In our case, however, there is no choice but to give Dr. Acacio and his staff 5 stars.”

“If you want to be treated exceptionally well by helpful staff, a welcoming front office and a highly knowledgeable, caring and responsive clinical team, then look no further. Dr. Brian Acacio and his team helped us conceive and also made sure that we never felt alone in the process. It's an extremely dedicated group of people that genuinely help people fulfill their dream of parenthood.”

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