Gestational Surrogacy 101: Medical Aspects for Intended Parents
Gestational surrogacy is an option for women who cannot carry a pregnancy and for the LGBTQ+ community, including gay men or couples, who want to create a family. Women may not be able to carry a pregnancy due to lack of a uterus, either from birth or a prior surgical procedure. Even women who have their own uterus may not be good candidates for pregnancy due to a severe chronic condition, such as chronic kidney disease, pulmonary hypertension, or severe heart disease. And some women may be on medications that, due to their teratogenic nature, are not compatible with pregnancy or may harm the fetus.
Since gestational surrogacy was legalized in New York State in February 2021, it is expected that there will be a surge in requests for these services. The aim of this blog is to explain the medical procedures that the intended parents have to undergo in order to establish a safe and successful pregnancy.
Intended parents, the intended mother and father (or the egg or sperm donor in case the gamete source(s) is not the intended parent) undergo screening that includes a medical history and physical examination with special attention to tattoos, piercings, and genital lesions, if any. They are also evaluated by a clinical psychologist who specializes in third party reproduction. Next, the intended mother or the egg donor undergoes blood tests and ultrasound to determine the quantity of the eggs remaining in the ovaries. Both the intended mother (or the egg donor) and the intended father (or the sperm donor) are advised to undergo genetic testing to determine whether they are carrier for any genetic disease that they may transmit to their offspring. Both gamete donors are also tested for infectious diseases like HIV, Hepatitis B and C, Syphilis, Chlamydia, Gonorrhea, and, in the case of the intended father (or sperm donor), HTLV 1 and 2 and Cytomegalovirus. The intended father (or the sperm donor) also undergoes a semen analysis to ensure normal shape and amount of swimming sperm in the semen. Other testing may be performed based on the findings from the history or physical examination and at the discretion of the treating physician.
Once screening and testing are completed, then the intended mother (or the egg donor) undergoes a treatment that is called controlled ovarian hyperstimulation followed by in vitro fertilization (IVF). During this treatment, the intended mother (or egg donor) takes injectable medications for ten or so days in order to grow many eggs in the ovaries. Once the eggs reach the mature stage, they are taken out of the body with a procedure called “Egg Retrieval”, which is performed under anesthesia so the woman does not feel discomfort. The same day, the eggs are fertilized with the sperm in the IVF laboratory. The next day, the eggs are examined under the microscope to determine whether fertilization has occurred. The embryos are reanalyzed over the next several days to determine whether they have reached the “blastocyst” or “blast” stage. Once at the blastocyst stage, an embryo can either be transferred to the uterus of the gestational surrogate or it can be biopsied to find out whether it has a normal genetic (chromosomal) complement. In this case, the embryos are frozen after the biopsy and once the biopsy results are available, the healthy embryo is transferred to the uterus of the gestational surrogate.
This journey can be a complicated one, but one that commonly results in an extremely rewarding outcome. Here at Reproductive Medicine Associates of New York, we are licensed by the FDA and NY State to help intended parents to achieve their dream of a family in the safest and most successful manner.