Gestational Surrogacy 101: Medical Aspects for the Surrogate
When intended parents are unable to carry a pregnancy, they often turn to gestational surrogates to help them fulfill their dreams of parenthood. Use of a gestational surrogate is indicated for women who lack their uterus for various reasons, who have severe chronic disease precluding pregnancy, or who are unable to conceive after multiple attempts of embryo transfers. It is also indicated for members of LGBTQ+ community, i.e., gay men or couples, transgender men, etc. Gestational surrogacy is a great option for these women, men or couples to create a family of their own. However, both gestational surrogates and their partners, if applicable, undergo certain screenings and tests in order to determine their eligibility to carry a pregnancy for the intended parents. In this blog, we will summarize the testing requirements for gestational surrogacy candidates.
The gestational surrogate and her partner, if applicable, present for a medical appointment in which a thorough history is taken, a physical examination is performed, and blood tests and an ultrasound are performed to ensure the safety of all participants. We will talk about the psychological evaluation in a different blog, entitled “Gestational Surrogacy 101: Psychological Aspects”.
Ideally, gestational surrogates would have delivered at least 1 baby but not more than 4; one of the most important aspect of the history for the gestational surrogate is their prior pregnancies, and deliveries, with special attention to mode of delivery and complications that may have occurred during pregnancy, delivery or after birth. The optimal candidate would be free of any chronic disease that may affect the pregnancy or that may be exacerbated by it. The surrogates are screened for risk of communicable diseases to identify those individuals who are at high risk for sexually transmitted or acquired infections that may be transmitted to the fetus. All surrogacy candidates undergo a full physical examination. Attention is given to findings that may indicate a sexually transmitted or any other chronic infection or disease; or signs that are associated with increased risk for these conditions: needle tracks that may suggest intravenous drug use; tattoos and piercings, especially those performed under nonsterile conditions, etc.
Following a full history and physical examination, both the gestational carrier and her partner are tested for infectious diseases like HIV, Hepatitis B and C, syphilis, gonorrhea, chlamydia, human T-lymphotropic virus, and cytomegalovirus. The surrogate is also tested for blood type and Rh status, in order to prevent Rh immunization and other complications that may arise from blood incompatibility. Screening for chicken pox, German measles, and illicit drugs is also performed. Other tests may be ordered as indicated and at the discretion of the treating physician.
Last but not least, the surrogate undergoes a transvaginal ultrasound examination in order to evaluate the uterus and the ovaries for the presence of abnormal findings like fibroids or cysts. Another ultrasound test called saline infusion sonography is also performed. In this test, the uterine cavity is filled with saline (salty water) that helps open the walls of the uterus, and the lining of the uterus is evaluated for abnormalities like fibroids, polyps, or scar tissue. If any of these findings are present, then either the pathologic finding(s) is (are) treated or the surrogate may not be eligible.
Once the screening process is completed and the surrogate is eligible to carry the pregnancy, then she undergoes treatment to prepare her for her embryo transfer. In brief, the gestational surrogate undergoes blood work and ultrasound on day 2 or 3 of her menstrual cycle. If results are normal, she starts taking an estrogen medication to prepare the lining of her uterus. Roughly 10-14 days after starting the medication, another ultrasound is performed to measure the lining of the uterus. If the lining is thick enough, she starts another medication called progesterone to ready the lining for the transfer. The embryo transfer is performed under sonographic guidance, and the single healthiest embryo is transferred into the uterus of the gestational surrogate.
Here at Reproductive Medicine Associates of New York, before attempting pregnancy, both gestational surrogates and intended parents undergo a rigorous screening process that follows the guidelines implemented by FDA, New York State, and American Society for Reproductive Medicine, in order to provide the most successful and healthiest outcome for the surrogate, intended parents, and for the baby.