Need to Know: Gestational Surrogacy
A gestational surrogate or gestational carrier is a woman who carries a pregnancy for another person or couple who is (are) the genetic parent(s) and with whom she is not in intimate sexual contact. Historically, the term gestational surrogate was used for women who contributed the egg and also carried that pregnancy whereas gestational carriers only carried the pregnancy without donating their eggs. However, when the laws were changed and contract arrangements for gestational carriers became legal in New York state in February 2021, the term used in the law was “gestational surrogate”. This individual is defined as a woman who carries the pregnancy for another person or couple but doesn’t have a genetic connection to the fetus that she carries.
A gestational surrogate is needed in many clinical circumstances: women who do not have a uterus from birth or who had their uterus removed for various reasons and want to have a child; women who have severe chronic conditions that preclude them from getting pregnant, such as pulmonary hypertension, severe heart disease; women who have to take medications that can’t be used during pregnancy; and gay single men or couples who wish to have their own biologic child(ren).
Gestational surrogacy arrangements are multifaceted with medical, social, psychological, and legal implications.
- Both intended parent(s) or egg and sperm donors, gestational surrogate, and partner of the gestational surrogate, if any, are screened for psychological and infectious disorders. A detailed medical history is taken from the gestational surrogate and a complete physical examination is performed together with a transvaginal ultrasound to rule out any condition that may prevent the surrogate from carrying a healthy pregnancy to term.
- The female intended parent or, if the eggs are donated, then the egg donor, undergoes testing to determine their ovarian reserve, namely the quantity and quality of the eggs remaining in their ovaries.
- The male intended parent, or sperm donor (if donated sperm is used) undergoes a semen analysis to confirm enough sperm in the semen.
These screening tests are followed by in vitro fertilization (IVF) where the eggs of the genetic parent (or egg donor) are retrieved and fertilized with the sperm of the intended male parent (or sperm donor), and the ensuing embryo is transferred to the uterus of the gestational surrogate. In the case of gay men or couples, the donated egg (which can be from a woman known or anonymous to the intended parent(s)) is fertilized with the sperm of the intended parent and, again, the embryo is transferred to the uterus of the surrogate.
One of the most important aspects of surrogacy arrangements is legality. It is important to determine the states of residence of all parties involved and the laws governing surrogacy in those states. Both parties, the surrogate and the intended parent(s) should agree on the number of embryos to be transferred; the duration of the treatments, and how many attempts will be made; the decisions to be taken in case complications arise during pregnancy, like birth defects, multiple pregnancy, etc. A legal contract should be signed before starting any treatment on all parties involved. Pre-birth orders are routinely put in place before the delivery of the baby, so the intended parents’ name can be included on the original birth certificate to prevent the later need for a formal adoption process.
The gestational surrogacy arrangements are complex and involve medical, psychological, and legal teams. Here at RMA of New York, we will guide you through this process with our expert team of physicians, nurses, coordinators, psychologists and last but not least, social workers.