Gestational Carriers

When a woman is unable to carry a pregnancy, she may use a gestational carrier.  The gestational carrier agrees to carry a pregnancy for another person, or couple.  The carrier is designated as the “gestational carrier” or GC, and the individuals that desire to have a child are designated as the intended parent(s).  In addition to the medical procedures, there are several laws and regulations that must be addressed in order to protect everyone involved.  While the process may seem complex, our staff and representatives from the gestational carrier agencies can help guide you through the process.  California IVF does not operate an internal gestational carrier agency, however we work with gestational carrier agencies that can assist in selecting a gestational carrier.  We also work with gestational carriers that have been identified by the intended parent, or parents, without the involvement of a gestational carrier agency.

Surrogacy

Surrogacy is a term commonly used instead of gestational carrier.  Surrogacy treatments include treatments in which women provide the eggs and carry the baby for another woman.  This type of treatment can introduce many more legal complexities and challenges to parental rights.  California IVF does not participate in this type of surrogacy arrangement.  Gestational Carriers do not have genetic ties to the baby and carry the pregnancy for another person through a contract arrangement.

Initial Consultation

It is important for patients to have a consultation with a fertility specialist to discuss treatments with gestational carriers.  In many cases, women assume they are unable to carry a pregnancy and have an interest in using a gestational carrier.  Many times the patients may actually have egg or sperm problems that are preventing pregnancy and do not need a gestational carrier.  During the initial consultation, or physicians will review your history and assess your need for a gestational carrier.  They physician will discuss the various steps needed and our staff can provide you with useful resources for additional information.

Finding a Gestational Carrier

Gestational carriers can be friends, family members, or someone hired through an agency.  Getting to know the potential gestational carrier is very important.  Intended parents will need to feel comfortable with the carrier and have a sense that they will be able to work well together.  Agencies can assist with locating gestational carriers, but agencies will charge fees for screening and matching a gestational carrier with the intended parents.  Once a gestational carrier is identified, she will need to complete registration and health questionnaires for the clinic.  The physician will review this information and determine if the gestational carrier is cleared to proceed based on the information in the medical history.  At some point before proceeding forward, the gestational carrier will have a specialized ultrasound, known as a saline contrast ultrasound, to evaluate the uterus and complete a physical exam.  Laboratory studies will also be required as part of the gestational carrier evaluation.  Once all of the screening and testing is complete, the gestational carrier and intended parents proceed forward with the contracting portion of the process.

Legal Contracts

The gestational carrier and intended parent must have a legal contract in place.  It is advisable to make contact with a family law attorney early in the process, even before the physical exam and screening.  This allows the attorney to provide an overview of the legal process and outline the terms of the legal contract.  This contract should contain information designating the roles of all parties involved with respect to parental rights.  Additionally, the contract should address issues such as compensation (if any), insurance, medical care, and any other relevant information as it would pertain to a pregnancy or parental rights.

All parties involved should be aware that different states will have different regulations and laws pertaining to parental rights and gestational carriers.  The state laws of the state where the baby is delivered will be the laws that must be followed.  Not every state has favorable laws for protecting parental rights.  California has laws that are favorable for gestational carrier cycles.  A lawyer with experience in family law and gestational carrier contracts should be consulted in the state where the delivery is anticipated to occur.  The intended parent(s) will have to take legal actions to allow the intended parent(s)’ name(s) to be entered on the birth certificate.  The laws can become more complicated when a baby delivers in one country and the intended parents are from another country.  The clinic, and any employees or contractors, are not able to review the contract for completeness or content, and are not able to give legal advice.  A letter of clearance from the representative attorneys will be expected with a statement indicating a legitimate contract prepared to the satisfaction of the intended parent(s) and the gestational carrier has been completed and all parties understand and assume the risks of proceeding.

Clinical Psychologist

One of the most important first steps is for the intended parents (IP’s) to meet with a psychologist to discuss the proposed gestational carrier (GC) arrangement, including the reasons for choosing to pursue surrogacy, as well as the relationship and expectations they have with the GC.  Counselors used for evaluation of the IP’s and GC need to be experienced with third party reproduction, including being familiar with the appropriate guidelines established by the American Society for Reproductive Medicine (ASRM).  The visits will explore topics such as expectations of all parties before, during, and after birth, consideration of pregnancy with multiples (twins/triplets), and potential fetal-reduction or abortion for medical reasons.  Additional topics may also include consideration of future disclosure to the IP’s and GC’s children, and conflict resolution in the event of unforeseen conflicts.  Not all prospective gestational carrier arrangements are approved and couples may need to start a new search for another gestational carrier.

Infectious Disease Screening

The intended parent(s), or a designated donor, will provide gametes (sperm and eggs) to be used to make embryos that will be transferred into the uterus of the gestational carrier.  The person providing the gametes is considered to be a tissue donor with regards to state and federal regulations regarding infectious disease screening.  The word “donor” in this sense does not imply the transfer of legal rights.  Before the tissues may be transferred to the gestational carrier, the providers of the sperm and egg must undergo the appropriate clinical history review, examination, and laboratory testing in accordance with state and federal regulations.  California and the U.S. Food and Drug Administration (FDA) have strict guidelines which must be followed.  These extra steps are in place as a precaution to prevent the spread of infectious diseases.  The tests must be performed at specific times in relation to the collection of the sperm and eggs, and must be performed in FDA approved labs.  Many patients may have recent infectious disease labs, however, the testing will need to be repeated in accordance with State and Federal regulations.  Screening questionnaires and physical exams will also be required.

Insurance

Usually, the intended parent(s)’ insurance policy will not cover a gestational carrier during her pregnancy.  The gestational carrier’s insurance may not cover the pregnancy expenses when the baby does not belong to the gestational carrier.  The intended parents should also make sure their policy will cover the baby’s newborn care.  Several insurance agencies offer coverage for gestational carriers.  You will need to make certain there is adequate insurance coverage in place before proceeding with treatments.  Experienced family law attorneys or gestational carrier agencies can assist with insurance options.

Treatment Overview

The individual providing eggs will undergo medications that will increase the number of eggs available for treatment.  This treatment will be identical to in vitro fertilization (IVF) with the exception that the embryos will be placed into the uterus of the gestational carrier.
The instructions below provide an overview of the treatment for a gestational carrier.  The clinic will provide a detailed treatment schedule that may be different than what is outlined here for informational purposes.
A gestational carrier cycle includes these steps:
• Oral Contraceptive Pills (OCP’s) – same as birth control pills
• Prenatal vitamins, supplements, and prescription medications
• Pituitary suppression using leuprolide (Lupron)
• Development of mature endometrium (uterine lining) using transdermal estradiol (Vivelle Patches) and/or vaginal estradiol
• Progesterone for luteal phase support
• Transfer of the embryo(s) back into the uterus
• Pregnancy test

Potential Risks and Disadvantages

Medications
The risks associated with the medications, both oral and injectable, include mood changes, weight gain, headaches, hot flashes, vaginal dryness, discomfort and bruising at injection sites, increased vaginal discharge, breast tenderness, nausea, and constipation.  A few people may have an allergic reaction to the progesterone, which may include hives, a rash, and itching. Rarely, high doses of estrogen and progesterone can increase the risk of blood clots, liver disease, gallbladder disease, or increased growth of any estrogen-sensitive tumor that may be present.  There may be other risks which, at the present time, have not yet been identified.  The occurrence of any of the above may also result in increased financial cost and emotional strain.  Blood sampling may result in bruising or infection.  The embryo transfer may be slightly uncomfortable and carries a minor risk of infection.  Ultrasound exams may cause discomfort. There are no other known risks associated with ultrasound.
Multiple Pregnancies (Twins, Triplets, and More)
There is a risk of multiple pregnancies that increases with the number of embryos transferred.  The clinic makes a recommendation about the number of embryos to transfer into the uterus based on the goal of maximizing the chance of a pregnancy and minimizing the risk of multiples.  The intended parent(s) and the gestational carrier have input on the number of embryos to transfer, and everyone, including the physician, must be in agreement.
Pregnancy Problems and Complications
All pregnancies are at risk of complications.  Complications may increase the health risk to the gestational carrier or result in risk to the baby/babies.  Fertility treatments may increase some of these risks.  There are also risks of malformations or birth defects that are common to all pregnancies.  There may be unknown long-term side effects as a result of this procedure, including those that could occur in subsequent generations as a result of currently unknown genetic problems associated with the embryos.  Any specific questions regarding risks should be addressed with the physician.