There are many reasons why someone may be unable to carry a child on their own, including infertility, age, or a medical condition that would make pregnancy difficult or impossible, such as a hysterectomy. If this is the case, individuals or couples may choose to use a gestational carrier, also known as a surrogate. A surrogate is a person with a uterus who carries a child for someone else.
Although surrogacy can be a challenging and costly way to grow your family (1), it is the best option for some people to have a child that is biologically theirs. Because the surrogacy process is one of the most intensive ways to grow your family, it’s important to be prepared before starting your surrogacy journey.
There are two types of surrogacy: traditional surrogacy and gestational surrogacy. In traditional surrogacy, the person who carries the child uses their own egg and is the child’s biological mother. Sperm can come from an intended parent or a donor.
In gestational surrogacy, which includes 95% of surrogacy cases in the US, the egg and sperm are unrelated to the surrogate. In vitro fertilization (IVF) is used to create and transfer an embryo into the uterus of the surrogate. The surrogate then carries the child to term for the intended parents.
Sometimes, people find a surrogate who is a friend or family member who will carry their child without being compensated for it (altruistic surrogacy). In most cases, though, you will contact a surrogacy agency that can match you with a surrogate who will be compensated.
Before you start looking for a surrogate, it’s important to know whether surrogacy is possible where you live. Because of legal and ethical concerns, laws about surrogacy vary widely from state to state, and country to country. In particular, the recent Supreme Court decision to overturn Roe vs. Wade has created uncertainty as to whether IVF and surrogacy will continue to be available in certain parts of the country.
It’s important to get familiar with the laws where you live and contact a lawyer who specializes in surrogacy.
Having a child by gestational surrogate means that IVF treatment will be a part of your journey into parenthood. While you may use your own egg and/or sperm, you may also choose to find an egg donor, sperm donor, or embryo donor. Your choice will affect what part of the IVF process you’re involved in.
If you are using your own egg, you will undergo an egg retrieval procedure at a fertility clinic, which is the first part of an IVF cycle. If you are using your own sperm, you will collect a semen sample. Once an embryo has been created and selected, the embryo transfer to the gestational surrogate can occur.
If implantation is successful, the surrogate will become pregnant and carry your baby to term.
Research has shown that rates IVF with a surrogate are higher than non-surrogacy IVF; according to an article published in Fertility and Sterility in 2016 that looked at outcomes from gestational surrogacy between 2009 and 2013, “[g]estational carrier cycles had higher rates of ART success than nongestational carrier cycles” (2). This may be because surrogates are likely to be under 35 and screened carefully for any health problems that might prevent pregnancy. It is important to note that when you’re planning for surrogacy, if the embryo does not implant or the surrogate has a miscarriage, you may need to do another round of IVF with the surrogate. In this case, the overall cost of surrogacy can rise very quickly.
Many people who decide to pursue parenthood via surrogate have already been on a long journey through infertility and may have already undergone extensive infertility treatment. Surrogacy offers hope, but its many challenges mean that it may not be the right choice for everyone. Here are some questions to consider when determining if IVF via surrogacy is right for you:
As intensive as it can be, surrogacy is an important option for people hoping to grow their family, and many people have successfully had a child through surrogacy.
Patel, N., Jadeja, Y., Bhadarka, H., Patel, M., Patel, N., & Sodagar, N. (2018). Insight into different aspects of surrogacy practices. Journal of Human Reproductive Sciences, 11(3), 212. https://doi.org/10.4103/jhrs.jhrs_138_17
Perkins, K. M., Boulet, S. L., Jamieson, D. J., & Kissin, D. M. (2016). Trends and outcomes of gestational surrogacy in the United States. Fertility and Sterility, 106(2), 435-442.e2. https://doi.org/10.1016/j.fertnstert.2016.03.050
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