Surrogacy – along with donation of eggs, sperm or embryos – is a form of third-party reproduction. A surrogate is a woman who carries a pregnancy for another couple or woman who cannot carry the pregnancy on their own. A surrogate pregnancy may be carried by the egg donor (traditional surrogate – not offered by UCARM), or by another woman who is not genetically related to the embryo (gestational surrogate). Traditional surrogacy requires insemination with sperm from the male partner of a couple or donor sperm to fertilize the surrogate’s egg. A gestational surrogate, on the other hand, carries a transferred embryo created using the couple’s own egg and sperm (although donor sperm or donor eggs may be used as well).
Surrogacy is a complex issue – though not medically, as the assisted reproductive technique is the same as other infertility treatments. The complexity lies in the legal and emotional issues of surrogacy, a process that involves careful evaluation by physicians, mental health professionals, and attorneys to ensure that the procedure succeeds for both the surrogate and the intended parents.
Traditional surrogacy carries more legal risks than gestational carrying because the surrogate uses her own eggs. Most providers feel that traditional surrogacy is ethically suspect. This is why the majority of surrogates employed in the United States are gestational carriers.
Typically, a woman who needs a surrogate has normally functioning ovaries, but lacks a uterus, or has medical problems preventing her from carrying a pregnancy. For instance, women with congenital absence of the uterus or who have had a hysterectomy due to benign or malignant conditions may choose to achieve pregnancy through a gestational carrier. Women with other uterine anomalies or a history of infertility or repetitive miscarriages may also choose to use a surrogate. Gestational surrogacy is also appropriate for women with medical conditions that could make pregnancy dangerous, including severe kidney disease, cystic fibrosis, severe diabetes, severe heart disease, systemic lupus, erythematosus, history of breast cancer, and a history of severe pre-eclampsia.
Gestational surrogates may be known to the intended parents or anonymous. Typically, known surrogates are friends or relatives who have volunteered to carry the pregnancy for the infertile woman or couple. Anonymous surrogates are found thorough agencies that specialize in recruiting surrogates. Women serving as surrogates must have already delivered a live child that was carried to term, as well as be a minimum of 21 years old, but within a young fertile age. Older surrogates carry a risk for complications like pregnancy-induced hypertension or gestational diabetes.
Gestational surrogates must also undergo evaluation of overall health, including underlying medical condition that could complicate a pregnancy. Surrogates must have their complete medical histories reviewed – including lifestyle and obstetric history – as well as complete a physical examination that screens for syphilis, gonorrhea, chlamydia, cytomegalovirus, HIV, and Hepatitis B and C. An evaluation of the uterine cavity must also be performed. Immunity to measles, German measles, chicken pox, and mumps must be checked, and blood type should be noted. Finally, potential surrogates see a counselor to be informed of obstetric risks.
Couples intending to use a surrogate will also undergo a complete medical history and physical examination. The male partner will give a semen sample for analysis, and the female partner will have her ovarian function evaluated. Both partners will also be screened for the same infectious diseases as the surrogate.