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Gestational Carriers (Surrogacy)

Gestational Carriers (Surrogacy)

Gestational Carriers (Surrogacy)

What is gestational surrogacy?

Gestational surrogacy is an arrangement in which a woman carries and delivers a baby for another person or couple. The woman who carries the baby is the gestational surrogate, or gestational carrier. The parents-to-be are known as the intended parents, and they are involved in the pregnancy, can be present at the birth, and become the child’s parents after the baby is born.

In gestational surrogacy, the baby isn’t genetically related to the gestational surrogate – the egg comes from the intended mother or an egg donor, and the sperm comes from the intended father or a sperm donor. Donor embryos may also be used.

Without a donor embryo, in vitro fertilization (IVF) is necessary because eggs from one woman are used to create embryos to be implanted in another woman’s uterus. In IVF, fertilization occurs after eggs and sperm are combined in a laboratory. One or more of the resulting embryos are then transferred to the gestational surrogate’s uterus.

Only 1 percent of all assisted reproductive technology procedures involve gestational surrogacy. It’s likely that cost is a major factor preventing more people from using a gestational surrogate.

Is using a gestational surrogate for me?

Using a gestational surrogate may be a good option if:

  • You don’t have a uterus.
  • You have problems with your uterus.
  • You can’t carry a pregnancy safely.
  • Other fertility treatments have failed.
  • You’re a single man or gay male couple.

What are the challenges of gestational surrogacy?

Whether you set up the arrangement through an agency or negotiate it privately, using a gestational surrogate is a legally complex and emotionally intense process. If you decide to go this route, be prepared to commit a lot of time, money, and patience.

Currently, a handful of states allow gestational surrogacy contracts, but they aren’t always enforceable, depending on what’s legal. Some states require couples to be married, and some don’t allow gestational surrogates to be compensated. Also, there may be requirements about sexual orientation.

Most states don’t have specific laws covering gestational surrogacy, so it’s important to work with a licensed attorney in your state who has expertise in third-party reproduction. An attorney can advise you on your options and draft a legally binding contract.

We’ve decided to try gestational surrogacy. How do we get started?

Get ready for a complex process that can be stressful. Although you won’t carry the baby, you’ll be very involved in the pregnancy. You’ll probably pay the gestational surrogate’s expenses, including medical appointments, health insurance bills, travel costs, legal bills, and agency fees (if you’re using one). Here’s how to get started:

1. Find a gestational surrogate. Decide whether to ask a relative or friend to be the gestational surrogate, or use an agency that can match you with someone. Most experts recommend choosing someone who:

  • Is between 21 and 45 years old
  • Previously gave birth without any complications
  • Has a supportive family
  • Is in good physical and emotional health

2. See a fertility counselor. Most doctors require that you and the gestational surrogate speak with a mental health professional (individually and together) to help you consider the pros and cons of the arrangement, process your emotions, and discuss the potential impact of a relationship with each other.

3. Schedule a medical exam for the genetic parents. If you’re using your own eggs or sperm, you’ll have a checkup and genetic evaluation to make sure you’re healthy enough for IVF. (If you’re using donated sperm, eggs, or a donor embryo, they’ll be screened during the donation process.)

4. Schedule exams for the gestational surrogate. She’ll need to have a medical exam and drug screen, and her partner or spouse will undergo psychological and medical screening as well.

5. Sign a legal agreement.You and the gestational surrogate should each hire separate attorneys experienced in gestational surrogacy to avoid potential conflicts of interest. Create a legal agreement that protects everyone and includes such important details as compensation, parental rights, legal custody, delivery location, future contact between the parties, insurance coverage, and control over medical decisions made during the pregnancy.
In some states, as long as one parent is genetically related to the baby, the gestational surrogate signs away parental rights before the baby’s birth, and the intended parents’ names are listed on the birth certificate. In other states, the gestational surrogate signs over parental rights after the baby is born.

How does gestational surrogacy work with fresh eggs?

Your doctor uses IVF to produce one or more embryos that will be transferred to the surrogate. Here’s how it works:

  • Match menstrual cycles. If you’re using your own egg, you and the gestational surrogate take medication to synchronize your menstrual cycles. That way, the surrogate’s uterus will be ready to support an embryo by the time your eggs are retrieved and fertilized. (Similarly, an egg donor will need to sync her cycle with the surrogate.)
  • Stimulate egg production. Once you (or the egg donor) are in sync with the surrogate, taking gonadotropins stimulates the ovaries to develop multiple eggs.
  • Fertilize the eggs. When mature eggs are ready to be fertilized, the doctor retrieves them during a minor outpatient procedure. Unless you’re using donor sperm, the intended father may need to provide a sperm sample at this time. Then the eggs are fertilized in the laboratory.
  • Transfer embryos. After fertilization, the embryos are transferred to the surrogate’s uterus.

The surrogate becomes pregnant when at least one embryo implants in her uterus. The chance of a successful pregnancy varies with the age of the woman who provided the egg.

How does gestational surrogacy work with frozen eggs?

Here’s how gestational surrogacy works when using frozen eggs:

  • Take medication. The surrogate takes medication over several weeks to prepare her uterus for a possible pregnancy.
  • Thaw and fertilize the eggs. Unless you’re using donor sperm, the intended father may need to provide a sperm sample, so the eggs can be fertilized in a laboratory.
  • Transfer embryos. After fertilization, the embryos are transferred to the surrogate’s uterus.

The surrogate becomes pregnant when at least one embryo implants in her uterus. The chance of a successful pregnancy varies with the age of the woman who provided the egg.

How does gestational surrogacy work with frozen embryos?

Using frozen embryos is similar to the process for using frozen eggs. Menstrual cycles don’t need to be synced, and the surrogate only needs to take medication to prepare her uterus for a possible pregnancy before the embryos are thawed and transferred into her uterus.

How long does gestational surrogacy take?

Finding a healthy, willing gestational surrogate can take months or even years, whether you screen candidates through an agency, decide to ask a friend or relative, or search for someone online.

Once you’ve finalized the agreement and have begun treatment, it can take at least three or four IVF cycles to achieve a successful pregnancy. Each IVF cycle takes four to six weeks.

What’s the success rate for gestational surrogacy?

Using your own eggs, your chance of having a baby through gestational surrogacy is as good as or higher than that of a woman your age using traditional IVF.

Recent national data on gestational surrogate IVF cycles using the intended mother’s eggs show the following live birth rates per cycle (ages refer to the intended mothers’ age):

  • 51 percent for women age 34 and younger
  • 49 percent for women age 35 to 37
  • 38 percent for women age 38 to 40
  • 21 percent for women age 41 to 42
  • 10 percent for women age 43 and older

With frozen embryos using the intended mother’s eggs, the birth rates per cycle were:

  • 46 percent for women age 34 and younger
  • 46 percent for women age 35 to 37
  • 42 percent for women age 38 to 40
  • 38 percent for women age 41 to 42
  • 22 percent for women age 43 and older

The donor egg data in the national report wasn’t grouped by age, but it showed that the overall live birth rate was 64 percent when fresh donor eggs were used in gestational surrogacy. When frozen donor eggs were used, the birth rate was 42 percent. When frozen embryos created from donor eggs were used, the birth rate was 51 percent.

What are the pros of gestational surrogacy?

  • If you and your partner are unable to conceive or carry a pregnancy to term, using a gestational surrogate can give you the chance to parent your own biological child.
  • You can be intimately involved in the details of your gestational surrogate’s pregnancy.

What are the cons of gestational surrogacy?

  • In addition to the possible side effects from fertility medication, your gestational surrogate goes through the discomfort and usual risks of pregnancy.
  • Using a gestational surrogate is expensive and legally complex. It involves intricate contracts and arrangements. In several states, using a gestational surrogate is illegal, which usually means that people must contract with a gestational surrogate who delivers in a surrogacy-friendly state.
  • You not only experience the usual suspense and anxiety of waiting for a pregnancy to safely reach full term, you may also have to deal with friends and relatives who don’t understand why you chose gestational surrogacy.
  • You might worry about legal snags and the possibility that your gestational surrogate could back out and not carry your baby. If she goes ahead with it, you might worry that she’ll have a hard time letting the baby go.

How much does gestational surrogacy cost?

The cost for gestational surrogacy depends on factors including your health insurance, the gestational surrogate’s expenses, and the cost of IVF where you live. Relatives or friends who serve as a gestational surrogate usually aren’t paid.

Most people find a gestational surrogate through an agency, and the cost can be almost $150,000. Here’s an estimated breakdown:

  • Agency fee: $22,000
  • Gestational surrogate fee: $25,000 to $35,000, though compensation is typically higher for a multiple pregnancy
  • Health insurance: $15,000 to $30,000 for supplemental or special coverage for the gestational surrogate
  • Gestational surrogate’s nonmedical expenses: $10,000 to $15,000
  • Legal fees: $14,000
  • Counseling services: $7,000
  • IVF: Up to $20,000 (Gestational surrogacy IVF is generally more expensive than traditional IVF, which averages around $12,400.)

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Photography credits: Jonas Mohamadi

Is it normal to have abdominal pain during pregnancy?

Is it normal to have abdominal pain during pregnancy?

Occasional abdominal pain during pregnancy is a common and often harmless complaint, but it can also be a sign of a serious problem. Never ignore severe or persistent abdominal pain. Call your healthcare provider if your pain doesn’t go away after several minutes of rest, or if you also have any of the following:

  • Vaginal spotting or bleeding
  • Unusual vaginal discharge
  • Chills or fever
  • Lightheadedness
  • Pain or discomfort while urinating
  • Nausea and vomiting


Is it normal to have mild pain with cramping during pregnancy?

Yes, a little bit of pain with cramping in early pregnancy is common. Later in pregnancy, cramps might be harmless Braxton-Hicks contractions or round ligament pain. And occasional mild cramps throughout pregnancy without any other symptoms are usually nothing to worry about.

When is it not normal to have pain with cramping during pregnancy?

It’s not normal to have cramping during pregnancy with pain that’s severe, persistent, or accompanied by other symptoms, such as nausea, vomiting, vaginal bleeding, headache, or fever. Pain with cramps and vaginal bleeding in early pregnancy can be a sign of ectopic pregnancy or miscarriage.

It’s also not normal to have any pain in the upper abdomen. And if your abdomen is unusually sensitive to touch, especially when pressure is released, a serious abdominal infection (peritonitis) could be the culprit.

What causes harmless abdominal pain during pregnancy?

Not all abdominal pain during pregnancy is a sign of a serious problem. Common causes of minor abdominal pain include:

Gas and bloating: You’re much more likely to have gas pain and bloating during pregnancy because of hormones that slow your digestion and the pressure of your growing uterus on your stomach and intestines.

Constipation: Pregnancy hormones that slow down your digestion and the pressure of your growing uterus on your rectum can lead to constipation.

Cramping during orgasm: You may notice a bit of cramping during or right after an orgasm. As long as it’s mild and short-lived, it’s perfectly normal and nothing to be alarmed about.

Round ligament pain: Round ligament pain is generally a brief, sharp, stabbing pain or a dull ache that you may feel on one or both sides of your lower abdomen or deep in your groin. It usually starts in your second trimester when the ligaments in your pelvis that support your uterus begin to stretch and thicken to accommodate its growing size.

You may feel a short, sharp pain if you suddenly change position, such as when you get out of bed or up from a chair or when you cough, roll over in bed, or get out of the bathtub. Or you may feel a dull ache after an especially active day. Call your provider if this discomfort continues even after you’ve rested.

Braxton Hicks contractions: After midpregnancy, you may start to feel a tightening sensation in your uterus from time to time. Before 37 weeks, these Braxton Hicks contractions should be infrequent, irregular, and essentially painless. (Once you’re close to your due date, this type of cramping during pregnancy can be a sign of labor.)

Call your provider if:

  • The contractions are accompanied by lower back pain.
  • You feel more than six contractions an hour (even if they don’t hurt).
  • The contractions are coming at regular intervals.
  • You also have vaginal discharge or bleeding.
  • You have any other signs of premature labor.


What serious problems cause abdominal pain during pregnancy?

An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, typically in one of the fallopian tubes. It may cause cramping in early pregnancy and other symptoms.

Miscarriage is the loss of a pregnancy in the first 20 weeks. Vaginal spotting or bleeding is usually the first symptom, followed by abdominal pain a few hours to a few days later.

Placental abruption is a life-threatening condition in which your placenta separates from your uterus, partially or completely, before your baby is born.

Preeclampsia is a serious pregnancy complication that causes changes in your blood vessels and can affect organs including your liver, kidneys, brain, and the placenta. You’re diagnosed with preeclampsia if you have high blood pressure after 20 weeks of pregnancy and protein in your urine, liver or kidney abnormalities, persistent headaches, or vision changes.

Being pregnant makes you more susceptible to urinary tract infections of all kinds, including kidney infections. It’s important to call your provider if you think you might have a bladder infection because it can lead to a kidney infection, which can cause serious illness and premature labor if left untreated.


Other causes of abdominal pain during pregnancy

Many other conditions can cause abdominal pain, whether you’re pregnant or not. Some of the most common causes of abdominal pain during pregnancy include:

  • Stomach virus
  • Food poisoning
  • Appendicitis
  • Kidney stones
  • Hepatitis
  • Gallbladder disease
  • Pancreatitis
  • Fibroids
  • Bowel obstruction

Both gallbladder disease and pancreatitis are often a result of gallstones, which are more common during pregnancy. Fibroids may grow during pregnancy and cause discomfort. And the pressure of the growing uterus on previously scarred intestinal tissue may cause bowel obstruction, which is most likely to occur in the third trimester.

Is there anything I can do to relieve abdominal pain during pregnancy?

If you have minor pain and no symptoms of anything more serious, try these tips to relieve abdominal pain:

  • Move around or do some gentle exercises to relieve gas pain.
  • Take a warm (not hot) bath or shower.
  • Bend toward a pain for relief.
  • Drink plenty of fluids. (Dehydration can cause Braxton Hicks contractions.)
  • Try lying down. This might relieve pain caused by Braxton Hicks contractions.