Understanding Your Options: How Surrogacy Helps Families Grow
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). Historically, the term gestational surrogate was used for women who donated their egg(s) and carried that pregnancy whereas a gestational carrier only carried the pregnancy and did not have any genetic connection to the fetus. However, when the laws were changed and contract arrangements for gestational carriers became legal in New York State in February of 2021, the term used in the law was “gestational surrogate”, defined as a woman who carries the pregnancy for another person or couple but does not have a genetic connection to the fetus that she carries. Again, this was previously the definition for a gestational carrier.
There are many circumstances where the use of a gestational surrogate is indicated:
• Women who are born without a uterus or who had their uterus removed for various reasons and want to have a child
• Women who have severe chronic medical or psychiatric conditions that preclude them from getting pregnant, such as pulmonary hypertension, severe heart disease
• Women who must take medications that can harm the fetus during pregnancy
• 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. The first step is for the intended parents to meet a reproductive endocrinology and infertility specialist for a comprehensive consultation explaining the whole process. The intended parents enlist an agency to help find a gestational surrogate and a reproductive lawyer who will represent the intended parents and the surrogate. It is important to note that both parties have to have separate lawyers; they cannot be represented by the same lawyer. The lawyers prepare the contract that describes the terms of the arrangement, mainly focusing on the actions to be taken if unexpected events occur during pregnancy. 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 medical aspect of the process is managed by the reproductive endocrinology and infertility specialists and their team. The intended parents and the gestational surrogate and her partner, if any, undergo a physical examination and infectious disease screening to minimize the risk of transmission of an infection to the gestational carrier and to the fetus. The intended parents or egg/sperm sources are also tested for genetic disorders using a test called expanded carrier screening, to decrease the risk of a transmission of a genetic disorder to the child. The gestational surrogate undergoes an evaluation of her uterus to rule out any disorder that may interfere with the establishment of a pregnancy or that may increase her risk for a miscarriage.
All involved parties undergo a psychological evaluation. This evaluation is done on an individual basis as well as by bringing all involved parties together to discuss the social and psychological aspects of the surrogacy arrangements as well as to rule out any psychiatric disorders.
Following the screening process, the intended parent(s) undergo an IVF cycle where the female partner is given medications to grow eggs in the ovaries. When ready, the eggs are retrieved and fertilized with the partner’s eggs. In case of single or lesbian women, the eggs are fertilized with the sperm of a directed (known sperm donor) or an anonymous sperm donor (the woman and the sperm donor don’t know each other). In the case of single, gay men or gay couples, the eggs are donated by a directed or anonymous donor and fertilized with the sperm of the intended parent(s). The embryos that are created are often tested genetically to assure euploidy (correct number of chromosomes) and a single embryo is transferred to the uterus of the surrogate following the preparation of her uterus using hormones in a frozen embryo transfer cycle.
The gestational surrogacy arrangements are complex, but the expert team of physicians, physician assistants, nurses, coordinators, psychologists, geneticists and last but not least, social workers at RMA of New York can guide you through this process.
To make an appointment with one of our physicians, please reach out to info@rmany.com or call 212-756-5777.