What is third-party reproduction?
- Third-party reproduction refers to the involvement of a third person (outside of the Intended Parent or Parents) to create a baby.
- This blanket term encompasses the use of sperm donors for IUI or IVF, egg donors, and gestational carriers.
- A gestational surrogate (GS) agrees to carry the child for another individual or couple. The GS provides the uterus without contributing genetic material.
Who should consider gestational surrogate IVF?
- Gay male couples or single men who wish to become parents.
- Women who have a contraindication to carrying a pregnancy, such as:
- Uterine abnormalities, such as a T-shaped uterus or Mullerian anomaly, or hypoplastic uterus with history of infertility or repetitive pregnancy loss
- Women with untreatable intrauterine scar tissue
- Absence of the uterus, whether surgical (hysterectomy) or from birth (Mullerian agenesis)
- Medical conditions in which risks of pregnancy would outweigh any benefits, such as:
- Severe heart disease
- Systemic lupus erythematosus
- History of breast cancer
- Severe renal disease
- Cystic fibrosis
- Prior poor obstetric history, like history of severe pre-eclampsia with HELLP syndrome
Who should consider becoming a gestational surrogate?
- NRM requires that intended parents be acquainted with gestational surrogate before undergoing a third-party IVF cycle. Many gestational surrogates are family members or close friends of the intended parents. You can also choose from gestational surrogate agencies that help coordinate intended parents with a healthy GS candidate.
- Gestational surrogates should be at least 21 years old and have delivered a live-born child at term.
- The older the GS, the higher the risk of age-related obstetric complications, especially pregnancy-induced hypertension or gestational diabetes. Evaluation of overall health and screening for underlying conditions, as well as counseling regarding risks, should be performed if an older GC is being considered.
What is the screening process for Intended Parents?
- NRM follows American Society for Reproductive Medicine (ASRM) and FDA guidelines for all processes.
- Intended parents undergo complete medical history and physical examination by their physician. Semen analysis is performed for the male partner, and ovarian reserve assessment performed for a female partner that is using her own eggs.
- Infectious disease testing is performed on intended parents, as well as any genetic testing if indicated in the family history.
- NRM strongly recommends that intended parents undergo mental health counseling regarding their ability to maintain a respectful relationship with the GS, as well as what emotional issues may arise with children born of gestational surrogate IVF.
What screening will be performed on gestational surrogates?
- The GS should undergo a complete medical history including the following:
- Detailed obstetric history
- Lifestyle history
- Physical examination
- Evaluation of uterine cavity (most commonly by saline-infusion ultrasound)
- Lab testing
- Infectious disease testing
- Screening for immunity to rubella and varicella
- Blood type and antibody screen
- Mental health evaluation: the goal of GS counseling is to provide the carrier (and her partner if present) with a clear understanding of the psychological issues related to pregnancy. Other issues to be discussed include managing a relationship with the intended parents; coping with attachment issues to the fetus; and the impact of a GC pregnancy on her children and her relationships with partner, friends, and employers.
What other components are needed prior to undergoing a gestational surrogate IVF cycle?
- The GS (and her partner) and intended parents meet together with a mental health professional to discuss expectations regarding a potential pregnancy. This includes a discussion of the type of relationship all parties desire; the number of embryos for transfer; prenatal diagnostic interventions; fetal reduction and therapeutic abortion; and respecting the GS’s right to privacy.
- Consultation with an attorney familiar with third-party reproductive law is required. With GS arrangements, a legal contract should cover the following:
- Financial obligations on the part of the intended parents and the GS
- Expected behavior of the GC to ensure a healthy pregnancy
- Prenatal diagnostic tests
- Agreements regarding fetal reduction or therapeutic abortion if indicated
- Declaration of parentage according to state laws
When you are ready, the next step is to schedule an initial consultation so that we can meet with you and develop a personalized plan designed to deliver the family of your dreams.