In the case of a gestational carrier, the woman carrying the pregnancy is in no way biologically or genetically related to the child she is carrying. She is merely providing a nurturing environment in the form of a uterus for the child to grow for the gestational period of, ideally, 40 weeks. A gestational carrier is not a traditional “surrogate,” as a surrogate is someone who donates her egg and then subsequently carries the child.
CANDIDATES FOR USING A GESTATIONAL CARRIER
A gestational carrier is required for any couple in which the female partner cannot carry the pregnancy. This may result from conditions in which the female partner has had her uterus surgically removed—such as in the case of cervical or uterine cancer, fibroids, severe endometriosis, or conditions requiring a hysterectomy. In other cases, the woman may have an intact uterus, but the uterus still may not be able to carry a pregnancy to term. Medical conditions such as severe diabetes may also be a reason for using a gestational carrier. A physician will obtain the eggs from the intended mother or from an egg donor.
Same-sex male couples will also work with a gestational carrier, egg donor, and most often one of the partner’s sperm to conceive.
GESTATIONAL CARRIER WITH DONOR EGG
If a woman is unable to conceive using her own eggs, the intended parents can also use donor egg treatment. A physician will then transfer the embryo to the gestational carrier. In the case of a same-sex male couple, once the couple has identified both a gestational carrier and an egg donor, one or both male partners will provide sperm samples to inseminate the donated eggs. While the goal of every pregnancy is a singleton, or one baby, male couples may opt to transfer back one embryo from each male partner if their gestational carrier agrees. However, as twin or higher-order multiples present potentially higher risks to the babies and the gestational carrier, Bedi IVF Centre does not advise this, for safety reasons.
What to Expect
HOW TO GET STARTED
Step 1: Schedule a new-patient appointment with a reproductive endocrinologist at Bedi IVF Centre to review history and determine treatment plan.
Step 2: If the plan is to proceed with a known gestational carrier, your donor nurse will schedule her for a consult at Bedi IVF Centre. If you are choosing a gestational carrier you do not know, your donor nurse will direct you to an attorney or agency to start the recruiting process.
Step 3: Your health care team will outline the necessary screening for all parties.
Step 4: Bedi IVF Centre must receive confirmation of legal counsel and contracts prior to the start of the fresh cycle.
SELECTING A GESTATIONAL CARRIER
Bedi IVF Centre will refer couples needing a gestational carrier to experienced and reputable agencies and attorneys who recruit carriers. Prospective carriers (all of whom have had successful pregnancies/live births previously) and intended parents will meet in order to determine compatibility. If they decide to work together, an attorney will draw up a legally binding contract at that time. The gestational carrier will also have to undergo medical and psychological screening. The average wait to be matched with a gestational carrier can run from approximately 2 to 6 months.
THE GESTATIONAL CARRIER CYCLE PROCESS
The female partner of the intended parent couple will be undergoing an IVF cycle if she is using her own eggs. If she’s using an egg donor, the donor will undergo an IVF cycle. This is a cycle where we will use high doses of the same hormones that are secreted by her brain each month (that normally stimulate one ovary to produce one egg) in order to get both ovaries to produce many eggs (usually 10 to 20). Donors will receive these hormones (follicle-stimulating hormone [FSH] and luteinizing hormone [LH]) via subcutaneous injections (using small needles given directly into the fatty tissue underneath the skin). She will be monitored in the office with transvaginal ultrasound frequently to measure the size of the developing follicles (the fluid-filled sacs that contain the eggs) until they reach a size of 18 to 20 mm. She will also have her blood tested for estradiol levels as well. Once the lead follicles reach 18 to 20 mm in size, she will need an intramuscular injection to “trigger” egg maturity, and in 36 hours exactly, a physician will retrieve her eggs transvaginally.
Her eggs will then be brought into the lab. We will thaw the male intended parent’s sperm that was previously frozen and an embryologist will inject one normal appearing sperm into each mature egg, via a procedure called intracytoplasmic sperm injection (ICSI). The embryos will then be allowed to grow in the lab and the physician will transfer a certain number of embryos (depending on embryo quality and age of the intended parent or egg donor) into the gestational carrier.
While the intended parent is undergoing the IVF cycle, you will receive estrogen and progesterone in sequential fashion via intramuscular injections, in order to prepare your uterine lining for implantation. Before you start this prep, you will come in to be sure your uterine lining is thin and your ovaries have no cysts. If everything looks normal, you will start the estrogen. Approximately 2 weeks later, you will come in for another transvaginal ultrasound and bloodwork to be sure your lining is developing adequately. If so, you will start the progesterone when instructed by your nurse. In order to be sure that you respond adequately and develop a lining that is perfectly primed and ready to support a developing embryo, you will undergo a “mock” cycle first, which is a practice cycle. The mock cycle involves injections of estrogen, followed by a mid-cycle uterine evaluation to confirm the endometrial thickness is appropriate. If the lining is not favorable, we will make adjustments for the fresh cycle. After the mock cycle and all of the pre-screening bloodwork and psychological screening is complete, the real cycle can begin.
From the time the intended parent and gestational carrier are initially seen for consultation, it generally takes 4 to 6 months to complete the necessary pre-screening and fresh cycle. If a patient is working with an attorney or agency to recruit a gestational carrier, it can take an additional 2 to 6 months to recruit a gestational carrier.