Overview of Gestational Surrogacy

For couples trying to get pregnant, surrogacy offers an alternative option to becoming parents when a pregnancy cannot otherwise take place. There are different types of arrangements that couples trying to get pregnant may turn to when it comes to surrogacy. Of these, gestational surrogacy - in which the gestational carrier (surrogate mother) will not be genetically related to the baby - is one option to consider.

What is a Gestational Surrogacy?
There are two main types of surrogacy arrangements that can be made: a traditional surrogacy and a gestational surrogacy. In a traditional surrogacy, the surrogate mother will be inseminated with the sperm of the intended father during ovulation. In other words, the surrogate mother also donates her egg for fertilization and will thus be genetically related to the baby.

A gestational surrogacy, on the other hand, will use both the intended mother’s egg as well as the intended father’s sperm for fertilization in order to achieve pregnancy. The fertilized egg (embryo) will then be implanted into the surrogate mother’s uterus.

In some cases, a donor egg from a source other than the intended mother and the surrogate mother may be used. In addition, donor sperm is sometimes used.

Gestational Surrogacy Process: Preparation
Couples who opt for gestational surrogacy often find it easier to choose a surrogate mother, since a person’s genetic history does not play as significant a role. However, there are nonetheless a series of testing procedures that the surrogate mother must undergo before the pregnancy may take place. Testing procedures for gestational surrogacy may include the following to ensure a healthy pregnancy:

• Hysteroscopy/HCG test to determine the shape and size of the uterus and ensure that the fallopian tubes are clear
• Testing for infectious disease such as sexually transmitted diseases (STDs)
• Pap smear
• annual physical examination
• a mock cycle of medications to assess the uterine lining’s response to hormone replacement
• Trial transfer to check the angle of the cervix as well as the length of the uterus in preparation for implantation
• Psychological evaluation

Gestational Surrogacy Process: Ovulation Cycles
Once the initial testing procedures have been performed, the surrogate mother as well as the egg donor will be given medications in order to synchronize their ovulation cycles. This will usually involve beginning a cycle of hormonal birth control pills, which is followed by a dose of Lupron. Lupron is used to stop the body’s natural production of hormones, which allows doctors to control the ovulation cycle and ensure that the surrogate mother’s uterus will be ready to receive the donor embryo. Typically, the surrogate mother’s cycle will be one week ahead of the egg donor to ensure that the uterine lining will be ideal for implantation.

Both the egg donor and the surrogate mother will undergo estrogen replacement therapy once menstruation begins. The egg donor will be given injectable hormones to stimulate the ovaries in order to produce more than one mature egg during ovulation. Once the egg follicles have reached a certain size, the egg donor will be given an HCG shot to aid egg maturation. After 36 hours, the eggs will be retrieved and fertilized.

Gestational Surrogacy Process: Pregnancy
Once the fertilized eggs or embryos reach a certain stage (usually either two or five days old), they will be inserted into the surrogate mother’s uterus. This is performed using a syringe with a thin catheter that is inserted through the cervix into the uterine cavity. In some cases, an ultrasound will be used to assist implantation. An HCG test will be performed to assess pregnancy hormone levels.

If a pregnancy has occurred, an ultrasound will be performed at approximately 6.5 weeks to check for a heartbeat. Another ultrasound will be performed at 12 weeks to ensure proper growth before the surrogate mother may be recommended for regular prenatal care by an obstetrician/gynecologist or other prenatal care practitioner.

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