Why use a Gestational Carrier?

Infertility may result not from the inability to conceive, but to support the developing baby during the pregnancy. Motherhood is still possible thanks to the generosity of women who are willing to carry a fetus that is not theirs. Gestational surrogacy is a treatment option in which embryos created by IVF are transferred into the uterus of a woman genetically unrelated to the embryos. Surrogacy may be used for women without a functional uterus; for women with underlying medical problems which could cause great risk to mother or baby during pregnancy, or for women with history of multiple failed IVF cycles without a known cause.

Overview

Fertility Specialists of Texas works with local and national surrogacy agencies to assist couples in the opportunity to become parents. The process is very similar to those used in donor egg cycles with embryo transfer into the recipient's uterus. The woman producing the eggs undergoes an IVF cycle. At the same time, the gestational carrier prepares her uterus for conception with estrogen and progesterone. The eggs are fertilized and on the day of transfer, the embryos with the highest pregnancy potential are placed in the uterine cavity of the gestational carrier. The number of embryos transferred depends on the age of the woman producing the eggs and the quality of the cultured embryos.

Starting the Process

We have established relationships with several of this country's most highly regarded surrogacy agencies. The surrogacy agency conducts the initial recruitment and screening of potential surrogates, provides legal referrals and offers administrative assistance during the process. Dr.Goldstein then see the surrogate and perform an extensive medical screening exam to confirm a candidate's adequacy for surrogacy.The process of being a gestational surrogate or gestational carrier involves finding a woman who has had healthy pregnancies; feels she is done having her own children; and would like to participate in the joy of helping another woman have a child for whom there is no option otherwise.

Emotional issues of finding a carrier

We do not underestimate the issues with finding a carrier and realize that the women who need this help, are in some ways forgotten in the infertile population. The women who need to use a gestational carrier often struggle with not only the emotional issues of being unable to carry their own child, but also the additional financial burden and challenge of finding a woman who is willing to do this for them. After passing both medical and psychological screening exams, a gestational carrier is available to be matched. Once the agency has matched a couple or individual with a gestational carrier and all contracts have been signed, medical treatment begins. Prior to delivery of the child, the surrogacy attorney files a declaration with the State Courts defining that the legal parents are the biological or intended parents and not the gestational carrier.

Cycle Coordination

Throughout this overview, the couple contributing the eggs and sperm is referred to as "The Female" and "Male Partner" or collectively as "The Couple" and the woman receiving the fertilized eggs and carrying the pregnancy is referred to as "The Carrier." A gestational carrier cycle requires a great deal of coordination, from selecting the carrier and matching her with a couple, to synchronizing and performing the related medical procedures. Before the cycle begins, we focus on educating the "The Couple" and the gestational carrier. Prior to begining this process, you will have met your carrier. The more you know prior to starting this process, the more comfortable you will be because you will know what to expect.

Candidates for the Gestational Carrier Program are usually couples in which the Female Partner has no uterus due to surgery (hysterectomy), has an abnormally shaped (malformed) uterus, has had an endometrial ablation, or has a medical condition that prevents her from carrying a pregnancy. These women usually are good candidates for ovarian stimulation with fertility drugs. Egg donation is also recommended to these couples when the woman is not a good candidate for ovarian stimulation because of age or decreased egg quality

1. Synchronizing the Female Partner's and Carrier's Cycles

Like The Female Partner, The Carrier will be placed on birth control pills in order to synchronize their two cycles. Instead of medication to stimulate egg development, the carrier requires a medication called Lupron (GnRH agonist) to suppress ovulation, and hormone injections (estradiol and progesterone) to prepare her uterine lining for implantation of the transferred embryos.

2. Ovulation Induction and Monitoring of the Female Partner

ART success rates depend upon the numbers of eggs or embryos available for transfer. Additionally, the egg retrieval must be carefully timed so as to retrieve mature eggs. To accomplish these two goals, ovulation induction medications and careful monitoring are employed.

The start of the ovarian stimulation is timed using oral contraceptive pills (OCP). The Female Partner takes OCP for two to four weeks prior to the beginning of the stimulation. The Female Partner begins injections of gonadotropins (Follistim, Gonal-F), according to a schedule that is provided by the clinic. We arbitrarily call this first day of gonadotropin administration Stimulation Day 1.

Once the follicles (containing the eggs) are deemed ready or mature, the Female Partner takes an injection of human chorionic gonadotropin (hCG). This hormone replaces the woman's normal LH surge, and is necessary for the final maturation of the eggs so that sperm can fertilize them.

3. Building the Carrier's Lining with Hormonal Injections
In a natural cycle the uterine lining is built up in response to the hormone estradiol that is produced by the developing follicles within the ovaries. In the carrier, we replace the follicle-derived estradiol with the medication

Approximately 4 to 6 days before the anticipated embryo transfer, daily injections of progesterone begin in order to optimize the gestational carrier's endometrium for implantation.

4. Egg Retrieval
At Fertility Specialists of Texas, the egg retrieval is accomplished non-surgically using a vaginal ultrasound probe to guide a needle into the ovaries. The procedure does not require general anesthesia and is performed with intravenous sedation. An anesthesiologist administers the sedation to maximize your comfort and safety.

5. Sperm Processing
To comply with Federal Government regulations, The Male Partner collects sperm for freezing before the IVF cycle is initiated. The sample is collected after his infectious disease screening has been completed. After the egg retrieval the frozen sperm sample is thawed and prepared for IVF.

6. In Vitro Fertilization
In-vitro fertilization literally means "fertilization in glass". Follicular fluid removed from the ovaries is examined in our lab for the presence of eggs. These eggs are isolated and placed in culture media where they are allowed to further mature. A few hours later, the processed sperm are placed around each egg.

7. Embryo Transfer to the Carrier's Uterus
At Fertility Specialists of Texas, all embryo transfers are performed under trans-abdominal ultrasound guidance. We have found that ultrasound-guided transfers are easier to perform and have resulted in higher pregnancy rates. The ultrasound allows for the accurate placement of the embryos approximately 1.5 centimeters from the top of the uterus. The embryos are transferred via a thin plastic tube and this catheter is carefully guided into the upper part of the uterus where the embryos are placed. The transfer is a painless procedure and the patient remains resting for 30 minutes, after which she is sent home.

8. Post Embryo Transfer Management and Follow-up
To ensure an optimal environment for implantation, The Carrier continues the hormone injections of Progesterone and Estradiol during the post-embryo transfer phase. 10 days after the Gestational Carrier's transfer (assuming day 5 embryo transfer) a pregnancy test is performed. If the test is positive the hormone injections continue for an additional 8 weeks until the placenta is fully functional. A second pregnancy test is obtained approximately 8 days after the first to confirm that the pregnancy is ongoing. Confirmation of a clinical pregnancy is made by ultrasound about 2 to 3 weeks later.