IVF Surrogacy/Gestational Carrier Program

ACFS has watched the demand for surrogacy, mainly the need to use a gestational carrier, increase dramatically over the last 10 years. ACFS has made the decision not to do traditional surrogacy (TS), where the surrogate, using her own eggs, is inseminated with the patient's partner's sperm and then carries the pregnancy to term. TS involves the greatest risk that the surrogate will change her mind and decide that she either wants to keep the baby or, at least, have visitation rights. In 44 states, surrogacy is legalized, and is not a problem; but in 6 states, Arizona being one of them, surrogacy, in any form, is illegal and has to be set up as an adoption, there can be no contract and the GC cannot be offered money other than normal living expenses related to the procedure and pregnancy. ACFS has done numerous IVF surrogacy procedures with good success, but to avoid any possibility that the surrogate may change her mind, ACFS will only provide services when surrogacy is done by using a gestational carrier GC).

Some women think that since they were born without a uterus (mulleriana genesis) or their uterus has been removed (hsyterectomy) that they can no longer have children. That is not true, as long as she has her ovaries, she can be given gonadotropins to make multiple eggs, which can be recovered vaginally, fertilized with her partner's sperm and than transferred into a gestational carrier. If she does not have ovaries, she can use donor eggs. A lot easier said than done. The hard part is finding a person who is willing to carry the pregnancy.

Other reasons to consider using a GC are:

1. Continued pregnancy loss after treatment
2. Serious medical condition where pregnancy is contraindicated, like congenital heart disease or severe diabetes
3. Severe scarring of the uterine cavity, known as Asherman's Syndrome, due to previous uterine surgery, D&Cs and/or subsequent uterine infections
4. Multiple uterine surgeries, like cesarean sections or fibroid surgery, where the woman was told that being pregnant was unsafe because of the increase risk of uterine rupture during that pregnancy

The GC, ideally, should be a family member or close friend, so there are no issues about giving the baby up for adoption after the GC gives birth. Also, by using a GC, she will not be using her own eggs, and the "attachment should be less". In Arizona, since surrogacy is not approved, it has to be done as an adoption; where at birth, the GC will give up the baby for adoption. The adopting couple does not have to go through the traditional adoption process. All parties involved will sign legally binding papers, that have been prepared in advance; with the GC giving up all parental rights, and the couple formally adopting the child.

When a GC is being considered, she can carry embryos that came from the patient's eggs or donor eggs, fertilized by the patient's partner's sperm or donor sperm. The procedure is similar to using donor eggs; with the patient being the "egg donor" and the GC being the "recipient". The cycles are synchronized by putting the GC, "the recipient", on Lupron for 30 days and then starting her on oral estrogen to prepare the lining of her uterus for implantation. The patient, or "egg donor", is started on gonadotropins for multiple egg follicle development and followed by ultrasound. Once the patient's, or "donors", follicles reach 18 mm in size, she is given 10,000 IU of hCG to trigger ovulation and TVA (transvaginal ultrasound aspiration) of her eggs is scheduled for 36 hours. The day after egg recovery, the GC, or "recipient", begins either intramuscular (IM) progesterone injections or progesterone vaginal gel (Crinone), stops her Lupronand continues her estrogen. Egg recovery is done and the eggs are fertilized by ICSI, to maximize the percentage of fertilization, and the embryos are cultured until a day 3 or day 5 blastocyst transfer to the GC. Additional procedures like PGD or AH are done prior to transfer, as indicated. The GC then stays on her estrogen and progesterone until a pregnancy test 9-11 days later depending on when the transfer was done. The "donor" does not need to do anything further and waits for her period. If the pregancy test is positive the GC stays on all her medications and is followed by ultrasounds every 1-2 weeks until1 2-14 weeks pregnant when the placenta is fully functional to make all the hormones needed to support the pregnancy. At that time, the GC can stop all her meds, unless otherwise instructed.

Being a gestational carrier is a profound selfless gift that one person can do for another.

GESTATIONAL CARRIER CONSENT

I/we have been informed of the following procedures, risks and limitations and have had the opportunity to discuss these with my physician.

1. If fertilization is successful, a pre-determined number of embryos will be transferred into the uterus by a small catheter inserted through the cervix based on ASRM guidelines for the age of the "donor’s" age.
2. Transferring the embryos into the uterus may cause slight discomfort, cramping, spotting, or infection. There is a possibility of ectopic pregnancy, although extremely unlikely, with any attempt at pregnancy. This would require treatment by MTX (methotrexate) or surgery to remove the ectopic pregnancy.
3. The transfer of multiple embryos may result in multiple gestation. The risks of prematurity and other complications have been explained.
4. Medical emergencies may make an operating room and/or anesthesia unavailable, but this is rare.
5. The embryo(s) may not develop normally and therefore would not be transferred.
6. Implantation may not occur.
7. A laboratory accident may result in loss or damage to the egg, sperm, or embryo, but this is rare and has never happened, to date, at ACFS.
8. Transfer of the embryo(s) may not be successful.

The goal of this procedure is to achieve a normal pregnancy. Once the pregnancy is established, miscarriage, ectopic pregnancy, stillbirth and/or congenital abnormalities may occur. There is no evidence to date that the occurrence of these is increased or decreased by this procedure.

Although, many couples are already working with an adoption attorney to draw up the necessary legal papers for the final adoption; if you do not have one, ACFS recommends Dan Ziskin, who is an attorney that specializes in reproductive law, and has many years of experience dealing with issues related to reproductive medicine.

Dan Ziskin
301 E. Bethany Home Rd.
Ste# B 100
Phoenix, AZ 85012
W# 602-234-2280
Fax# 602-274-9297