- Raymond M Anchan, MD, PhD
Raymond M Anchan, MD, PhD
- Assistant Professor of Obstetrics, Gynecology & Reproductive Biology
- Harvard Medical School
- Elizabeth S Ginsburg, MD
Elizabeth S Ginsburg, MD
- Associate Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
Medical science allows motherhood to be divided into three categories: the genetic, the gestational, and the social mother. These "mothers" may be represented by as many as three different individuals.
A “gestational” surrogate is a woman who agrees to carry a pregnancy for another woman (intended mother). The intended mother provides the egg and the intended father provides the sperm; rarely, egg donors or sperm donors are involved. In vitro fertilization (IVF) is used to create an embryo, which is transferred into the uterus of the gestational surrogate . The gestational surrogate has no genetic connection to the embryo.
By comparison, a “traditional” surrogate typically has a genetic connection to the embryo. The surrogate's own egg is fertilized by intrauterine insemination (IUI) of sperm from the intended father (or a sperm donor) . Therefore, the surrogate has a genetic, as well as a gestational, connection to the embryo.
The role of surrogates is usually limited to carrying the pregnancy and delivery of the infant; it does not extend to the raising of the child (social mother). However, gestational and traditional surrogates may be family members, and thus may maintain familial contact with the child .
This topic will review issues related to gestational surrogate pregnancy. Many of these issues also apply to traditional surrogacy.
- Utian WH, Sheean L, Goldfarb JM, Kiwi R. Successful pregnancy after in vitro fertilization and embryo transfer from an infertile woman to a surrogate. N Engl J Med 1985; 313:1351.
- Utian WH, Goldfarb JM, Kiwi R, et al. Preliminary experience with in vitro fertilization-surrogate gestational pregnancy. Fertil Steril 1989; 52:633.
- Ethics Committee of the American Society for Reproductive Medicine. Using family members as gamete donors or surrogates. Fertil Steril 2012; 98:797.
- Centers for Disease Control and Prevention, American Society for Reproductive Medicine, Society for Assisted Reproductive Technology. 2009 Assisted Reproductive Technology Success Rates: National Summary and Fertility Clinic Reports. Atlanta: U.S. Department of Health and Human Services; 2011.
- Practice Committee of the American Society for Reproductive Medicine, Practice Committee of the Society for Assisted Reproductive Technology. Recommendations for practices utilizing gestational carriers: a committee opinion. Fertil Steril 2015; 103:e1.
- Steigrad S, Hacker NF, Kolb B. In vitro fertilization surrogate pregnancy in a patient who underwent radical hysterectomy followed by ovarian transposition, lower abdominal wall radiotherapy, and chemotherapy. Fertil Steril 2005; 83:1547.
- Meniru GI, Craft I. Assisted conception options for patients with good-prognosis cervical cancer. Lancet 1997; 349:542.
- Siddle N, Sarrel P, Whitehead M. The effect of hysterectomy on the age at ovarian failure: identification of a subgroup of women with premature loss of ovarian function and literature review. Fertil Steril 1987; 47:94.
- Esfandiari N, Claessens EA, O'Brien A, et al. Gestational carrier is an optimal method for pregnancy in patients with vaginal agenesis (Rokitansky syndrome). Int J Fertil Womens Med 2004; 49:79.
- Beski S, Gorgy A, Venkat G, et al. Gestational surrogacy: a feasible option for patients with Rokitansky syndrome. Hum Reprod 2000; 15:2326.
- Brinsden PR. Gestational surrogacy. Hum Reprod Update 2003; 9:483.
- Stafford-Bell MA, Copeland CM. Surrogacy in Australia: implantation rates have implications for embryo quality and uterine receptivity. Reprod Fertil Dev 2001; 13:99.
- Farley DM, Grainger DA, Tjaden BL, et al. Use of a gestational carrier for a patient with recurrent adverse pregnancy outcomes from early onset severe pre-eclampsia. Fertil Steril 2007; 87:189.e1.
- Braverman AM, Corson SL. Characteristics of participants in a gestational carrier program. J Assist Reprod Genet 1992; 9:353.
- Marrs RP, Ringler GE, Stein AL, et al. The use of surrogate gestational carriers for assisted reproductive technologies. Am J Obstet Gynecol 1993; 168:1858.
- Pirhonen J, Bergersen TK, Abdlenoor M, et al. Effect of maternal age on uterine flow impedance. J Clin Ultrasound 2005; 33:14.
- Ubaldi F, Rienzi L, Baroni E, et al. Implantation in patients over 40 and raising FSH levels--a review. Placenta 2003; 24 Suppl B:S34.
- Pellicer A, Simón C, Remohí J. Effects of aging on the female reproductive system. Hum Reprod 1995; 10 Suppl 2:77.
- Cano F, Simón C, Remohí J, Pellicer A. Effect of aging on the female reproductive system: evidence for a role of uterine senescence in the decline in female fecundity. Fertil Steril 1995; 64:584.
- Abdalla HI, Wren ME, Thomas A, Korea L. Age of the uterus does not affect pregnancy or implantation rates; a study of egg donation in women of different ages sharing oocytes from the same donor. Hum Reprod 1997; 12:827.
- Navot D, Drews MR, Bergh PA, et al. Age-related decline in female fertility is not due to diminished capacity of the uterus to sustain embryo implantation. Fertil Steril 1994; 61:97.
- Cherry AL. Nurturing in the service of white culture: racial subordination, gestational surrogacy, and the ideology of motherhood. Tex J Women Law 2001; 10:83.
- Pretorius, D. Surrogate motherhood: A worldwide view of the issues. New Eng J Med 1994; 331:685.
- Golombok S, MacCallum F, Murray C, et al. Surrogacy families: parental functioning, parent-child relationships and children's psychological development at age 2. J Child Psychol Psychiatry 2006; 47:213.
- Van Zyl L. Intentional parenthood: responsibilities in surrogate motherhood. Health Care Anal 2002; 10:165.
- Fuscaldo G. Genetic ties: are they morally binding? Bioethics 2006; 20:64.
- Bravennan AM, Corson SL. A comparison of oocyte donors' and gestational carriers/surrogates' attitudes towards third party reproduction. J Assist Reprod Genet 2002; 19:462.
- Gunn, W. Bioethics and Law: Standard of Care: The Law of American Bioethics. JAMA 1994; 271:795.
- Yamamoto K, Moore SA. A trust analysis of a gestational carrier's right to abortion. Fordham Law Rev 2001; 70:93.
- Rosen A. Third-party reproduction and adoption in cancer patients. J Natl Cancer Inst Monogr 2005; :91.
- Brinsden PR. Surrogacy. In: A textbook of in vitro fertilization and assisted reproduction, Brinsden PR (Ed), The Parthenon Publishing Group, New York 1999.
- MacCallum F, Lycett E, Murray C, et al. Surrogacy: the experience of commissioning couples. Hum Reprod 2003; 18:1334.
- Massachusetts. Supreme Judicial Court. Culliton v. Beth Israel Deaconess Medical Center. Wests North East Rep 2001; 756:1133.
- American College of Obstetricians and Gynecologists’ Committee on Ethics. ACOG Committee Opinion No. 660: Family Building Through Gestational Surrogacy. Obstet Gynecol 2016; 127:e97.
- Guichon J. The body, emotions and intentions: challenges of preconception arrangements for health care providers. CMAJ 2007; 176:479.
- Reilly DR. Surrogate pregnancy: a guide for Canadian prenatal health care providers. CMAJ 2007; 176:483.
- Adams KE. Gestational surrogacy for a human immunodeficiency virus seropositive sperm donor: what are the ethics? J Am Med Womens Assoc (1972) 2003; 58:138.
- Ethics Committee of the American Society for Reproductive Medicine. Consideration of the gestational carrier: a committee opinion. Fertil Steril 2013; 99:1838.
- Duffy DA, Nulsen JC, Maier DB, et al. Obstetrical complications in gestational carrier pregnancies. Fertil Steril 2005; 83:749.
- Parkinson J, Tran C, Tan T, et al. Perinatal outcome after in-vitro fertilization-surrogacy. Hum Reprod 1999; 14:671.
- Brinsden PR, Appleton TC, Murray E, et al. Treatment by in vitro fertilisation with surrogacy: experience of one British centre. BMJ 2000; 320:924.
- Meniru GI, Craft IL. Experience with gestational surrogacy as a treatment for sterility resulting from hysterectomy. Hum Reprod 1997; 12:51.
- Batzofin, J, Nelson, J, Wilcox, J, et al. Gestational surrogacy: is it time to include it as part of ART? Fertil Steril ASRM Annual Meeting Programme Supplement 1999.
- Goldfarb JM, Austin C, Peskin B, et al. Fifteen years experience with an in-vitro fertilization surrogate gestational pregnancy programme. Hum Reprod 2000; 15:1075.
- Raziel A, Schachter M, Strassburger D, et al. Eight years' experience with an IVF surrogate gestational pregnancy programme. Reprod Biomed Online 2005; 11:254.
- Corson SL, Kelly M, Braverman AM, English ME. Gestational carrier pregnancy. Fertil Steril 1998; 69:670.
- Anchan, RM, Ginsburg, ES. Gestational carriers: A viable alternative in assisted reproductive medicine. American Society for Reproductive Medicine 62nd Annual Meeting Abstract P-133. New Orleans, Louisiana.
- Gibbons WE, Cedars M, Ness RB, Society for Assisted Reproductive Technologies Writing Group. Toward understanding obstetrical outcome in advanced assisted reproduction: varying sperm, oocyte, and uterine source and diagnosis. Fertil Steril 2011; 95:1645.
- Jadva V, Murray C, Lycett E, et al. Surrogacy: the experiences of surrogate mothers. Hum Reprod 2003; 18:2196.
- Jadva V, Imrie S, Golombok S. Surrogate mothers 10 years on: a longitudinal study of psychological well-being and relationships with the parents and child. Hum Reprod 2015; 30:373.
- Jadva V, Imrie S. Children of surrogate mothers: psychological well-being, family relationships and experiences of surrogacy. Hum Reprod 2014; 29:90.
- Nonfunctioning uterus
- Maternal medical disease
- Biologic inability to conceive or bear a child
- MEDICAL MANAGEMENT AND PSYCHOLOGICAL EVALUATION
- FINDING A GESTATIONAL SURROGATE
- SELECTION OF A GESTATIONAL SURROGATE
- CONTRACTUAL ISSUES
- PROTECTION OF GESTATIONAL SURROGATES
- SUMMARY AND RECOMMENDATIONS