What Texas couples need to know about gestational surrogacy
February 13, 2018
One of the best aspects of working at an academic medical center is having the freedom to proactively respond to the needs of patients. Our gestational carrier program was born as a result of patients having their eggs harvested and resulting embryos frozen at UT Southwestern but could not carry the pregnancy themselves while wanting to have their babies.
This essential addition to our infertility program offers hope to couples who might have never had their own children. Couples don’t have to be wealthy celebrities like Kanye and Kim Kardashian West to seek gestational surrogacy services. We help people from all walks of life across North Texas successfully conceive, and protecting the safety and health of both the carrier and the baby is our highest priority.
There are many important points to consider before embarking on the sometimes long and emotional journey of surrogate pregnancy, but when you’re ready, our care team will be there with you, from preconception screening through delivery and beyond.
Who might consider gestational carrier services?
We work with a wide range of couples and individuals. Three of our most common categories of patients include:
1. Women without a uterus or with uterine complications
Many of these women still have functioning ovaries from which we can harvest and cryogenically freeze eggs or embryos. If not, these women have access to donor eggs.
2. Women or couples with hereditary conditions or contraindications to pregnancy
Some health conditions make it risky for a woman to carry a baby, including certain heart conditions, cancers, or autoimmune disorders such as lupus. While their eggs might be healthy, their general health might be put at risk by pregnancy. As such, so would the baby’s.
3. People in the LGBTQ community
Many LGBTQ couples want to have children but can’t conceive on their own. We help them start families with gestational carriers through egg, embryo, or sperm donation.
Those who want to have a baby through a gestational surrogate are called the commissioning couple. The woman who will carry their baby is the gestational surrogate or carrier. All parties are considered as patients.
Legal items to consider regarding gestational carriers
Some commissioning couples choose a family member or a close friend to carry their baby, and some go through reputable agencies. Our program does not connect couples to gestational carriers. In Texas, the gestational surrogate cannot use her own eggs as in traditional surrogacy. In other words, the carrier cannot be the biological mother of the baby. The egg must come from a screened and eligible donor or from the commissioning female.
In order to join our program, the commissioning couple and the patient must agree to each other’s terms and conditions. We require a letter of agreement between the commissioning couple and the carrier, which often comes from the couple’s lawyer. We are not involved in this process.
We also require that all commissioning couples and gestational carriers undergo health screenings as determined by the Food and Drug Administration. This includes testing for sexually transmitted infections prior to the embryo transfer. Once these tasks have been completed, the patient can enter our program to start the conception process.
How our gestational carrier program works
Before we talk conception, we examine the gestational carrier to make sure she can safely carry a baby. We give her the same exam we’d give any patient seeking preconception care, including a physical exam and getting a solid health history to determine risk factors. We don’t want to put the gestational carrier at more risk than that of a typical pregnancy. The patient must have a history of healthy, uncomplicated pregnancy and be free of pregnancy risk factors. We also assess her uterus and uterine cavity with ultrasound techniques.
If the patient passes this initial evaluation, she’ll meet with one of our psychologists to ensure that she fully understands the emotional implications of pregnancy and that she has volunteered to help the commissioning couple of her own free will. Then she’ll meet with a maternal-fetal medicine specialist to discuss the general risks of pregnancy, including the possibility of having multiple babies or developing a condition such as blood clots, preeclampsia, or gestational diabetes.
Once we agree that the patient is physically and emotionally healthy enough to be a gestational carrier, we can proceed with the embryo transfer process. Our infertility experts will combine the couple’s or donated eggs and sperm for fertilization and implant the embryo(s) within the uterus of the patient. We transfer no more than two embryos at a time to reduce the risk of multiples and to protect the health of the gestational carrier. In terms of number of embryos transferred, the age of commissioning female, embryo stage, and embryo grades are taken into account following The American Society for Reproductive Medicine guidelines.
If the implantation is successful, the rest of the pregnancy will be managed just like any other pregnancy. We’ll have the gestational carrier in for routine exams and ultrasounds, which, depending on the agreements and preferences of both parties, the commissioning couple is welcome to attend. When it’s time for the baby to be born, the commissioning couple often is in the delivery room to support the patient and watch their child come into the world. During the immediate post-partum period, the commissioning couple might be able to stay in their own hospital room with the infant, allowing them the same chance to bond with their new baby as other new parents.
Things to consider before choosing a gestational carrier
It’s important to really know your gestational carrier and trust each other before you enter into a contract. When everything goes well, the carrier is a hero. But when something goes wrong, such as a pregnancy loss or a breach of contract, it can have devastating consequences on the commissioning couple’s and carrier’s relationship.
It’s also vital to make sure all financial obligations are covered. Check with your insurance provider about coverage before entering a gestational carrier program. Depending on the terms of your legal contract and the insurances involved, the cost of gestational carrier services can vary. UT Southwestern’s program includes financial counselors to help navigate coverage and answer any questions either party might have. In Texas, pregnancy is covered by most insurances.
After delivery comes the final paperwork. Married couples in Texas can easily get a birth order stating that the biological parents (the commissioning couple) should be listed on the birth certificate. The process needs more legal proceedings for unmarried couples, which should be discussed with a qualified legal professional.
Where you seek gestational carrier services and care is important. As mentioned, many commissioning couples want to use our services because they have an existing patient relationship with us and since we have a close relationship with our maternal-fetal medicine group we can coordinate the evaluation. Patients and commissioning couples also have access to an entire health system of experts in genetics, cardiology, endocrinology, neurology, and any other field they could need in the event of unexpected concerns during pregnancy or after delivery.