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Overview

For some, welcoming a child into the world is among life’s top priorities. If a woman is unable to carry a pregnancy to term, gestational surrogacy may be the best option. Also called a surrogate, a gestational carrier is a woman who carries and delivers a child for a couple or individual.

Surrogate mothers are impregnated through the use of in vitro fertilization (IVF). This is a treatment option for managing infertility, in which doctors create an embryo by fertilizing eggs from the intended mother or an egg donor with sperm from the intended father or a sperm donor. Because the gestational carrier doesn’t provide the egg, she is not genetically related to the child.

Yale Fertility Center’s Third Party Reproductive Program has achieved successful results for couples from around the country and all over the world for more than 20 years.

“Gestational surrogacy is a great option for people who really want to be parents but have faced long odds.” says Emre Seli, MD, a reproductive endocrinologist and infertility specialist. “Gestational surrogacy alone or in combination with egg donation is used with great success at the Yale Fertility Center.” 

Who may benefit from gestational surrogacy?

After a comprehensive medical evaluation, our reproductive endocrinology and infertility experts will determine if you need a gestational carrier. A carrier may be recommended for the following patients:

  • Women without a functioning uterus
  • Women who have acquired disorders that make their uterus unsuitable for pregnancy such as extensive fibroids, scarring of the uterine cavity or adenomyosis (when the inner lining of the uterus grows into the wall of the uterus)
  • Women who have a medical condition that puts them at significant medical risk if they become pregnant
  • Women who have a history of recurrent pregnancy loss

Gestational surrogacy is also an excellent option for male same-sex couples who want to have children. 

What steps are involved in finding a surrogate carrier?

At the Yale Fertility Center, the first step in learning more about gestational surrogacy is a consultation with a program counselor. At this appointment you will learn about all that is involved, including education about the process of finding a gestational carrier, the types of screening required, treatment protocols and program costs. Our program counselor will also discuss the social and psychological aspects of gestational surrogacy.

Following that meeting, the next step for potential parents is to see a Yale Fertility Center physician for a medical consultation (generally the same day). This meeting includes a comprehensive description of the surrogacy process, as well as a thorough evaluation and review of the intended parents’ medical history, a medical examination, information about what the treatments will entail, and a discussion of possible side effects and medical complications.

How do I find a gestational carrier?

Gestational surrogacy can be complicated, so we require that couples choosing a gestational carrier work with an agency and provide a signed contract to us prior to the initiation of treatment medications. The agency’s role, typically, involves identifying a potential carrier and establishing legal agreements between the parties. We provide interested parties with an agency referral list.

According to program counselor Dorothy Greenfeld, MSW, “Most surrogates want the intended parents to be involved in the pregnancy.” Therefore, she says, “I always tell intended parents that they should be clear about their geographical restrictions and how far they are willing to travel.”

Though they are paid for their services, most gestational surrogates have altruistic motivations and enjoy being pregnant, she adds. “In the contract, there is a line about the surrogates’ expectations in terms of contact after the baby is born,” Greenfeld says. “Often, they just want an occasional holiday card or something simple like that.” 

How is the gestational carrier screened?

The ideal surrogate falls within the guidelines of the American Society for Reproductive Medicine (ASRM). She should be a healthy woman between the ages of 21 and 42 (preferably younger than 35), with a history of a normal pregnancy and full-term delivery without complication. 

The Yale Fertility Center also requires gestational carriers to have a body mass index (BMI) less than 30 (preferably less than 27), and not to have had more than two caesarean section deliveries in the past.

Can a friend or family member be the gestational carrier?

Yes, if she meets our screening criteria.

What is the medical process?

Once you identify a potential gestational carrier, we will provide the evaluation and medical treatment. Evaluation includes a thorough medical and psychological screening by our staff, and a consultation with our colleagues in Maternal-Fetal Medicine. The gestational carrier will also undergo a mock (or trial) cycle that mimics the medication protocol followed during the embryo transfer cycle. The purpose of the mock cycle is to evaluate the response of her uterine lining to the medications, which helps prepare the uterus for the implantation of an embryo.

Depending on the individual’s or couple’s medical condition, eggs will either be donated by the intended mother or by someone else. Similarly, sperm may come from the intended father or from a donation. Fertilization of the eggs by the sperm will occur via IVF to produce embryos.

The gestational surrogate’s cycle will be synchronized with the ovulation induction (or stimulation of ovulation using medication) of the intended mother in order to create the best possible environment for the embryo. The embryo is then transferred to the carrier, who will deliver the baby.

“After the transfer, which we do in our offices, we follow the surrogate for 10 weeks until we can hear the baby’s heartbeat. At that point, she can return to care from her own obstetrician-gynecologist,” Greenfeld explains. 

Is a legal contract necessary?

Yes, a legal contract is required for both parties, intended parents and their gestational carrier, before proceeding with medical treatment.

What are the program costs?

Total costs vary, depending on whether you and your partner have insurance coverage for testing and medications. You will meet with a financial coordinator at the time of your initial visit for a complete review of the fee schedule.

What stands out about Yale Medicine’s approach to gestational surrogacy?

The Yale Fertility Center’s Third Party Reproductive Program offers state-of-the art treatment and have successfully facilitated parenthood to many through assisted reproduction. 

“Our patient-centered approach is aimed at making this medically complex procedure a smooth and easy one for our patients,” Dr. Seli says.