Gestational Surrogacy – What is it and How does it Work?

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Parents with the surrogate mother of their child.

Surrogacy, by its very definition, is where a woman raises a child in her womb that isn’t her own and later hands it over to the parents who’ve been wanting a child for themselves. Although traditional surrogacy had been popular earlier, looking for a gestational surrogate has gained prominence amongst parents wanting a child that is biologically their own.

What is Gestational Surrogacy?

Parents with the surrogate mother of their child.

A woman offers her uterus for the growth of a baby, which is then delivered and handed over to the parents for whom she was the carrier. However, this surrogacy does not have the baby carrying any genetic traits of the surrogate mother. The fertilisation process happens outside the womb, using the eggs and the sperm.

How is Gestational Surrogacy Different from Traditional Surrogacy?

For a long time, traditional surrogacy was how a childless couple could enjoy the joys of being parents. In an infertile couple, the fertile partner would end up having intercourse with another partner. As medical science improved, the process of intercourse was replaced with in-vitro fertilization or IVF.

In such cases, no matter who the baby goes to, biologically, the child is a combination of a different sperm and egg as that of the actual parents. With gestational surrogacy, it is just the uterus of the surrogate mother that is used for the growth and development of the baby. Once the embryo is formed, it is transferred to the surrogate mother, who ends up raising the baby for a full-term pregnancy.

Who can Opt for Gestational Carriers?

Although gestational carriers are primarily used by infertile couples, there are a number of scenarios where someone might opt for one. These are usually:

  • If a woman has opted for removal of her uterus and cannot biologically hold a baby.
  • If a woman’s uterus is not optimal for the baby’s development due to certain conditions.
  • If a woman has had repeated miscarriages or the body is unable to hold a baby for a full-term.
  • If multiple fertility treatments have failed to conceive a child successfully.
  • If the couple is a same-sex couple or a single man/woman wanting to be a parent.

Possible Risks of Gestational Surrogacy

As with any medical procedure, there are certain risks that accompany gestational surrogacy as well, which you should be completely aware of before opting for it.

  • Since the eggs that are used for fertilization in a gestational surrogacy come from the mother, she would need to undergo a procedure for inducing ovulation and retrieving eggs from the body. This process itself carries quite some risks. On the other hand, if donor eggs are being used, then such a process is not required.
  • A larger risk poses itself in the form of financial investment that comes with gestational surrogacy. Not only will the gestational carrier have a fee for carrying the baby for the full pregnancy term, but all the medical costs that are associated with it have to be borne by the opting parents. These include all the checkups and tests that are regularly required to monitor the baby’s growth, but also the costs that might arise in the presence of any complications or requiring any surgery if the case arises so. These can easily go quite higher than expected.
  • Perhaps the biggest risk involving gestational surrogacy, or surrogacy of any sort for that matter, is an emotional one. Prior to proceeding ahead with the procedure, a number of contracts and legal documents will be signed to ensure that the child that a surrogate mother delivers will be legally and rightfully the child of the intended parents. But, the entire journey of pregnancy and the process of delivery could cause the surrogate carrier to develop a strong attachment for the baby and not adhere to the terms set in paper. The loopholes in laws present in various areas could create unseen complications in this regard, bringing into question the legal ownership of the child. Even though that may not always be the case, the parents opting for such a surrogacy might live in perpetual worry and anxiety of dealing with a situation like this, if it were to arise.
  • A massive health risk is taken by the gestational carrier herself in carrying the baby to full term. Many times ovulation needs to be artificially induced to be able to have the embryo successfully implant itself in the uterus. This does merit additional compensation for the carrier but that may not always happen. Even if a family member or a friend agrees to be the carrier, the parents need to be aware of the risks she would be taking as well, and make sure she is cared for on those lines.

How can you Get Started?

If your decision of proceeding ahead with gestational surrogacy has attained a complete acceptance, then it is time to start understanding how to begin with it.

1. Finding a Willing Gestational Carrier

This is the process that might take quite some time by itself. Some parents prefer asking the people closest to them, including their friends and family, if they’d be willing to be a surrogate for their child. Certain private agencies house profiles that can be used to find the right one for you, based on various parameters. A good carrier generally has a previous history of successful deliveries, is around between the ages of 20-40, and is healthy with a good support system for herself.

2. Undergoing Necessary Counselling

The process and journey of gestational surrogacy look simple and straightforward on paper. However, most parents are quite unaware of dealing with the emotional impact that accompanies it. Once a surrogate has been selected, it is best to have a common counselling session with a fertility expert, who would walk you through the stages and help you manage the various scenarios that might arise. Any emotional queries or figuring out a relationship standpoint can be freely discussed at this stage.

3. Medical Evaluation of The Sperm and Egg

For parents who would be using their own sperms and eggs, a genetic and medical evaluation would be required. In case of donors, most of them are usually screened before making them available for parents. The evaluation ensures that both the sperm and the egg are in a condition that is good enough to have a successful IVF, as well as there exist no medical complications as such, which might affect the gestational carrier.

4. Medical Evaluation of The Surrogate

If your surrogate has been arranged by a private agency, they would mostly have all her medical evaluation in place or might undertake a recent one themselves. In any case, a recent medical checkup is highly advised to address any issues or complications in her health or constitution. At the same time, if the carrier is married, then her partner might also have to undergo a checkup as well as a psychological evaluation to understand the impact of the surrogacy.

5. Getting All Legal Matters Cleared

A legal agreement is absolutely necessary for the benefit of both, the parents as well as the surrogate. It is advised for each party to have their own advocates, who can go through the details of the agreement, and reach a final contract that is acceptable to both. Keep all aspects of finances, transfer of rights, the legal acquisition of the baby prior to after delivery, and many other pointers clear in the legal contract.

Gestational Surrogacy Process

A simpler way of looking at gestational surrogacy is to equate the surrogate mother as an oven and the baby as a food item prepared by someone else. This clarifies a mental thought process regarding the ownership of the child.

Once surrogates are selected and legal requirements satisfied, there are many more procedures to undergo. Blood tests and ultrasounds will be done regularly to keep a constant check on the surrogate. Furthermore, a variety of hormones are injected into the carrier so that the body prepares itself to go into a pregnancy mode. This continues for about a month until the doctors are sure that the hormones have been successfully absorbed by the body.

If the body is prepared and the embryo has been formed after successful fertilization, the important part begins. The transfer of the embryo into the surrogate’s womb is done by using a technique which makes use of an ultrasound-guided catheter. This enters the woman’s body via the cervix and implants the embryo on the uterus. Hormone injections might continue even after that and blood levels will be checked regularly to look for signs of pregnancy

In unfortunate cases, the embryo may fail to take hold. In such a case, all medical procedures are stopped immediately and the surrogate undergoes a menstrual cycle. Following that, if both parties approve, the process is tried again with a different embryo.

How does Gestational Surrogacy Work?

Carrying out gestational surrogacy can be done in multiple ways, depending on the availability of eggs or embryos.

1. How Does It Work with Fresh Eggs

  • Menstrual cycles are matched so that the timings of retrieving your eggs and preparing your embryo is in sync with the uterus of the surrogate being ready to accept an embryo to be implanted.
  • Egg production is stimulated using gonadotropin medicines.
  • Once eggs are matured, they are retrieved and fertilized using the necessary sperm.
  • When they achieve fertilization, the embryo is transferred to the surrogate.

2. How Does It Work with Frozen Eggs

  • The surrogate is already on the appropriate medical procedures required to prepare her uterus for implantation.
  • Once the time is close, the frozen eggs are thawed and fertilization is commenced using the appropriate sperms.
  • These fertilized embryos are then transferred to the ready uterus.

3. How Does It Work with Frozen Embryos

  • This is quite similar to how frozen eggs are prepared, only that the waiting time is even less.
  • Since the embryo is already ready, once the surrogate achieves a prepared uterus, the embryo is thawed and inserted into the carrier for implantation.

How Long does the Process of Gestational Surrogacy Take?

Finding a willing surrogate itself can take many months to even a year or more. As for the medical procedures, around 3-4 IVF cycles, each lasting 4-6 weeks, might be required for a successful pregnancy to be attained.

Success Rates of Gestational Surrogacy

The success rates for surrogacy using one’s own eggs begin at 51 percent for women up to 34 years old and then starts reducing down to 10 percent for women beyond the age of 43. If frozen eggs are used instead, these success percentages are increased slightly.

What are the Benefits of Gestational Surrogacy?

Some of the benefits of gestational surrogacy are,

  • Everyone from infertile parents to same-sex couples can enjoy the joys of parenthood with this.
  • The child has the same genetic traits as that of the intended parents, making it biologically their own.
  • Surrogacy helps develop a strong bond with the carrier and helps in easy transfer of the child since the baby is not biologically related to her.

What are the Drawbacks of Gestational Surrogacy?

Gestational surrogacy has a few disadvantages like,

  • Opting to use for your own eggs might make it necessary to get the required fertility treatments for successful fertilization.
  • Intended mothers could have a hard time coming to the terms of another woman enjoying the process of pregnancy for their own child.
  • The legal complications are immense and the expenses in such cases are quite high.

How Much does Gestational Surrogacy Cost?

The costs can vary from person to person and agency to agency, along with the medical expenses, all ranging from 15 lacs to even 40 lacs or higher.

Gestational surrogacy is one of the best ways to have your own biological baby born the natural way. With the right measures in place, and by undertaking the right medical precautions, gestational surrogacy allows you to not only form a great bond with the carrier and ensure proper growth of the baby, but also be the joyous parents of a child that is your very own.

Also Read:

Surrogacy: Treatment for Fertility
Heterotopic Pregnancy
Fertility Treatments Options for Women
Intrauterine Insemination (IUI) Process

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