Gestational surrogacy is an amazing way to grow a family. It allows individuals and couples the ability to have children in situations where it would have been impossible just a few decades ago. There are so many misconceptions around how a surrogate becomes pregnant! So, how does surrogacy work?

What is the Difference Between Traditional Surrogacy and Gestational Surrogacy?

Traditional surrogacy is where the surrogate is both the egg donor and the person carrying the child —and therefore has a genetic relationship with the baby.

In this type of surrogacy, the surrogate is impregnated using a process called intrauterine insemination (IUI), where a doctor takes sperm from the intended father or donor and transfers it into the uterus of the surrogate. Then, natural fertilization of the egg takes place. Despite the common misconception, there is no intercourse!

Due to advances in medical science, traditional surrogacy is becoming much less common than gestational surrogacy.

Gestational surrogacy is where the surrogate has an embryo implanted into her uterus—and therefore has no genetic relationship with the baby. This is the most common type of surrogacy today. 

In gestational surrogacy, the intended mother’s egg or a donor egg is fertilized with the intended father’s sperm or donor sperm, and the embryo is implanted in the surrogate’s uterus using in vitro fertilization, or IVF.

Reasons for Gestational Surrogacy

There are a host of reasons that a person may be unable to get pregnant or carry a pregnancy to term. Often, the underlying reason that a person can’t deliver a baby themself is more obvious, such as when a woman has had a hysterectomy, a person is transgender, or a male couple that does not have a uterus. Other times there may be other medical issues in their history or mental health related issues that might make carrying a child difficult or not recommended.

All Parties Go Through Screening

Each person involved in the gestational surrogacy will undergo some type of medical screening; the most thoroughly screened being the carrier. Someone may choose to use a gestational carrier who they know personally, such as a sister or close friend. Other times, a surrogate will be screened via an agency. In either case she will be evaluated for physical, emotional and psychological health to ensure the best possible odds of a successful and healthy outcome for all parties.

The FDA has testing guidelines in place for egg and sperm donors using a gestational carrier. It may seem silly to people who aren’t technically “donors” as they are using their own genetic material, but the rules still apply! These guidelines are to prevent the spread of disease and minimize risk to the surrogate. Genetic testing is also frequently performed on the embryos to increase the odds that the transferred embryo will be free of chromosomal disorders.

Whether or not the intended parent(s) provide the eggs or sperm themselves or a donor is used, they will undergo psychosocial education and counseling. This counseling helps the intended parents understand the impact that the pregnancy will have on relational and community dynamics, as well as develop a plan regarding future contact with the gestational carrier.

How IVF is used in Gestational Surrogacy:

First, the biological mother (or an egg donor) takes fertility medications to produce multiple mature eggs that are ready for fertilization.

The next step is an egg retrieval where the doctor collects the mature eggs from the woman, typically through a process called transvaginal ultrasound aspiration. The woman is sedated and given pain medication first. Next, an ultrasound probe is inserted into the vagina to identify follicles. Finally, the doctor inserts a thin needle into an ultrasound guide, which goes into the follicles and retrieves the eggs. This entire process only takes about 15–20 minutes!

Sperm is collected from the partner (or a donor) and the eggs are fertilized in a lab. To fertilize the egg, the sperm is either injected into the egg or mixed with the egg in a petri dish.

The embryo grows in the lab for two to five days. Typically, the 3- or 5-day old embryos are frozen to await the right timing to be transferred to a gestational surrogate.

In preparation for the embryo transfer the gestational carrier will take medications, typically estrogen and progesterone, but depending on a clinic’s protocol frequently more medications as well, to make her body mimic a hormonal cycle of early pregnancy. In addition, she has multiple ultrasounds to assess her uterine lining in preparation for the transfer as well as blood draws to check hormone levels.

During embryo transfer, the doctor inserts a catheter into the vagina, which then goes through the cervix and into the uterus. There is a syringe at the end of the catheter which contains the embryo in a small amount of fluid. Using the syringe, the doctor inserts the embryo into the uterus! Just like traditional surrogacy, despite the misconception, there is no intercourse to get the surrogate pregnant!!

Fun fact! If transferring a 5-day embryo, the gestational carrier will be considered 2 weeks 5 days pregnant on the day of the transfer!

Gestational surrogacy is an excellent option for many individuals who are unable to have children without that assistance. We are passionate about creating ideal matches between surrogates and intended parents and providing an exceptionally supportive environment throughout the surrogacy journey. If you're looking for more information on how gestational surrogacy can work for your family, or considering becoming a surrogate yourself, or simply want to learn more about the surrogacy process, get in touch today!