Q: [Whole Family] I have watched my sister struggle with infertility and miscarriages. It is heartbreaking and I want to help. My husband and I already have a full family, I would love to be her surrogate. Other than the emotional concerns, what physical considerations do I need to know about before I offer?
A: Helping couples achieve this long-hoped for dream is one of the most altruistic expressions of love and support for another person. It is important to be evaluated by a physician to ensure you are physically ready to carry another pregnancy. This determines whether your obstetric history may increase complications, ensures no current medical conditions that may affect your health or that of the baby, and rules out any active infections that may be transmitted to the fetus.
Ideally, surrogates have had one or more uncomplicated pregnancies and term births, less than 6 vaginal or 4 cesarean births. It is ideal to be between 25 and 40-45 years of age. One imperative is to have a stable family environment that is conducive to her pregnancy.
The process of becoming pregnant entails taking hormones to prepare your uterus to accept one or more embryos. You will be monitored by a fertility specialist to ensure the uterine lining is appropriate. The embryo transfer itself is a minor procedure that involves a tiny catheter placed into your uterus under ultrasound guidance.
The pregnancy isn’t significantly impacted by medical conditions of intended parents. The live birth rate is equivalent or better than women of similar age pregnant with in-vitro fertilization.
This physical portion is only one facet of the surrogacy process. Potential carriers must undergo a psychological evaluation. Legal contracts must be drawn up. The carrier must clarify desires and expectations surrounding potential pregnancy complications (for example, it’s important to determine how to handle a prenatal diagnosis of a chromosome abnormality or birth defect). The surrogate, especially when the intended parents are family members, must determine how best to approach the family, the intended parents, and the relationship with any children born through this surrogacy process.
Though complex, the process of being a surrogate would be overseen by a fertility center. A great resource for more information is reproductivefacts.org, which is produced by the American Society of Reproductive Medicine. Best of luck to you and your sister!
Lauren Rubal, MD is a Reproductive Endocrinology and Infertility Specialist with the Kaiser Permanente Orange County Obstetrics and Gynecology Department. Dr. Rubal has a special interest in recurrent miscarriage, anovulation, and oncofertility.
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