By Dr. Joe Massey, MD
In honor of Pride Month, we’re addressing the possibility for men to have a child or children through a gestational carrier, whether they’re partnered, married, or unpartnered.
All fertility clinics have access to eggs from a wide choice of egg donors. Often these eggs are frozen, and they are available in batches of 6 to 12. You’ll be able to review detailed aspects of the various listed egg donor’s health, education, and social situation, as well as photographs to consider physical characteristics. All donors are go through a screening process prior to being approved to donate their eggs.
Egg donor screening process
Egg donors are paid to produce eggs, which carries considerable cost. Part of the cost is associated with the rigorous screening involved to qualify an egg donor. Prospective donors fill out an extensive health questionnaire with focus on their personal and family history. If close relatives have major birth defects or hereditary diseases, they are excluded. Aspects of their social history will exclude many, as does obesity and other adverse personal medical data.
There is extensive testing for carrier states, searching for mutations in the genes which put babies at risk for serious disorders. If a donor has a positive test, as many do, the man providing the sperm should be screened to be sure he does not have the same disorder. Your positive test for a carrier state for rare disease is not a threat as long as the egg donor is clear of the same mutation. We all have mutations, so it’s not something to be overly concerned with; both the male and female must have the same mutation to put children at risk.
If the donor has evaluation of her ovarian reserve and appears to be a promising egg donor, she has a physical exam and sexually transmitted disease testing. Another important step is an interview with a specially trained independent counsellor. In some processes, a donor will undergo an objective evaluation for mental health disorders.
Compassionate egg donor
In some cases, the couple will know their egg donor; she is called a compassionate egg donor. This would be perhaps a relative or a close friend who is willing to go through the rigors of being an egg donor. This is wonderful if the donor is under age 32 and meets the screening requirements applied to other donors.
A compassionate donor is subjected to much of the same screening as an anonymous egg donor for the health of her ovaries, termed ovarian reserve, and her general health. Blood testing for screening for sexually transmitted disease protects everyone. In-person psychological counseling with an experienced counselor will validate that she is making a decision that is in her best interests.
Egg donor retrieval
To produce eggs, the donor goes though injectable hormone stimulation of the ovaries and has frequent monitoring visits for blood tests and ultrasounds. When eggs are optimally developed, she has eggs retrieved with a needle with ultrasound guidance under anesthesia. It is a rigorous process which is not to be taken lightly.
If you’re part of a couple, one of the decisions you’ll need to make is whose sperm will be used. Some couples have a firm idea that one of them would provide the sperm while others prefer to fertilize half of the eggs with one partner’s sperm and half with the other’s sperm. They make a decision later about which embryo to put back first.
This is one of the reasons that the intended parents are well advised and usually required to have counseling with a professional counselor with experience in reproductive technology. These issues are covered in consultation with the staff and physician in the fertility clinic and reinforced with open-ended sessions with the counselor.
Choosing a gestational carrier
Gestational carriers are compensated for their time, effort, and willingness to take medical and psychological risks. Typically, an agreement is reached to provide for living expenses incurred during the attempts to conceive, as well as during the pregnancy, set through the agency that recruits the surrogate.
Your IVF clinic will often refer you to a surrogacy agency that specializes in finding and screening prospective gestational carriers. A careful screening process is required in order to select gestational carriers who have a positive mental outlook, particularly regarding pregnancy and childbearing. As with egg donation, if the primary motivator for a gestational carrier is the money, this brings up significant questions whether she is suited for this important role.
Despite the fact that they are being paid, gestational carriers regard this as a gift for the intended parents. Psychologically, being a gestational carrier is stressful in many ways. Giving up a baby requires an ability to compartmentalize one’s feelings. The agencies have experience in dealing with not only the matching, but also the entire process. Their staff provide support for the attempts to conceive using embryo transfer, and later throughout the entire pregnancy.
What is involved in gestational carrier screening?
Surrogates in general must be at least 21 years old and usually not older than 43. They must have had uncomplicated pregnancies and have given birth to at least one child. Your medical team will review the medical records of the last birth and all other births, if possible, to rule out potential recurring complications. Gestational carriers must have healthy personal habits and not be exposed to drugs, smoking, or excess alcohol.
The gestational carrier completes a health questionnaire and has a physical exam with ultrasound, including a thorough evaluation of her uterus to make sure that there is no tissue, such as a polyp or fibroid, which would interfere with implantation. The surrogate will have at least one and usually more than one counseling session with an experienced, objective counselor.
She and her husband, if she is married, will have sexually transmitted disease testing.
Assuming the donor eggs have produced one or more embryos, they may be replaced after 5 days of development. Sometimes they are frozen before they are replaced, at which time a few cells can be removed and submitted to genetic testing. This option, called preimplantation genetic testing (PGT), improves the success of the process. It also increases the chance that a transferred embryo will become a baby and not a miscarriage or non-pregnancy. Using PGT, the risk of miscarriage is reduced from 15%, to half of that.
Additionally, using the incredible technology of PGT, the gender of each embryo is identified. Some couples like to select the gender of their embryos if there are several available. The other embryos would be reserved for another pregnancy if this one is successful, or for a subsequent attempt if not successful.
Once the embryo transfer is scheduled, the gestational carrier goes on hormones to control her cycle in a way that simulates a pregnancy cycle. She is monitored with ultrasound at least once to be sure the lining of the uterus develops favorably.
It is very risky to put back more than 1 embryo, because twins carry inordinate risks to both mother and baby. Since any one embryo generally has about a 40% chance of being a baby, the intended parent or parents have to be prepared for more than one embryo transfer. There is an IVF center procedure cost associated with each transfer, and typically the gestational carrier is compensated for additional medical procedures.
Once a pregnancy does occur, the surrogate is monitored at the fertility clinic up to a certain point, and then her estrogen and progesterone medication is tapered off later in the first 12 weeks of the pregnancy. She is then released to her ob/gyn.
The legal side
During all of this, there is typically a great deal of contact between the gestational carrier and the intended parent or parents. If possible, they visit with the carrier for every medical visit. This is all arranged and agreed upon with the contract. Even though the woman has had one or more successful pregnancies, complications are always possible. These are discussed by the medical staff with the surrogate to make sure she is willing to accept these risks.
There is also a psychological risk if the surrogate becomes attached to the pregnancy and makes an attempt to keep the child. Firm legal agreements are made so that this does not occur. The child is recognized on the birth certificate as belonging to the intended parent or parents through legal procedures.
One of the biggest hurdles in using third party reproduction becomes the accumulated costs. Your surrogacy agency and IVF center will be able to discuss what you can expect in detail. Some IVF centers offer financing for the medical side of the equation.
As a well-known pioneer in IVF, Dr. Joe Massey loves to share in the joy of helping build families. Dr. Massey’s achievements in fertility medicine include involvement in the first pregnancy in the world following assisted hatching in 1988 and in the world’s first pregnancy following intracytoplasmic sperm injection (ICSI) in 1993. He has led a number of clinical trials and co-authored many articles published in medical journals.