Using a Gestational Carrier

• A gestational carrier (GC) is a woman who carries a pregnancy for someone else but is not genetically related to the child because her pregnancy is achieved using an embryo created by the intended parents through in vitro fertilization (IVF).
• It is essential for patients considering a gestational carrier to protect themselves with an attorney who specializes in local, reproductive law, and we can help with recommendations.
• Intended parents can choose to use a family member or friend who meets the physical requirements of a gestational carrier, or they can view profiles of women who offer their services through Carolina Conceptions.
• Once the gestational carrier has been chosen, the next step is to review her medical records, conduct a psychological evaluation and perform tests to clear her for pregnancy.
• The carrier will then begin taking medications to prepare her uterus for surgical transfer of the embryo to achieve pregnancy.
• While the GC is preparing to receive the embryo, the intended parents complete an IVF cycle (or obtain donor eggs and/or donor sperm), including egg retrieval and fertilization of the retrieved eggs.

Sometimes a woman will have viable eggs to fertilize but cannot carry a pregnancy due to medical complications. These can include a previous hysterectomy, uterine abnormalities, genetic disorders, recurrent miscarriage and failed IVF attempts. Some women may be advised not to attempt pregnancy due to heart disease or having conditions that require medications that can’t be taken during a pregnancy.

Single males, gay male couples and any couple without a female reproductive system may also require the use of a gestational carrier to have a biological family.

After an individual or couple decides to use a gestational carrier, Carolina Conceptions will provide assistance in selecting a reproductive law attorney and a gestational carrier. Intended parents can choose to use a family member or friend who meets the physical requirements, or they can view profiles of women who offer their services through Carolina Conceptions.

It is essential for patients considering a gestational carrier to protect themselves with an attorney who specializes in local, reproductive law. Read more on legal steps in the GC process follows below.

We can break down the timeline of using a gestational carrier into three steps: finding a carrier, clearing the carrier and the embryo transfer cycle.

Finding a carrier is often the step that takes the longest, sometimes up to a year. After you’ve found your carrier, it takes some time to review her medical records and do the necessary testing to clear her to become pregnant. The time for this step can vary, but often takes one to two months. While we’re working on this, you can be working on the psychological and legal requirements, discussed below.

After all of this is completed, the gestational carrier is ready to begin medications to prepare her uterus for embryo transfer. This timeline is much more predictable. Typically, she will be on medications for about three weeks prior to the transfer. Her pregnancy blood test will be done in our office 9 to 11 days after transfer.

We encourage you to start this process as soon as you’re ready. We can begin the gestational carrier process while you, or your egg donor, are undergoing IVF to make embryos.

Intended parents will need to meet with a Carolina Conceptions provider to discuss using a GC. After the consultation, you’ll need to speak with our financial team to review costs associated with a GC cycle. They will discuss which services are included as part of the cycle package and which services are billed separately. When you’re ready, a $3,000 deposit is required to commit to the process and begin working with the GC coordinator. The coordinator will reach out to you after your deposit is received.

Selecting the gestational carrier

There are three essential ways to select a GC: use a friend or a family member, use GCs we have in our program, or use a national or local agency. Part of the selection process includes several steps to evaluate the medical and psychological aspects of the carrier and her compatibility with the intended parents (IPs). After a prospective carrier is initially selected, she and the intended parents will meet to determine compatibility.

• You can use any national GC agency if you’re open to your GC potentially being located out of state. If you’d like to use a local agency and local GC, we recommend Village Surrogacy. There is also a Facebook group, ‘Surrogates and IPs Of North Carolina,’ where you can connect with potential GCs.
• Carolina Conceptions may be able to help you find a GC, but we are not an agency. While we actively screen GCs, we do not do so until after she is picked by the couple.
• Once you find your GC, we start the process of clearing her to carry. This consists of a review of her records, an ultrasound and blood work.
• The initial requirements for a gestational carrier are as follows:
  • Normal prior pregnancy with full term delivery
  • BMI less than 30
  • In good health
  • Less than 38 years old
  • No smoking or drugs

Medical record review

• Your GC will need to create a patient portal on our website. If she has a partner, they will also need a patient portal. The portal is for secure communication as well as ordering labs, medications, etc.
• Your GC will need to fill out the GC application on our website. If you matched with your GC through an agency, this is not necessary.
• If your GC’s application is approved, she will need to have her medical records sent to us for your doctor to review. We will need all of her pregnancy records from her doctor’s office(s) and her delivery records from the hospital(s). These records need to include all of her previous pregnancies and deliveries. We will also need a physical exam and Pap smear that are no more than 2 years old.
• Reviewing your carrier’s medical history is part of our responsibility to you to make sure she is healthy to carry a pregnancy.

Medical clearance

After your GC’s records are reviewed and she is approved to move forward with the process, she will undergo a saline ultrasound to make sure her uterus is normal. She will also have lab work to screen for infectious diseases. If she has a partner, her partner will need lab work. The GC coordinator will contact her to set up these tests.

Psychological evaluation

There are three parts to the psychological evaluation:

• A psychological evaluation of the carrier and her partner including psychological testing. The purpose of this evaluation is to assess whether serving as a gestational carrier would have a positive, rather than negative, effect on her life. The consultation will cover potential psychological risks for the GC and help her to anticipate difficulties that could arise during the arrangement. It will also assess her current and past psychological health to assess whether she will likely be able to provide a safe environment for the unborn baby during pregnancy. The GC’s partner (if any) is required to participate as pregnancy has the potential to place additional demands on him/her and their family, and it is imperative that the GC has her partner’s full support.
• A psycho-educational meeting between the psychologist and the intended parents including psychological testing (90 – 120 minutes). There will be a focus on expectations for the relationship before, during and after the pregnancy and preferences related to embryo transfer, prenatal testing, selective reduction and termination. The session will also help the IPs to plan for emotional and logistical issues that may arise during the pregnancy or as they parent a child born through third party reproduction.
• A joint counseling session with all parties: gestational carrier, her partner and the intended parents (30 – 60 minutes). This final counseling session is an opportunity to ensure that all parties have the same expectations and to identify and plan for possible rough patches in the arrangement.

These appointments can all take place on the same day or can be divided across two days. Sometimes the intended parents will choose to complete their portion of the evaluation prior to matching with a GC so that they can use the consultation time to figure out what is most important to them in finding/ matching with a GC. Other times, the intended parents will wait to complete their portion after matching with a GC.

A gestational carrier contract is a lengthy and detailed legal document that ensures that all parties understand their rights, obligations and expectations. The contract covers critical issues around each party’s behavior before, during and after the pregnancy, as well as all of the financial details about the arrangement. Some examples of such issues include:

• Acknowledgements by all parties that you are the sole legal parents of the resulting child with all of the rights and obligations, and the gestational carrier and her partner are not the parents. This includes an agreement by the gestational carrier and her partner that you will take immediate physical and legal custody of the child upon birth.
• Agreements about the conduct of the gestational carrier during the pregnancy (prohibitions on drinking, smoking and other activities not advised for pregnant women), as well as travel restrictions guard against a delivery taking place outside of North Carolina.
• Agreements about when and under what circumstances the pregnancy would be terminated or reduced.
• Agreements about what is to occur in the event that any party or parties die or get separated or divorced.
• A plan about the gestational carrier’s health insurance coverage, and who is responsible for the various costs of the pregnancy and delivery.
• The financial details of the arrangement, including information about escrow agents, life insurance, and what is to occur in the event of physician-ordered bedrest, as well as when and how the gestational carrier will receive various payments and stipends throughout the pregnancy.

We do not need a copy of the contract between you and your gestational carrier, but we will need a letter of legal clearance from your attorney. This letter simply states that there is an executed agreement between all parties.

Patients who are using a gestational carrier must be cleared as tissue donors per Food and Drug Administration (FDA) guidelines. This consists of a physical exam performed by a Carolina Conceptions provider, a questionnaire and Viromed labs to screen for infectious diseases. The physical exam and questionnaire are completed at the same time at Carolina Conceptions. Patients can choose their Viromed labs to be drawn in our office or at LabCorp. Patients who choose LabCorp will be provided with a kit during their exam appointment that they will bring to LabCorp.

• FDA clearance for female intended parents or fresh egg donors must be completed within 30 days of egg retrieval. This will be scheduled to take place during the IVF stimulation cycle. Your nurse will help coordinate this appointment when you have your IVF class. This appointment takes about an hour in our office and for the blood draw.
• FDA clearance for male intended parents or known sperm donors must be completed within seven days of sperm collection. This will be coordinated when the female intended parent or fresh egg donor is scheduled for egg retrieval. We will not know the egg retrieval day until 48 hours ahead of time. For ease of scheduling, some intended parents choose to freeze sperm in advance and complete FDA clearance then. This appointment takes about two hours in our office and for the blood draw.
• If you are using anonymous frozen donor sperm or frozen donor eggs, FDA clearance has already been completed on those.
• If your embryos were created at a time when you were not planning to use a GC, FDA clearance was likely not done. We will need to complete FDA clearance prior to your embryos being transferred to a GC.

Intended parents

While the carrier is preparing her uterus for implantation, intended parents complete an IVF cycle (or obtain donor eggs and/or donor sperm), including egg retrieval, and fertilization of the retrieved eggs. Once the eggs are retrieved, the male intended parent’s sperm will be used to fertilize each mature egg. The embryos will then be allowed to develop in the lab and a certain number of embryos will be transferred into the GC.

The number transferred depends on several factors, such as embryo quality, age of the intended parent or egg donor and patient preference to reduce the chance of multiples. Usually, one to three embryos are transferred. This is agreed upon by all parties involved.

Gestational carrier

While the intended parents are undergoing the IVF cycle, the GC will be given estrogen and progesterone to prepare her uterus for embryo implantation.

A typical cycle consists of a baseline ultrasound and blood work prior to starting estrogen to thicken the uterine lining. After about a week of taking estrogen, we check the carrier’s lining to make sure it’s growing nicely. We check the lining one more time and do another round of blood work after about two weeks of taking estrogen.

At this point, if the lining is thick enough and the blood work is normal, the carrier will start progesterone injections. She will take these for six nights prior to transfer. You will be contacted by the end of the day after each one of your carrier’s appointments to keep you updated on her progress.

Transfer will take place at our Central: Raleigh office. Intended parents are welcome to join their carrier on transfer day.

An ultrasound is done at six weeks to verify a healthy pregnancy.