The earliest mention of the term surrogacy is in the Old Testament of the Holy Bible (Genesis 16.1 215). The story is told that because Sarai had been unable to bear Abraham a child, she suggested to him he “go unto my maid Hagar, it may be that I may obtain by her.”
Abraham did as he was told and at the age of 90 years, he was able to father a child by Hagar and Ishmael was born. It is likely that the surrogacy has been used through the ages to help women who were unable to have children themselves to have families, but no specific instances are recorded in the medical history text. This was in the form of traditional surrogacy.
The term Surrogate mother is usually applied to the woman who carries and delivers a child on behalf of another couple.
Women with Congenital absence of the Uterus and women who have had Hysterectomy for carcinoma or hemorrhage, but who still have functioning ovaries are obvious candidates for treatment by gestational surrogacy.
A less obvious indication is for women who have suffered repeat miscarriages and for whom the chance of ever carrying a baby to term is remote. Similarly, women who repeatedly fail to implant normal healthy embryos in treatment by IVF, for no obvious reason, may be considered as suitable candidates.
Certain medical conditions, such as heart or renal disease, which might threaten her life along the way she is to become pregnant, are also indications, provided that she is considered to be fit enough to look after the child after birth and that her life expectancy is reasonable. Women who have requested treatment by gestational surrogacy for purely social or career reasons are not treated.
Third party reproduction, which includes both egg donation and gestational surrogacy, is one of the largest growing areas of assisted reproductive technology. FCI treats one of the largest number of third party patients in the United States of America, 400 per year, having treated egg donors and surrogates for 20 years. Patients are referred both locally, nationally and internationally for the above technologies.
At Fertility Centers of Illinois, we work in conjunction with multiple surrogacy program – agencies, to facilitate the process. A gestational surrogacy agency is designed to assist the woman in the recruitment of a surrogate and matching her with the intended parents. Potential surrogates must meet an extensive list of qualifications: complete medical, psychological, and laboratory evaluation and undergo a background check to be considered a surrogate.
Uterine assessment is an obvious prerequisite before being accepted as a gestational surrogate and counseling, for both the surrogate and the intended parents, is a crucial part of the process. Counseling includes the full indications of undergoing treatment for IVF, the possibility of multiple pregnancies, the medical risk associated with pregnancy, the implications of guilt on both sides if the host should spontaneously abort the pregnancy and the possibility that the child might be born with a handicap.
A discussion with both couples about what they will tell children born as a result of treatment, about their origin, is also discussed at the time of counseling.
Discussion topics with the commissioning couple include:
- Review of alternative treatments.
- The possibility of adoption instead of surrogacy.
- The full cost of the treatment.
- The potential medical and psychological risks involved.
- The implications of multiple pregnancies.
Management of the process involves a typical IVF treatment of the intended parents and, therefore, a full workup for IVF, as would be normally performed in an IVF patient, is done. There is particular emphasis on assessment of functional ovarian reserve, as this will be the limiting factor when it comes to the outcome. The gestational surrogate is prepared in a more physiological manner, in order to optimize the endometrial milieu for Implantation. Synchronization between gestational surrogate and the intended parents is then done.
The legal aspect of surrogacy is another factor that must be considered because the autonomy of individuals states specific regulations regarding surrogate mother is different from state-to-state. Illinois happens to have some of the most surrogate friendly laws in the United States. Illinois has established their gestational surrogacy act (750-ILCS-47) its purpose is “to establish consistent standards and procedural safeguards for the protection of all parties involved in a gestational surrogate contract in the state and to confirm the legal status of children born as a result of these contracts.”
If it is also stated that “sole custody of the child shall rest with the intended parents immediately upon birth of a child and neither a gestational surrogate nor partner if any, shall be the parents of the child for purpose of the state law immediately upon the birth of the child.” This act may aid us as providers in appropriately informing patients of legal issues associated with surrogacy.
For the small percentage of patients that gestational surrogacy is clearly indicated, Fertility Centers of Illinois looks forward to assisting a fellow obstetrician/gynecologist providing the best reproductive healthcare for our 3rd party reproductive patients. Gestational surrogacy is commonly performed at Fertility Centers of Illinois. It is a successful treatment for a woman who otherwise would not be able to conceive her own genetic children.
Medical contribution by Brian Kaplan, M.D.
Dr. Kaplan completed both his residency in Obstetrics and Gynecology and a two-year fellowship in Reproductive Endocrinology and Infertility in Chicago. He has numerous published articles and has presented topics, nationally and internationally in the field of Assisted Reproductive Technology (ART). He has been honored every year since 1999 by Castle Connelly on the list of “Best Doctors” in Chicago and America.
