Assisted reproductive technologies (ART) have transformed the landscape of family building, with IVF working with gestational carriers playing an increasingly important role for individuals and couples who cannot safely carry a pregnancy themselves. Unlike traditional surrogacy, where the carrier also provides the egg, gestational carriers carry a pregnancy without genetic relation to themselves, offering a medically sophisticated and legally clearer pathway for family formation.
However, working with gestational carriers is complex medically, psychologically, and legally. Recognizing this, professional bodies like the American Society for Reproductive Medicine (ASRM) and American College of Obstetricians and Gynecologists (ACOG) have released recommendations for clinicians and programs offering these services.
1. When to Consider Working with a Gestational Carrier
A foundational aspect of practice is deciding when working with a gestational carrier is appropriate. According to ASRM, working with a gestational carrier is recommended when a medical or psychological condition would preclude a safe pregnancy for the intended parent or would pose significant risk to the parent or future child.
- Absence of a uterus (due to congenital absence or prior hysterectomy).
- Uterine abnormalities (irreparable scarring or significant malformation).
- Medical conditions that make pregnancy life-threatening (e.g., pulmonary hypertension or severe cardiac disease).
- Absolute psychological contraindications to pregnancy.
- Situations where the intended parent is biologically unable to carry (e.g., single male or male couples).
2. Screening and Evaluation of Intended Parents and Genetic Contributors
Before initiating any reproductive cycle with a gestational carrier, screening of intended parents and any genetic contributors is essential. ASRM emphasizes a thorough medical evaluation, genetic screening, and psychosocial preparation.
Medical Evaluation
Intended parents should undergo a complete history and physical, including any assessments necessary to ensure that egg retrieval and embryo creation procedures can safely proceed. This includes evaluation of reproductive history, relevant co-morbidities, and readiness for ART.
Genetic Screening
All gamete sources — whether from intended parents or donors — should receive appropriate genetic screening. ASRM strongly recommends pan-ethnic expanded carrier screening (not ethnicity-based panels alone), given the limitations of self-reported ancestry in identifying recessive conditions.
Screening typically includes conditions such as cystic fibrosis, spinal muscular atrophy, and thalassemia/hemoglobinopathies, with additional testing as indicated by history or family background. Ideally, the same panel should be used for all contributors.
3. Selection and Care of the Gestational Carrier
Selecting and preparing the gestational carrier is one of the most critical components of successful IVF reports with surrogacy.
Medical Criteria
According to ASRM and endorsed in educational fact sheets:
- The ideal carrier is typically aged 21–45, though some cases may extend beyond this range with appropriate informed consent.
- She should have had at least one uncomplicated term pregnancy previously.
- A limit of around five total deliveries and no more than three cesarean sections is often recommended to reduce obstetric risk.
- A stable family and social support environment should be evident to help manage the stresses of pregnancy.
Infectious Disease Screening
ASRM’s guidance outlines extensive infectious disease testing for carriers.
Uterine Evaluation
Assessment of the uterine cavity is recommended to rule out structural abnormalities that could interfere with implantation or pregnancy progression.
Psychosocial Evaluation
One of the most emphasized recommendations is formal psychosocial evaluation of the gestational carrier and intended parents. Mental health professionals conduct clinical interviews, validated psychological inventories, and counseling to ensure the parties full understand the implications, to ensure the parties have the same expectations, and supports are in place if stress arises.
4. Legal and Contractual Considerations
All parties must obtain independent legal counsel, experienced in third-party reproduction law, before any medical interventions begin.
A legally enforceable contract should address:
- Parentage and non-parentage determinations.
- Medical decision-making during pregnancy.
- Financial arrangements (fees, expenses, insurance coverage).
- Expectation around delivery logistics, and post-birth contact or disclosure.
- Risk allocation for prenatal testing results, complications, or multifetal pregnancies.
Conclusion
IVF involving gestational carriers demands comprehensive protocols that address medical safety, psychological wellbeing, legal clarity, and ethical integrity.
Modern Fertility Law has made this content available to the general public for informational purposes only. The information on this site is not intended to convey legal opinions or legal advice. For further information on medical issues, please consult the American Society for Reproductive Medicine.