When a woman cannot carry a healthy pregnancy, she can turn to a gestational carrier, a surrogate who carries the fetus created from the egg and sperm of the parents.
Dr. Alan Martinez explains how The Reproductive Science Center of NJ can help coordinate the care of the biological parents and gestational carrier for couples wishing to have children.
Role of a Gestational Carrier
From the Show: RSC NJ - Fertility Talk
Summary:
Air Date: 11/28/18
Duration: 10 Minutes
Transcription:
Melanie Cole (Host): When a woman cannot carry a healthy pregnancy, she might consider turning to a gestational carrier. My guest today is Dr. Alan Martinez. He's a specialist in reproductive endocrinology and infertility at the Reproductive Science Center of New Jersey. Dr. Martinez, what is a gestational carrier?
Dr. Alan Martinez, MD (Guest): Well, thank you for having me on the show today. I appreciate it as always. So a gestational carrier is when you have a female patient who is not the egg source, and in the laboratory setting - in an IVF laboratory - embryos are created between the egg and sperm of what we call the intended parents, and then that gestational carrier becomes exactly what we're talking about, which is carrying a pregnancy.
So you take an embryo that is developed to a certain stage, we prepare the gestational carrier's body (the uterus) to be ready for that embryo, and then the embryo is transferred in, and they go on to have the pregnancy test, pregnancy check-ups, they carry the baby, and then the intended parents then take over and essentially the gestational carrier has provided a service for the individuals and to help people try to conceive.
Host: It's really fascinating how that works. Now what's the difference between gestational carrier and surrogate?
Dr. Martinez: Okay, yes so the gestational carrier, we talked about, has the egg and sperm source that is responsible for making an embryo. That comes from what's called the intended parents, so that's a third party female and male patient. With a surrogate, in that case, the patient will actually serve as the egg source, and then sperm is then utilized to make an embryo and get that individual pregnant. So in that case of surrogacy, the person that is actually carrying the pregnancy is also the source of what we call the gametes, which is from the female side, is the egg source as a result of creating that pregnancy.
Host: So then why might a couple need a gestational carrier versus a surrogate? Why would you need one different from the other?
Dr. Martinez: Well, in the majority of cases, and more often than not, the gestational carrier is utilized, and the reason why is because you may have a same-sex couple in some situations, you may have a heterosexual couple, male and female partner, and for one reason or another, the egg source - the female of the intended parent - is not able to carry that pregnancy. So it could be because they've had prior surgeries, so they've had procedure on the uterus, or their uterus had been removed for various reasons. They may have situations where through their early development and before birth, the birth canal did not develop properly. There are some conditions where the uterus doesn't develop, or people have an absent uterus, or a very small uterus that's not able to carry a pregnancy.
So in those cases then, you have that person would want to have a child, but they're not able to carry it themselves, so then they go to what we call third party, which is using a gestational carrier. And that is the most common.
In some cases, there will be same-sex couples, particularly male patients that may want to conceive and start their family, and so they may use an egg donor, which will also serve as the carrier, or the surrogate in this case, and that's sometimes how the surrogate is used, and how the egg source also becomes the person who carries the pregnancy.
Host: So are there certain parameters to being a gestational carrier? I know it's a big deal for couples when they're looking for surrogates. And what about gestational carriers, Dr. Martinez? What are parents looking for and what are the parameters to actually offering this service?
Dr. Martinez: Yes, so that is a common question. Most commonly this is done in an anonymous fashion, meaning that there are agencies out there that work, and they have a group of gestational carriers; women who have agreed to provide this service. And there is an official agreement that happens. They are screened. Usually you want somebody of a certain age, and most commonly it's around the age of twenty-one to the age of forty, in that interval. That's usually an age requirement that we like to see.
We also like to have patients that have potentially carried a pregnancy before, so they have proven fertility, and they've also carried a pregnancy, and haven't had any significant pregnancy complications, and so they delivered a healthy child, and there was no major medical issues during the pregnancy.
So most of the time it is done in an anonymous fashion. There are individuals that will sometimes get a family member or good friend, and then through the proper channels and preparation, a known gestational carrier is used, and in that case, some of the requirements- there may be some flexibility with those. And then you may have a person that wants to be a gestational carrier, but maybe hasn't carried before, but she's healthy. So as long as both parties are aware of that detail, then we can sometimes proceed with those cycles.
So there are guidelines of age, and previous pregnancy success, and without any pregnancy complications, and we usually use those to counsel our patients accordingly.
Host: One of the things people always hear about in the media are the legal issues surrounding surrogacy and gestational carriers, I would suppose. Are there legal issues with a gestational carrier? Are there any?
Dr. Martinez: Yes. In any patients that come to us, and they present and it seems that they are considering using a gestational carrier, we do require those individuals to be properly counseled. And as well as the gestational carriers are carefully screened, they undergo rigorous testing, infectious disease, and requirements of updated pap smears to make sure that they're healthy, and then we involve a reproductive lawyer, and we highly encourage that, and it's often a requirement in many states because we want to make sure that the gestational carriers that want to provide this service and the intended parents understand the potential legal ramifications of this, and so everybody- it's a very systematic process where we want to make sure everyone has undergone informed consent, and then we proceed. It makes the process go much easier.
Host: So for the carrier, this isn't something like with a surrogate where they can say, "I've decided against this," or "It's my baby," or "I want to get to know the baby as they grow." None of that stuff sort of really applies because they're performing a service, but there's no biological connection there, yes?
Dr. Martinez: Correct. Correct. Yeah, there is no biological connection because the egg source is coming separate from them. But there is- obviously when you carry a pregnancy, and any woman that's carried a pregnancy, there probably is some sort of an emotional connection, not a genetic connection. So through careful counseling, screening, having these legal contracts in place, that person has agreed to say, "Hey, I will provide this service. I will carry this pregnancy. I will deliver, and then I have no legal rights to the child."
And with a gestational carrier, it's much easier than a surrogate, but in the surrogate it's also- there are contracts that are made, and we want to make sure that either the gestational carrier or the surrogate understands that this is a service and they are not to be involved as the primary parent, so to speak.
Host: And what about finding a gestational carrier? With surrogacy we hear a sister does it for a sister, or a best friend, for a gay couple. I mean, there's so many different variables there, but finding a gestational carrier, is that something that you at the Reproductive Science Center of New Jersey can help parents and couples-to-be look for? Or do they go out and find that on their own?
Dr. Martinez: Well, we are a full service center so we provide the counseling, we educate patients on how the process occurs, and we work closely with what we call agencies, and they are gestation carrier agencies, and they have a group of patients who are willing to provide this service.
So when a female decides to do this, then we guide them through the process. You can have someone that you know as well do this. It's just that you have to jump through a few more hoops and there's testing that needs to be done, and we still recommend the reproductive contracts. But when you involve a third party agency, they've already done this rigorous testing, the person's been screened, the process is nearly completed, you just need to coordinate the match and have everybody agree, and then the process can be initiated at that time.
Host: That is so cool, Dr. Martinez. Wrap it up for us for your best advice for couples wishing to explore the option of having a gestational carrier. What do you tell them that they really need to know about this?
Dr. Martinez: So I would say if you're thinking at all about this, you can call and make an appointment. You should definitely talk to a reproductive endocrinologist because we're very well-versed in this. We can walk you through the process, we can get the appropriate testing, and we can counsel you.
And this is a regulated process, it is well-established, it's an excellent avenue for people who may not be able to carry on their own, and they need to elicit help through either a surrogate or a gestational carrier. So we are more than happy to advise them, and they should not feel like they're alone. This is more common than they realize, and that we just want to be available as a service to patients to help them through the process.
Host: Thank you so much, as always, Dr. Martinez. You are such a pleasure to have on, and your expertise, and the way that you explain everything is just perfect for these segments, so thank you again for coming on with us today. This is Fertility Talk with RSCNJ; the Reproductive Science Center of New Jersey. For more information, please visit www.FertilityNJ.com. That's www.FertilityNJ.com. This is Melanie Cole, thanks so much for tuning in.
Melanie Cole (Host): When a woman cannot carry a healthy pregnancy, she might consider turning to a gestational carrier. My guest today is Dr. Alan Martinez. He's a specialist in reproductive endocrinology and infertility at the Reproductive Science Center of New Jersey. Dr. Martinez, what is a gestational carrier?
Dr. Alan Martinez, MD (Guest): Well, thank you for having me on the show today. I appreciate it as always. So a gestational carrier is when you have a female patient who is not the egg source, and in the laboratory setting - in an IVF laboratory - embryos are created between the egg and sperm of what we call the intended parents, and then that gestational carrier becomes exactly what we're talking about, which is carrying a pregnancy.
So you take an embryo that is developed to a certain stage, we prepare the gestational carrier's body (the uterus) to be ready for that embryo, and then the embryo is transferred in, and they go on to have the pregnancy test, pregnancy check-ups, they carry the baby, and then the intended parents then take over and essentially the gestational carrier has provided a service for the individuals and to help people try to conceive.
Host: It's really fascinating how that works. Now what's the difference between gestational carrier and surrogate?
Dr. Martinez: Okay, yes so the gestational carrier, we talked about, has the egg and sperm source that is responsible for making an embryo. That comes from what's called the intended parents, so that's a third party female and male patient. With a surrogate, in that case, the patient will actually serve as the egg source, and then sperm is then utilized to make an embryo and get that individual pregnant. So in that case of surrogacy, the person that is actually carrying the pregnancy is also the source of what we call the gametes, which is from the female side, is the egg source as a result of creating that pregnancy.
Host: So then why might a couple need a gestational carrier versus a surrogate? Why would you need one different from the other?
Dr. Martinez: Well, in the majority of cases, and more often than not, the gestational carrier is utilized, and the reason why is because you may have a same-sex couple in some situations, you may have a heterosexual couple, male and female partner, and for one reason or another, the egg source - the female of the intended parent - is not able to carry that pregnancy. So it could be because they've had prior surgeries, so they've had procedure on the uterus, or their uterus had been removed for various reasons. They may have situations where through their early development and before birth, the birth canal did not develop properly. There are some conditions where the uterus doesn't develop, or people have an absent uterus, or a very small uterus that's not able to carry a pregnancy.
So in those cases then, you have that person would want to have a child, but they're not able to carry it themselves, so then they go to what we call third party, which is using a gestational carrier. And that is the most common.
In some cases, there will be same-sex couples, particularly male patients that may want to conceive and start their family, and so they may use an egg donor, which will also serve as the carrier, or the surrogate in this case, and that's sometimes how the surrogate is used, and how the egg source also becomes the person who carries the pregnancy.
Host: So are there certain parameters to being a gestational carrier? I know it's a big deal for couples when they're looking for surrogates. And what about gestational carriers, Dr. Martinez? What are parents looking for and what are the parameters to actually offering this service?
Dr. Martinez: Yes, so that is a common question. Most commonly this is done in an anonymous fashion, meaning that there are agencies out there that work, and they have a group of gestational carriers; women who have agreed to provide this service. And there is an official agreement that happens. They are screened. Usually you want somebody of a certain age, and most commonly it's around the age of twenty-one to the age of forty, in that interval. That's usually an age requirement that we like to see.
We also like to have patients that have potentially carried a pregnancy before, so they have proven fertility, and they've also carried a pregnancy, and haven't had any significant pregnancy complications, and so they delivered a healthy child, and there was no major medical issues during the pregnancy.
So most of the time it is done in an anonymous fashion. There are individuals that will sometimes get a family member or good friend, and then through the proper channels and preparation, a known gestational carrier is used, and in that case, some of the requirements- there may be some flexibility with those. And then you may have a person that wants to be a gestational carrier, but maybe hasn't carried before, but she's healthy. So as long as both parties are aware of that detail, then we can sometimes proceed with those cycles.
So there are guidelines of age, and previous pregnancy success, and without any pregnancy complications, and we usually use those to counsel our patients accordingly.
Host: One of the things people always hear about in the media are the legal issues surrounding surrogacy and gestational carriers, I would suppose. Are there legal issues with a gestational carrier? Are there any?
Dr. Martinez: Yes. In any patients that come to us, and they present and it seems that they are considering using a gestational carrier, we do require those individuals to be properly counseled. And as well as the gestational carriers are carefully screened, they undergo rigorous testing, infectious disease, and requirements of updated pap smears to make sure that they're healthy, and then we involve a reproductive lawyer, and we highly encourage that, and it's often a requirement in many states because we want to make sure that the gestational carriers that want to provide this service and the intended parents understand the potential legal ramifications of this, and so everybody- it's a very systematic process where we want to make sure everyone has undergone informed consent, and then we proceed. It makes the process go much easier.
Host: So for the carrier, this isn't something like with a surrogate where they can say, "I've decided against this," or "It's my baby," or "I want to get to know the baby as they grow." None of that stuff sort of really applies because they're performing a service, but there's no biological connection there, yes?
Dr. Martinez: Correct. Correct. Yeah, there is no biological connection because the egg source is coming separate from them. But there is- obviously when you carry a pregnancy, and any woman that's carried a pregnancy, there probably is some sort of an emotional connection, not a genetic connection. So through careful counseling, screening, having these legal contracts in place, that person has agreed to say, "Hey, I will provide this service. I will carry this pregnancy. I will deliver, and then I have no legal rights to the child."
And with a gestational carrier, it's much easier than a surrogate, but in the surrogate it's also- there are contracts that are made, and we want to make sure that either the gestational carrier or the surrogate understands that this is a service and they are not to be involved as the primary parent, so to speak.
Host: And what about finding a gestational carrier? With surrogacy we hear a sister does it for a sister, or a best friend, for a gay couple. I mean, there's so many different variables there, but finding a gestational carrier, is that something that you at the Reproductive Science Center of New Jersey can help parents and couples-to-be look for? Or do they go out and find that on their own?
Dr. Martinez: Well, we are a full service center so we provide the counseling, we educate patients on how the process occurs, and we work closely with what we call agencies, and they are gestation carrier agencies, and they have a group of patients who are willing to provide this service.
So when a female decides to do this, then we guide them through the process. You can have someone that you know as well do this. It's just that you have to jump through a few more hoops and there's testing that needs to be done, and we still recommend the reproductive contracts. But when you involve a third party agency, they've already done this rigorous testing, the person's been screened, the process is nearly completed, you just need to coordinate the match and have everybody agree, and then the process can be initiated at that time.
Host: That is so cool, Dr. Martinez. Wrap it up for us for your best advice for couples wishing to explore the option of having a gestational carrier. What do you tell them that they really need to know about this?
Dr. Martinez: So I would say if you're thinking at all about this, you can call and make an appointment. You should definitely talk to a reproductive endocrinologist because we're very well-versed in this. We can walk you through the process, we can get the appropriate testing, and we can counsel you.
And this is a regulated process, it is well-established, it's an excellent avenue for people who may not be able to carry on their own, and they need to elicit help through either a surrogate or a gestational carrier. So we are more than happy to advise them, and they should not feel like they're alone. This is more common than they realize, and that we just want to be available as a service to patients to help them through the process.
Host: Thank you so much, as always, Dr. Martinez. You are such a pleasure to have on, and your expertise, and the way that you explain everything is just perfect for these segments, so thank you again for coming on with us today. This is Fertility Talk with RSCNJ; the Reproductive Science Center of New Jersey. For more information, please visit www.FertilityNJ.com. That's www.FertilityNJ.com. This is Melanie Cole, thanks so much for tuning in.