A gestational carrier is a woman who has agreed to carry a pregnancy for another woman/couple because the latter has been determined to have medical issues that make a successful pregnancy extremely unlikely or dangerous. A gestational carrier shares no genetic information with the baby she is carrying since the baby is the product of IVF using the eggs/sperm of the genetic parents. Traditional surrogacy (illegal in several states) differs from gestational surrogacy in that the egg is actually produced by the birth mother and pregnancy occurs following insemination in most cases.

Many medical conditions necessitate the use of a gestational carrier, including the absence of a uterus in the would-be mother, either because of a congenital (at birth) condition or when a disease necessitated its surgical removal. A gestational carrier may also be the best option when a woman has a systemic disease that may affect either her own or her baby’s health, such as advanced heart disease, severe diabetes, or multiple sclerosis. Likewise, a woman with a history of poor pregnancy outcome—including repetitive pregnancy losses, preterm labor, incompetent cervix, or severe preeclampsia—may be a good candidate for IVF using a gestational carrier.

Prior to any IVF treatment, thorough screening of the gestational carrier is routinely performed following ASRM guidelines. Gestational carriers are usually well known to the couple and may be relatives or friends. In addition, there are agencies that introduce gestational carriers to prospective patients. In such arrangements, the gestational carrier is usually compensated for her time and energy (especially if the pregnancy proves successful).

When using a gestational carrier, IVF is performed by combining the infertile couple’s sperm and eggs to produce their own genetic embryos. However, unlike in standard IVF, these embryos are then transferred into the uterus of the gestational carrier. This process resembles donor-egg IVF in that the process requires synchronization of two patients: the egg donor (genetic parent) and the recipient (gestational carrier). Pregnancy proceeds normally just as if the gestational carrier had become spontaneously pregnant. The major factor in determining the success rate is the age of the woman whose eggs are used. The ideal gestational carrier is a woman who has had a previous uncomplicated pregnancy and delivery.

Complex parenting situations can arise in cases using a gestational carrier in conjunction with donor sperm, donor eggs or donor embryos. Psychological assessment of all parties is crucial and separate legal representation should be pursued by the genetic parents and the gestational carrier to ensure as smooth a transition as possible.