Gestational Surrogacy Program
What is gestational surrogacy?
Gestational surrogacy is a process in which the individual carrying the pregnancy (the gestational surrogate) is not biologically related to the eggs that were used to create the embryo and is not planning to be the intended parent. Gestational surrogates were previously referred to as gestational carriers to differentiate them from traditional surrogates. In the case of traditional surrogates, the individual has provided her own egg which is fertilized by sperm of the intended parent or a donor.
There are a variety of reasons an individual or couple may choose to pursue surrogacy, including but not limited to:
- Medical conditions making it dangerous to carry a pregnancy (cancer, lupus, type 1 diabetes, and heart disease)
- No uterus/uterine conditions (history of hysterectomy or ruptured uterus from previous delivery)
- Reproductive health disorders (recurrent miscarriages, complications from previous pregnancies or deliveries)
- Intended parent(s) without an egg provider (for example same sex male parents)
Gestational Surrogacy in New York
On February 15th, 2021, the Child-Parent Security Act took effect in New York State. This law legalizes gestational surrogacy and provides a simpler path to establish legal parental rights for parents who rely on assisted reproductive technology to have children. In addition to expanding protections for LGBTQ+ families in New York State, the passing of this law makes it easier for intended parents to work with paid surrogates in New York as opposed to going out of state. As one of the last states in the U.S. to legalize surrogacy, New York is taking a significant step forward in reproductive rights for the LGBTQ+ community and individuals in need of a surrogate to start their family.
Third Party Reproduction
The Third Party Team at RMA of New York is committed to guiding intended parents through the surrogacy process. Comprised of nurse practitioners and other members of the clinical staff, the Third Party Team is a concierge service that specifically assists individuals in need of an egg and/or sperm donor, and/or a gestational surrogate. The Third Party Team is responsible for organizing the medical screening of potential surrogates, reviewing candidates to help determine eligibility, and coordinating transfer cycles.
Dr. Georgia Witkin, Director of Psychological Wellness Services at RMA of New York
RMA of New York wants to ensure that all parties are comfortable with their decision to participate in the surrogacy process and understand their roles and expectations. The Third Party Team, therefore, arranges for both the surrogate and intended parent(s) to speak with Dr. Georgia Witkin, Director of Psychological Wellness Services. Dr. Witkin is a professional expert for patients as they go through the surrogacy process. Not only does she provide clarity on the logistics of surrogacy, but she also offers valuable strategies on how to cope with emotional challenges that may arise during the journey.
The Gestational Surrogacy Program at RMA of NY
Though the search for a gestational surrogate can take up to 6 months, choosing a surrogate is a very personal decision and there are many factors that should be considered. Therefore, it is important to identify the right agency and legal representation as the family building process starts.
To find a surrogate, the Third Party Team refers patients to a list of surrogate agencies. Contacting these agencies and learning about their programs is the first step in this journey. The agencies help guide patients as they view surrogate profiles and find lawyers for ongoing representation. The agencies review the details of each case and develop a unique contract for each patient that outlines different scenarios. Additionally, the agencies give a breakdown of financial aspects and different programs they offer. The chosen agency will be responsible for identifying potential surrogates and for performing the in depth investigation of the surrogate. This includes background checks for the surrogate and any partner/spouse, home visits, criminal checks and financial checks.
A gestational surrogate is a woman who has given birth to at least one child of her own without complication, lives in a stable home environment, and has a good health history. They must be within the ages of 21-45 and not have a BMI greater than 35. Gestational surrogates can be known (family member or friend) or compensated (paid through an agency).
It is important to identify a surrogate that will be aligned with the intended parent(s) views on pregnancy. The surrogate will carry the child as it grows and the surrogate’s demeanor can impact the intended child’s development. It is helpful to consider the following questions, therefore, when choosing a surrogate:
- Where does the gestational surrogate live and where would she deliver?
- Is attending OB visits important to you and will the surrogate be accommodating?
- Will the surrogate allow you to be there for the delivery?
- Does the surrogate have a healthy diet?
- Does the surrogate have the same lifestyle values as you?
- Does the surrogate have a support system in place?
Before the start of any medical procedures, both the intended parents and the surrogate must work with their legal representation to write, review, and sign a surrogacy agreement. This agreement is legally binding and enforceable in order to best protect the interests and rights of all parties involved.
The surrogacy agreement is a comprehensive document that describes the rights and responsibilities of the surrogate and the intended parent(s). While every surrogacy agreement is different based on state surrogacy laws and each party’s individual needs and circumstances, in general it should include the following elements:
- The surrogate’s compensation
- The risks and liabilities associated with pregnancy
- The surrogate’s responsibilities to take care of herself and the baby throughout the pregnancy
- An agreement on sensitive issues such as termination should it become necessary
- List of individuals permitted at prenatal appointments and the birth
Once the intended parent(s) choose a surrogate and all legal contracts are in place, the surrogate will begin screening to ensure that she is able to move forward with an embryo transfer. Both the surrogate and their intimate partner (if applicable) will undergo specific screening as directed by the FDA and ASRM. Screening includes:
- Infectious Disease Testing for the surrogate and partner (if applicable)
- Urine drug screening for the surrogate and partner (if applicable)
- Physical exam of the surrogate
- Saline Sonogram to assess the uterine cavity
- General bloodwork
- Psychological screening with Dr. Georgia Witkin for the surrogate, partner (if applicable), and the intended parent(s)
Because a gestational surrogate cannot donate their own eggs as part of the surrogacy agreement, intended parent(s) must identify a sperm and egg source. Often, the intended parent(s) choose to use donor sperm and/or eggs from a bank.
Individuals who may be unable to conceive due to azoospermia (the absence of sperm), severe male-factor infertility, are a single woman, or a partner in a same-sex female couple or cis-gender/trans-couple may consider using donor sperm from a licensed sperm bank or a known donor. Similarly, individuals who are unable to achieve pregnancy using their own eggs due to egg quality, genetic abnormalities, previous surgeries, or are a partner in a same-sex male couple, or cis-gender/trans couple trying to conceive may consider using a donor egg to build their family. Donor eggs can come from a variety of sources, including an anonymous egg donor, an agency egg donor, a donor egg bank, or a known donor.
FDA screening will occur prior to the creation of the embryos based on the egg and sperm source. This will include infectious disease and genetics screenings and a physical exam for both the egg and sperm sources.
RMA of New York highly recommends Preimplantation Genetic Testing (PGT) on embryos intended for transfer into a surrogate. PGT can be used to evaluate embryos for genetic abnormalities before they are transferred into the uterus to attempt pregnancy.
Once the previous steps are complete, the surrogate is cleared to begin a transfer cycle. She undergoes additional infectious disease testing, bloodwork, and a transvaginal ultrasound. When these results are collected, the Third Party Team advises the surrogate on medications to prepare her body for the transfer cycle. The surrogate comes in for monitoring appointments about once a week to review her progress and medications are adjusted as needed in order to increase the thickness of her uterine lining. After approximately two and a half weeks, and after adding progesterone to the treatment regimen, the surrogate’s uterine lining should be ready to accept an embryo. At that time, an embryo from the intended parents (previously created using either their own or donor egg and sperm) is thawed and transferred into the surrogate where hopefully it will implant.
Two weeks after the embryo has been implanted, the surrogate will take a pregnancy test to confirm a pregnancy. If she receives a positive result and has achieved a successful pregnancy, RMA of New York will continue to follow the surrogate until about 9 weeks of gestation when a heartbeat can be identified on ultrasound. At that time, RMA of New York will recommend that the surrogate continue to receive care through her OBGYN.
Understandably, the intended parent(s) may want to be involved in the pregnancy as much as possible, including attending regular pregnancy check-ups. Terms of the level of involvement should be pre-determined and a mutual agreement should be reached before a pregnancy is achieved. Oftentimes, the gestational surrogate is located in another state and in-person visits are not feasible. However, telemedicine now offers more opportunities to be involved despite distance.
RMA of New York is thrilled to offer the Gestational Surrogacy Program to individuals and couples hoping to start their families. With the expanded access to care granted through the Child-Parent Security Act, RMA of New York welcomes the opportunity to care for an even more diverse pool of intended parent(s) who are serious about achieving their family building goals.
“Optimal care of the infertile couple involves compassion, science, and data-driven decisions.”
Why RMA of New York: Gestational Surrogacy Program
Since 2001, RMA of New York has helped individuals and couples successfully achieve their family building goals. The team of physicians and nurses are dedicated to providing personalized, patient-focused care that meets patients’ individual reproductive needs and goals. The clinical care team works together to provide comprehensive and customized fertility care to all patients, regardless of sexual orientation, gender identity or expression, or marital status.
By utilizing the most advanced technologies, such as blastocyst culture and preimplantation genetic testing (PGT) in a state-of-the-art laboratory, RMA of New York’s expert team of physicians and embryologists has successfully facilitated the births of thousands of healthy babies. In fact, over the past decade, RMA of New York has increased implantation rates, reduced miscarriage rates, and increased live birth rates, as evidenced by success rates well above the national average.
For the past 20 years, RMA of New York has successfully facilitated the births of thousands of healthy babies for patients across the New York area. As the Division of Reproductive Endocrinology and Infertility of the Icahn School of Medicine at Mount Sinai, our team is dedicated to scientific discovery, medical excellence, and compassionate, patient-focused care. We are proud to be a member of the Department of Obstetrics, Gynecology, and Reproductive Science at the Mount Sinai Health System, which is recognized as a Center of Excellence by U.S. News & World Report.
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