Pregnancy is both a simple and complex process. Technically it takes one sperm, one egg, and one uterus. It is the orchestration of a series of events that can be difficult for a couple to achieve. It is estimated that 15% of the couples in America trying to conceive will have difficulty with one or more of the steps of ovulation, fertilization, implantation, or gestation. With the current state of medical technology, it is possible for a couple to use a donated sperm, egg, or uterus when indicated.

In cases of male factor, a sperm donor can be found from sperm banks or a known donor. Because the threat of sexually transmitted diseases, especially AIDS, the American Fertility Society in March of 1993 set forth a series of guidelines on the use of donor sperm. Sperm from carefully screened donors is quarantined for six months until the donor can undergo repeat testing and is found not to have a disease. Couples seeking donor sperm should inquire if their physician adheres to these guidelines.

In cases of female factors, the guidelines are not as clear. Because human eggs cannot be frozen and quarantined, it is important for couples to utilize an agency that is committed to careful screening and upholding strict criteria for surrogates and gestational carriers. This helps with not only the medical safety of the procedure, but protects couples from legal complications as well.

A surrogate donates both the egg and uterus. A gestational carrier donates only the uterus to carry a pregnancy. Couples should chose either based on their underlying problem.

Utilizing a surrogate to establish a pregnancy involves placing husband's sperm into the surrogate's uterus at the fertile time of the cycle (artificial insemination AI). The surrogate then conceives, carries the pregnancy to term, and delivers the infant.

Since the ovaries are the source of eggs, any disorder which affects the ovaries can be an indication for surrogacy. Medical disorders such as: menopause or advanced maternal age, premature ovarian failure, genetic disorders of the wife, severe ovulatory disorders (refractory polycystic ovaries, fertility drug insensitivity, etc.), previous chemotherapy which has destroyed the ovaries, surgically absent ovaries, or severe endometriosis which has damaged the ovaries, are all possible indications for a surrogate.

A gestational carrier is a more complicated, involved, and expensive process. Eggs are harvested from the wife, fertilized in the laboratory with the husband's sperm and the resulting embryo is then transferred into the gestational carrier's uterus at a specific time during the cycle. Most centers give the gestational carrier hormones to help prime and time the uterus for conception.

Disorders confined to the uterus and tubes are indications for a gestational carrier. These include things such as previous hysterectomy, surgeries for fibroids (myomectomy) which may affect the uterus's ability to grow with a pregnancy, damage from infection or IUD (i.e. Dalkon shield), congenital abnormalities of the uterus (as seen in DES exposure), or severe pelvic adhesions which distort the uterus and/or bowel.

Medical conditions in the wife may also preclude her from tolerating the physiologic changes that occur during a pregnancy and/or may actually threaten her life. Severe cardiac or renal disease, brittle diabetes, active Lupus, estrogen dependent cancers (breast or other), or medical disorders which require the wife to take drugs which are potentially dangerous to the developing fetus, are all possible indication for a gestational carrier.

There are other possible indications which are less concrete but, in individual situations, may be an indication for a surrogate or gestational carrier. These would include: previous unexplained infertility, numerous failed IVF attempts (I believe that 4 cycles are enough to prove "it won't work".), a history of ectopic pregnancies, emotional factors, physical disabilities where weight gain can put undue pressure on the back, legs, or pelvis.

Any couple questioning whether a surrogate or gestational carrier is right for them needs to spend some time with a trained professional who understands the physiology of human reproduction and is capable of answering questions. Careful medical, legal, moral, and ethical considerations should be addressed in a professional, non-judgmental manner.

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Guest commentary and representations by others do not necessarily reflect the opinions of the principals of TASC, and should furthermore be independently verified.