The actual number of children born through surrogacy is not accurately known. Both the Society for Assisted Reproduction (SART) and the CD tract the number of cycles performed but reporting is not absolutely compete. SART data for the years 2004 and 2008 report 1508 and 2502 cycles of gestational surrogacy cycles respectively. These cycles resulted in the birth of 530 and 987 children respectively. These numbers reflect what seems to be a growing increase in the number of children born through gestational surrogacy per year. But the number of IVF cycles performed in 2008 was 140,795 which means that gestational surrogacy accounted for 1.78% of all IVF done in that year.
Gestational surrogacy is a tremendous benefit for some couples. Like all medical procedures, gestational surrogacy is successful and appropriate for indicated reasons. These might include women whose uterus has been removed or does not function properly. Examples of the removal of a uterus include cancer, fibroids, uncontrolled bleeding, and uncontrolled bleeding during delivery. Non-functional uterine indications might be recurrent pregnancy loss, scarring of the uterine cavity or multiple failed IVF cycles where visually good embryos were transferred without a pregnancy. Some women are born without a uterus but have ovaries and some women are born without a uterus or ovaries. Finally, some women may have a medical condition that is well managed but which would put them or an intrauterine pregnancy at significant risk were they to achieve a pregnancy.
The actual process for the gestational host is quite simple. Many programs will control the menstrual cycle of a gestational host, and after menses begin will start estrogen to induce the growth the lining of the uterus. When the lining is ready, progesterone is started and the embryo(s) are transferred non-surgically by flushing them into the uterine cavity. There is no “correct” protocol and each program will perform this in a manner they have developed which gives them the highest chance of success.
Many factors will determine the chance of success. That having been said, the use of gestational host has one of the highest pregnancy rates of all ART procedures. The highest success rates are achieved when donor oocytes are used and these rates can be as high as 60-75% per cycle. When the patient providing the oocytes is older the rates are lower and if she is over the age of 42, the per cycle rates are closer to 5%.
Gestational surrogacy is expensive. Many factors contribute to the cost if gestational surrogacy but for a cycle utilizing all of the reasonable components the cost can be as high as $80,000 to $90,000 per try. Some states have mandated health care insurance coverage for IVF which usually covers about $15,000 of the total cost. If an intended parent uses a gestational host that does not charge the intended parent to be a gestational host, then this can lessen the cost by as much a $30,000.
A critical component of the use of a gestational host concerns the legal assignment of parental rights. The laws governing the assignment of parental rights are determined by each state individually and vary widely. Some states prohibit surrogacy of any kind and some prohibit only true surrogacy. Other states have well-defined laws which permit the use of gestational surrogacy but regulate various aspects of this. An area of law which can become problematic is when an intended parent(s) live in one state but the gestational host will deliver in another state. The legal issue concern which state laws apply as to the assignment of parentage. Thus engaging competent legal counsel is an important aspect of the use of gestational surrogacy. Illinois has a law termed The Gestational Surrogacy Act which became effective in 2005. The law defines who the mother of the child will be and under what circumstances that occurs. The law defines who can be a surrogate and how the contract for surrogacy must be constructed and executed. The Illinois law requires that a physician attest that there is a medical indication for the use of gestational surrogacy.
In summary, gestational surrogacy has added one more weapon in the arsenal for people wishing to parent a child. Gestational surrogacy has many components but is safe and highly successful. All phases of the use of gestational surrogacy require adherence to established standards of care to insure that the intended parent(s) have the highest chance of success and that any resultant child benefits from the best possible care as well.