Please note that our offices will be closed after 12:30pm tomorrow, September 26, 2017, for a company event. Normal business hours will resume on 9/27. Nurses will continue making calls with instructions up until 7:00pm. Please do not page for instructions prior to this time. Non-urgent calls will be returned next business day.
A gestational carrier is a woman who carries a pregnancy for someone else. There are many reasons that patients may work with a gestational carrier, including:
• Absent uterus (congenital absence or prior hysterectomy)
• Severe uterine factor infertility (fibroids, adenomyosis, intrauterine adhesions, persistent thin lining despite hormonal treatment, pelvic radiation)
• Recurrent pregnancy loss
• Repeated implantation failure
• Medical conditions that preclude safely carrying a pregnancy (cardiac, pulmonary or renal disease)
• Same-sex male couples, single men and transgender individuals
At RMANJ, your care team will help guide you through the process of selecting the right carrier for your family. Some may choose to work with a friend or relative to carry the pregnancy, while others prefer to match through an agency with a woman who has applied to become a surrogate.
There are many important legal issues to consider when using a gestational carrier. As parental rights and obligations can vary from state to state and country to country, we recommend consulting with an experienced attorney that specializes in third party reproduction. At RMANJ we only work with carriers from surrogacy-friendly states to assure that legal parentage is established without question. Our staff can assist you in finding the legal professionals and resources necessary to help you make these important decisions for your family.
The process of locating, connecting with and achieving a pregnancy with a gestational carrier can be a stressful and lengthy experience, but hopefully a rewarding one, as well. Our multidisciplinary team approach, which involves collaboration between the Physician, Nursing, Mental Health and Financial Counseling teams, helps to ensure that every stage of this process is coordinated with the highest levels of expertise and patient support.
Take the next step toward parenthood. Speak to an RMANJ patient liaison today, 973-656-2089.
Screening the Intended Parents:
Intended parents undergo routine infectious disease screening in compliance with requirements by the U.S. Food & Drug Administration. Genetic testing, along with a genetic counseling appointment, are required. Embryos can be created at any time through in vitro fertilization (IVF), even prior to matching with a carrier.
Screening the Carrier:
All gestational carrier candidates (both known and recruited) undergo a thorough review of their medical and obstetric records, along with clinical interview by the RMANJ Physician and Mental Health teams prior to becoming available to match. This process is designed to ensure only healthy carriers are matched, both for the well-being of the child and the carrier herself. Carriers also undergo a uterine cavity evaluation with either a saline sonogram or hysteroscopy to verify that the uterine environment is optimal for carrying a child, free of polyps, fibroids and scar tissue. At RMANJ we only work with carriers from surrogacy-friendly states and countries. Typically, this involves the carrier traveling to New Jersey for one office appointment to complete the screening process and a second visit for the embryo transfer.
The All Day appointment in Basking Ridge is the culmination of a tremendous amount of coordination by the intended parents, carrier and agency, legal teams, and RMANJ staff. At this appointment, both the intended parents and carrier meet with one another, along with the Physician, Nursing, Mental Health and Financial Counseling teams and complete any remaining necessary testing, including personality assessment inventories. After all results are back from this final step of the screening process, the match between intended parents and carrier can be confirmed, and a customized treatment schedule is developed.
Without exception, a complete copy of the executed legal contract between the gestational carrier and the intended parents must be provided to your RMANJ care team by your attorney, prior to the initiation of treatment involving any medications. Intended parents must also agree to the payment requirements for these services and receive financial clearance from RMANJ. Any questions surrounding insurance coverage or other finance issues should be directed to the RMANJ Finance Department.
RMANJ is not responsible for any costs associated with medications and outside monitoring services for a carrier. These costs are paid directly by the intended parents. Any fees related to consultation with RMANJ Mental Health Professionals and counseling services are billed separately by RMANJ and are not included in the cost of treatment. Please contact the Collaborative Wellness Team for a fee schedule for these services.
For the intended parents, treatment involves a standard in vitro fertilization (IVF) cycle in which the female partner or an oocyte donor takes subcutaneous hormone injections to stimulate the ovary for approximately one week and undergoes a minor, same-day surgical procedure to extract the eggs. The eggs are then put with sperm to create embryos, which are then are frozen for future transfer to the carrier. In certain circumstances it is possible to also work with intended parents who have already created embryos elsewhere.
Intended parents may also elect to do comprehensive chromosome screening (CCS) prior to embryo freezing, which involves testing whether an embryo has the correct number of chromosomes and is capable of developing into a healthy pregnancy. CCS may decrease miscarriage rates and improve the live birth rate per transfer. In addition to testing the health of the embryo by looking at 22 chromosomes, CCS also tests the sex chromosomes, making it possible to determine whether a particular embryo is male or female. Some patients prefer to know this information when choosing which embryo to transfer.
Importantly, this process of embryo creation can occur at any time, even prior to matching with a carrier.
For carriers located within driving distance of RMA or any of its New York, New Jersey or Pennsylvania sites, our team will manage all monitoring during the treatment process. For carriers who do not live nearby, a local facility must be identified to conduct off-site monitoring visits during the course of treatment. All fees for outside monitoring services used by carriers are paid directly by the intended parents to the treatment center, not through RMANJ. Monitoring facilities must:
• Be open at least five days a week
• Be able to perform transvaginal ultrasound
• Obtain same-day results for blood tests to measure estrogen and progesterone levels
During the cycle the carrier will take estrogen supplementation to grow the uterine lining and daily intramuscular progesterone injections to prepare the lining to accept an embryo and maintain the pregnancy. The RMANJ nurse coordinator will advise both the carrier and the intended parents on medications, doses and monitoring requirements. Monitoring consists of three to four office visits for ultrasound and/or blood work, typically done at an off-site location that is convenient for the carrier.
Once the uterine lining is ready for implantation, the carrier returns to RMANJ. On the morning of the scheduled transfer, the carrier will undergo one final monitoring ultrasound and blood test to ensure that the endometrial lining is optimal before thawing the embryo. After this final check, the embryo will be thawed for transfer. The frozen embryo transfer is a brief procedure done under ultrasound guidance without anesthesia.
The intended parents are welcome to be in the room for the transfer, but their presence is optional. Typically the day after transfer the carrier returns to her own state of residence. Normal daily activity following the transfer is encouraged. Nine days after the transfer, the first pregnancy test is performed at the off-site monitoring location. If pregnancy results, the first ultrasound is done seven to ten days later. Once the carrier reaches approximately eight weeks of pregnancy, her care is then transitioned to a local obstetrician for the duration of pregnancy and delivery.
For additional information on gestational carriers in NJ, please contact us today.