Gestational Carrier 

In many cases, women who want to have a baby are unable to achieve or maintain a pregnancy that will result in a successful birth. Gestational carriers are very special women who help these women and their partners to become parents. RMANJ is now one of the nation’s leading centers for treatment involving gestational carriers. All of our services and support programs are designed to make this treatments easy and comfortable as possible for the parents to-be, the gestational carrier and, when necessary, the woman who will serve as the egg donor for the couple. 
 

Who is eligible?

 
Many couples can consider the option of using a gestational carrier when the woman is unable to carry a pregnancy to term. For couples treated at RMANJ, a physician must first determine that this treatment is appropriate. At your first visit, one of our physicians will determine if this treatment is appropriate. When a woman is eligible for a gestational carrier cycle, RMANJ is able to coordinate all aspects of care for the couple and the carrier. If an ovum donor is needed, the RMANJ team will also coordinate her care. Our team approach helps to ensure that every stage of this process is coordinated with the highest levels of medical expertise and patient support every step of the way.

Selection and screening of gestational carriers

 
Being a gestational carrier is an important responsibility that includes many physical, medical, emotional and legal issues for participants to consider. For this reason, RMANJ works closely with all carriers, beginning with an intensive physical and psychological screening process. In some cases, a couple will identify a gestational carrier on their own. More often, couples find a carrier by working with an outside agency that specializes in this service. This is generally preferable, because there are many important procedural and legal issues involved in using a gestational carrier. RMANJ is able to provide referrals to specialized professionals who can help couples identify a gestational carrier. Once a carrier has been identified, she must take part in a telephone appointment with a physician and a mental health professional. We also review copies of her medical records and history, and we require all carriers to complete some preliminary paperwork. (Couples should encourage carriers to complete these steps as soon as possible after a candidate is identified.) In some cases, RMANJ physicians will request additional medical information from carriers before scheduling an in-person screening appointment. Following these initial screening steps, eligible carriers and their partner take part in a meeting at RMANJ with the recipient couple. This meeting, known as a “screening appointment,” is mandatory and typically lasts a full day. It will include meetings with a nurse coordinator, a physician, and a mental health professional from our staff.

While a patient’s primary care physician can complete some elements of the pre-screening process, carriers and partners must complete the final phases of the screening process at RMANJ. No carrier will be permitted to begin treatment until RMANJ receives and reviews all of the required screening results and medical clearances for her and for her partner. Carriers who do not live within driving distance of RMANJ must also identify a qualified physician who will monitor their treatment cycles. The monitoring physician is most often an outside obstetrician/gynecologist or fertility specialist. (See Monitoring the treatment process.)

Important information about the screening appointment
 

During the screening appointment, the carrier together with her partner and the intended parents will meet with a nurse coordinator to review the carrier’s screening tests and to outline the treatment process and schedule. At this stage, the carrier will receive information about the medications used during this procedure. The coordinator will also review the contract between the carrier and the couple, which must be executed before a treatment cycle can be scheduled. RMANJ also requires that both the carrier and the intended parents retain separate legal counsel to handle all legal issues associated with this process. This is required even when a carrier is a family member. Under the terms of the contract the carrier must agree to take part in mandatory psychological follow up sessions throughout the pregnancy.

Prior to meeting with a member of our psychological team, carriers and their partners must complete a Personality Assessment Inventory (PAI) as a component of RMANJ’s psychological evaluation. The RMANJ team then conducts a series of interviews with the carrier, her partner and the recipient couple, as individuals and, when necessary, as a group. During this screening process, the carrier will also meet with an RMANJ physician for a complete physical, ultrasound, and trial transfer. This session will include a comprehensive series of blood tests for the carrier and her partner.

Monitoring the treatment process

 
Carriers who do not live within driving distance of an RMANJ office in New Jersey, New York or Connecticut must identify a qualified medical facility to handle the monitoring procedures required to complete the preparation and treatment cycles. (In these cases, carriers are typically treated at RMANJ only during the screening appointment and on the date of embryo transfer). Monitoring facilities must be open at least five days a week, and be able to perform transvaginal ultrasound and obtain same-day results for blood tests to measure estrogen and progesterone levels. A carrier’s OB/GYN can often handle all monitoring services or can identify a suitable local treatment center. While RMANJ can sometimes help to identify monitoring sites, the carrier is responsible for addressing this need and must provide RMANJ with all necessary contact information for the chosen facility. Once a monitoring center is selected, the carrier must schedule all monitoring appointments directly with that center, following guidelines provided by the RMANJ nurse coordinator. RMANJ makes every effort to provide as much advance notice as possible to help carriers schedule the necessary monitoring appointments. Carriers must coordinate directly with their monitoring facility to make sure that all test results are delivered to RMANJ in a timely manner. In addition, all fees for outside monitoring services used by carriers are paid directly by the intended parents to the treatment center and are never billed through RMANJ.

Prep cycles

 
Prior to beginning treatment, all gestational carrier candidates must undergo a “prep” or ‘mock’ treatment cycle. This requirement is sometimes waived by RMANJ for women who have previously completed a gestational carrier cycle. The prep cycle helps to determine whether the carrier will respond to medications used to prepare the uterine lining. During the prep cycle, a carrier is often treated with birth control pills to control the timing of her menstrual cycle. She is then treated with the medication Lupron® to keep her ovaries quiet during the treatment. Next, she is started on estrogen (taken orally) to make the uterine lining thicken. Finally, progesterone (Prometrium®, oral or vaginal) is added to stabilize the uterine lining. The prep cycle typically lasts from four to six weeks, and consists of up to six monitoring visits involving either blood work or a combination of blood work and ultrasound. Following the successful completion of the prep cycle, the carrier will be ready to enter a treatment cycle.

Treatment cycles

 
Treatment cycles for carriers are synchronized to coincide with the treatment schedule for the woman providing the egg. The treatment cycle includes many of the same tests and medications used in the prep cycle. However, in the treatment cycle, carriers receive nightly intramuscular injections of progesterone instead of Prometrium (the vaginal form of progesterone). The nurse coordinator at RMANJ will advise carriers on medications, dosages, and monitoring requirements. The treatment cycle typically lasts about four to six weeks. Monitoring again will consist of a combination of at least four to six office visits for ultrasound or blood work. When these tests are completed successfully, the carrier returns to RMANJ for the embryo transfer, which is initially scheduled to take place three days after eggs are retrieved from the woman providing the eggs. On day three, the RMANJ embryologist will determine whether the timing is optimal for the transfer. In some cases the embryologist will delay the transfer for up to three more days. In this case, the carrier can sometimes return home or can remain near the RMANJ treatment center. The RMANJ nurse coordinator monitors this process and coordinates all planning and schedules with the carrier.

Legal contracts / consents

 
Without exception, a complete copy of the executed legal contract between the gestational carrier and the intended parents must be provided to the RMANJ nurse coordinator before the start of the prep cycle and prior to the initiation of treatment involving any medications.

Treatment costs and payments

 
Prior to the start of a treatment cycle, intended parents must agree to the payment requirements for these services and receive a 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 the use of RMANJ mental health professionals and counseling services are billed separately by RMANJ and are not included in the cost of treatment. Please contact RMA of NJ Complementary Care for a fee schedule for these services. 

RMANJ Gestational Carrier Team

 
The RMANJ team includes renowned experts in all areas of infertility treatment and reproductive medicine. Our team approach means that all care provided during a gestational carrier cycle is carefully coordinated. This includes a physician who works closely with the egg donor (either the mother or an outside donor) and another physician who provides care for the carrier. The team also includes support and service from our outstanding team of nurse coordinators, scheduling and finance professionals. Patients also have access to the Complementary Care team of mental health professionals and counselors who specialize in working with patients in fertility treatment including gestational carrier cycles.