Gestational Surrogacy

Gestational Surrogacy

Some patients may work with a gestational carrier, including following reasons:

  • 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

RMA of Southern California can 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 RMA of Southern California, we only work with carriers from surrogacy-friendly states to assure that legal parentage is established without question.

The process of locating, connecting with and achieving a pregnancy with a gestational carrier can be a stressful and lengthy experience. We help 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 RMA of Southern California patient liaison today, 424.293.8841.


Screening the Intended Parents:

Intended parents are required to undergo infectious disease screening in compliance with requirements by the U.S. Food & Drug Administration, and genetic testing and counseling. Embryos can be created at any time through in vitro fertilization (IVF), even prior to matching with a surrogate.

Screening the Surrogate:

All surrogate candidates undergo a thorough review of their medical and obstetric records, along with clinical evaluation which includes an interview by the RMA of Southern California physician and psychologist. This process ensures only healthy surrogates are matched, both for the well-being of the child and the surrogate herself. Surrogate candidates 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 RMA of Southern California we only work with surrogates from surrogacy-friendly states. Typically, this involves two visits for the surrogate.

All Day Appointment in Los Angeles

The surrogate’s initial appointment involves the culmination of a tremendous amount of coordination by the intended parents, surrogate, agency and RMA of Southern California staff. At this appointment, both the intended parents and surrogate meet with one another, along with the physician, nursing 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 surrogate can be confirmed, and a customized treatment schedule is developed.

Gestational Carrier Process

Prior to Treatment: Legal Contracts and Payment

A complete copy of the executed legal clearance between the surrogate and the intended parents must be provided to your RMA of Southern California 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 RMA of Southern California . Any questions surrounding insurance coverage or other finance issues should be directed to the RMA of Southern California finance department.

RMA of Southern California is not responsible for any costs associated with medications and outside monitoring services for a surrogate. These costs are paid directly by the intended parents. Any fees related to a consultation with the psychologist and counseling services are billed separately and are not included in the cost of treatment.

Treatment Cycle: Intended Parents

For the intended parents, treatment involves a standard in vitro fertilization (IVF) cycle in which the female partner or an egg donor takes subcutaneous hormone injections to stimulate the ovaries for seven to ten days and undergoes an egg retrieval procedure to extract the eggs. Then the retrieved eggs are fertilized with sperm to create embryos, which are then frozen for future transfer to the surrogate. In some cases, it is possible to 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, also tests the sex chromosomes, some patients prefer to know this information when choosing which embryo to transfer.

Treatment Cycle: Surrogate

For surrogates located within driving distance of RMA of Southern California, our team will manage all monitoring during the treatment process. For out of state surrogates or 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 surrogates are paid directly by the intended parents to the treatment center, not through RMA of Southern California.
The outside 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 surrogate 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 RMA of Southern California nurse coordinator will advise both the surrogate 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 surrogate.

Embryo Transfer, Pregnancy Monitoring and Transition to Obstetric Care

Once confirmed the uterine lining is ready for implantation, the surrogate returns to RMA of Southern California on the morning of the scheduled transfer. The surrogate will undergo one final monitoring ultrasound and blood test to ensure that the endometrial lining is optimal before thawing the embryo. The thawing process does not take place until all departments have signed off that it is time to thaw the embryo. 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. If the surrogate is from another state, typically the surrogate returns to her own state of residence the day after transfer. 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 surrogate 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, please contact us today.