If a woman is unable to carry a pregnancy to term, she and her partner may choose a surrogate or gestational carrier.

A surrogate is a woman inseminated with sperm from the male partner of the couple. The resulting child will be biologically related to the surrogate and to the male partner. Surrogacy can be used when the female of the couple does not produce healthy eggs that can be fertilized.

A gestational carrier is implanted with an embryo that is not biologically related to her. This alternative can be used when a woman produces healthy eggs but is unable to carry a pregnancy to term. If needed, egg or sperm donation can also be used in this situation.

Women with no eggs or unhealthy eggs might also want to consider surrogacy. A surrogate is a woman who agrees to become pregnant using the man's sperm and her own egg. The child will be genetically related to the surrogate and the male partner. After birth, the surrogate will give up the baby for adoption by the parents.

Women with ovaries but no uterus may be able to use a gestational carrier. This may also be an option for women who shouldn't become pregnant because of a serious health problem. In this case, a woman uses her own egg. It is fertilized by the man's sperm and the embryo is placed inside the carrier's uterus. The carrier will not be related to the baby and gives him or her to the parents at birth.

Recent research by the Centers for Disease Control and Prevention showed that ART babies are two to four times more likely to have certain kinds of birth defects. These may include heart and digestive system problems, and cleft (divided into two pieces) lips or palate. Researchers don't know why this happens. The birth defects may not be due to the technology. Other factors, like the age of the parents, may be involved. More research is needed. The risk is relatively low, but parents should consider this when making the decision to use ART.

Key Findings: Use of Gestational Carriers in the United States

A gestational carrier is a woman bearing a genetically-unrelated child for another person or couple. Typically, in vitro fertilization is used to fertilize the intended parent’s egg, and then the resulting embryo is placed in the gestational carrier’s uterus. People who may decide to use a gestational carrier may include women with ovaries and no uterus or women who cannot carry a pregnancy because of a serious health problem. Because of limited information on the use of gestational carriers in the United States, data from CDC’s National ART Surveillance System were used to describe trends and outcomes of gestational carrier cycles. These findings provide important information on the potential risks and benefits of gestational surrogacy for intended parents, babies, and gestational carriers.

Has the use of gestational carriers changed over time?

• Between 1999 and 2013, about 2% (30,927) of all assisted reproductive technology cycles used a gestational carrier.
• The number of gestational carrier cycles increased from 727 (1.0%) in 1999 to 3,432 (2.5%) in 2013.

What were the characteristics and outcomes of gestational carrier cycles?

• Between 1999 and 2013, gestational carrier cycles resulted in 13,380 deliveries and the birth of 18,400 infants. The data shows 9,819 (53.4%) of these infants were twins, triplets, or higher order multiples.
• Intended parents using a gestational carrier tended to be older than parents who did not. Most gestational carriers were less than 35 years of age.
• Approximately 16% of intended parents using a gestational carrier were not US residents.
• Gestational carrier cycles had higher rates of implantation, pregnancy, and live births when compared to non-gestational carrier cycles. However, multiple birth and preterm delivery rates were higher among gestational carrier cycles—largely due to the frequent transfer of two or more embryos per cycle.

More about These Findings

Elective single embryo transfer was performed in only 15% of gestational carrier cycles. Transferring fewer embryos during ART cycles, including gestational carrier cycles, can reduce the risk for multiple births.

When couples do not achieve pregnancy from infertility treatments or traditional ART, they may choose to use a third party–assisted ART method to get pregnant. Assistance can consist of:

Sperm Donation

Couples can opt for donated sperm if a man does not produce sperm, produces very low numbers of sperm, or has a genetic disease. Donated sperm can be used with IUI or with IVF.

Egg Donation

This process may be an option when a woman does not produce healthy eggs that can be fertilized. An egg donor undergoes the superovulation and egg retrieval steps of IVF. The donated egg can then be fertilized by sperm from the woman's partner. The resulting embryo is placed into the woman's uterus, which is receptive for implantation because of hormone treatments.

Egg donation may be particularly helpful for women who:

• Have primary ovary insufficiency
• Have had chemotherapy or radiation therapy
• Have had surgical removal of the ovaries
• Were born without ovaries
• Are carriers of known genetic diseases
• Are infertile because of poor egg quality
• Are menopausal

Surrogates and Gestational Carriers

If a woman is unable to carry a pregnancy to term, she and her partner may choose a surrogate or gestational carrier.

A surrogate is a woman inseminated with sperm from the male partner of the couple. The resulting child will be biologically related to the surrogate and to the male partner. Surrogacy can be used when the female of the couple does not produce healthy eggs that can be fertilized.

A gestational carrier is implanted with an embryo that is not biologically related to her. This alternative can be used when a woman produces healthy eggs but is unable to carry a pregnancy to term. If needed, egg or sperm donation can also be used in this situation.

Embryo Donation

Embryo donation, sometimes called embryo adoption, allows the recipient mother to experience pregnancy and give birth to her adopted child. Couples who have undergone IVF and completed their families sometimes choose to donate their remaining embryos. An embryo donation agency, such as the National Embryo Donation Center, stores these frozen embryos and mediates adoption with the recipient woman or couple. Communication between the donating and adoptive couple can range from anonymous to a fully open relationship.

Reasons a woman may choose embryo adoption include:

• She or her partner is infertile and looking for alternatives to other ART.
• IVF has repeatedly failed.
• She or her partner is concerned about or at high risk for passing on genetic disorders.

The donated embryo is transferred to the recipient's uterus. According to CDC, 50% of transfers with donated frozen embryos result in pregnancy, and 40% result in a live birth.

Assisted reproductive technology (ART) procedures sometimes involve the use of donor eggs (eggs from another woman), donor sperm, or previously frozen embryos. Donor eggs are sometimes used for women who can not produce eggs. Also, donor eggs or donor sperm is sometimes used when the woman or man has a genetic disease that can be passed on to the baby. An infertile woman or couple may also use donor embryos. These are embryos that were either created by couples in infertility treatment or were created from donor sperm and donor eggs. The donated embryo is transferred to the uterus. The child will not be genetically related to either parent.