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Surrogates & Gestational Carriers

Surrogates & gestational carriers at a glance

  • A gestational carrier is a woman who carries a pregnancy to term and gives birth to a baby for another woman or couple.
  • A surrogate is a woman who conceives using her own egg(s) or using the sperm of the male partner or donor in order to give birth for an individual or couple who is unable to carry a pregnancy.
  • Women or couples using a gestational carrier will be genetically related to the child. This is a less complication situation, both legally and emotionally, than surrogacy, in which the surrogate is the genetic mother.
  • A woman may consider using a gestational carrier if she is unable to carry a pregnancy. This can be due to a number of factors including health concerns, uterine abnormalities, and unexplained infertility.
  • Gay male couples require a donor egg and a gestational carrier or a surrogate to have a genetic child.

When to consider using a surrogate or gestational carrier

A woman who cannot carry a pregnancy can use a surrogate or a gestational carrier to have a child that is genetically related to her and/or her partner. A woman might consider using a gestational carrier or surrogate for a number of reasons, including:

  • Previous hysterectomy
  • Severe fibroids or previous myomectomy (fibroid surgery)
  • Being born without a uterus, or uterine abnormalities
  • Damage to the uterus (from infection or other causes)
  • Menopause or other age-related health issues
  • Genetic disorders
  • Severe endometriosis
  • Problems with the pelvic area that prevent pregnancy
  • Recurrent pregnancy loss
  • Several failed pregnancy attempts with IVF

Additionally, other health problems may make becoming pregnant a risk to the woman’s health, such as a history of heart disease, estrogen dependent cancers, and disorders requiring medications that cannot be used during pregnancy.

Gay male couples also require a gestational carrier to have a genetic child, using one partner’s sperm with donated eggs to create embryos, with one or more embryos being transferred to the gestational carrier’s uterus.

Gestational carrier vs. surrogate

A gestational carrier carries a pregnancy created with the intended father’s or donor’s sperm and the intended mother’s or donor’s eggs. The sperm and eggs are combined to create embryos, and one or more embryos are transferred to the gestational carrier’s uterus. Although the gestational carrier carries the pregnancy and gives birth to the baby, she is not genetically related to the child.

A surrogate carries a pregnancy created with her own eggs and the intended father’s or donor’s sperm, and so is genetically related to the baby. To initiate the pregnancy, the sperm are either placed in the woman’s uterus in an intrauterine insemination (IUI) procedure (artificial insemination), or the surrogate’s egg are gathered and fertilized with the male partner’s sperm and the resulting embryo(s) are then placed inside the surrogate’s uterus (through IVF).

Using a gestational carrier is the preferred method of surrogacy to help avoid any legal or emotional conflicts or issues between the intended parents and the surrogate mother once the baby is born.

Laws governing gestational carrier and surrogates vary by state. Couples considering either of these should seek legal counsel who is familiar with the laws of the state where the couple is treated and where the carrier or surrogate resides.

Tennessee law has language regarding gestational carriers and surrogacy, but specifies parental rights only for the intended married couple. The law says nothing about single or gay individuals. Georgia has no laws addressing this issue, nor does Alabama.

Gestational carrier process

Choosing the gestational carrier

A gestational carrier can be someone the woman or couple knows – such as a family member or friend that has volunteered to carry the pregnancy – or found through a surrogacy service. Important factors, such as the gestational carrier’s health, lifestyle, and certain legal considerations, will go into making the decision.

Medical considerations

The gestational carrier will undergo medical examination to make sure her body is healthy and can safely carry a pregnancy. She will also be checked for any other health concerns, including any existing conditions or diseases. Both the intended mother and the gestational carrier will be tested for any negative reactions to the medications necessary to the surrogate process.

Both the gestational carrier and the intended mother/parents should undergo counseling to make sure both parties understand the emotional aspect of being a surrogate or using one.

Legal considerations in the surrogate process

It is important to involve knowledgeable legal counsel during the surrogate process. The gestational carrier and the intended mother/parents must complete legal paperwork outlining the terms of surrogacy, including items such as health care that the gestational carrier is required or entitled to receive, and lifestyle choices during pregnancy.

Most importantly, the legal agreement will clarify that the intended parents will be the legal guardians of the resulting child(ren), and the gestational carrier does not have any legal claim.

Egg retrieval & embryo creation

If a woman is using her own eggs in the surrogacy process, there are several steps involved in the egg retrieval and embryo creation process. The gestational carrier and the intended mother will be put on medication to synchronize their cycles if the embryos are to be transferred fresh (without being frozen), in order for the egg retrieval, embryo creation and embryo transfer to be perfectly timed.

If the embryos will be cryopreserved first, the intended mother and the gestational carrier do not have to have synchronized cycles.

The intended mother takes medication to stimulate her ovaries to produce multiple eggs in a process similar to IVF. When the eggs are fully developed, they are retrieved from the ovaries. The eggs are then fertilized with either the male partner’s sperm or donor sperm to create embryos.

The same process applies to an egg donor used in conjunction with a gestational carrier in the case of gay couples.

Embryo transfer

The embryos can be cryopreserved (frozen) and stored or transferred directly to the gestational carrier.

The gestational carrier’s body will be prepared for pregnancy with hormone medication. About three weeks after the start of her menstrual cycle, the frozen or fresh embryos are transferred to her uterus for implantation.


After embryo transfer, the gestational carrier will have a blood test to confirm pregnancy. Once an embryo transfer has been successful, the gestational carrier will transfer her care to an OB/GYN for the remaining pregnancy and delivery.

The gestational carrier will then carry the pregnancy to term, delivering the child to its intended parent(s) at birth.