In this episode, hosts Dr. Carrie Bedient from the Fertility Center of Las Vegas, Dr. Abby Eblen from Nashville Fertility Center, and Dr. Susan Hudson from Texas Fertility Center discuss the process of using a gestational carrier. They break down who might need a gestational carrier, the medical and legal aspects to consider, and how to navigate the journey from start to finish. The discussion also covers the difference between a traditional surrogate and a gestational carrier, explaining why modern surrogacy almost always involves a gestational carrier—someone who carries a pregnancy without a genetic connection to the baby. The docs also address common questions about choosing a carrier, working with an agency, and the emotional and financial aspects of the process. Whether you’re considering surrogacy due to medical conditions, infertility, or other personal reasons, this episode provides valuable insights into how a gestational carrier can help individuals and couples grow their families.
Episode Transcript:
Susan Hudson (00:01)
You’re listening to the Fertility Docs Uncensored podcast, featuring insight on all things fertility from some of the top rated doctors around America. Whether you’re struggling to conceive or just planning for your future family, we’re here to guide you every step of the way.
Susan Hudson MD (00:22)
This podcast is sponsored by ReceptivaDx. ReceptivaDx is a powerful test used to help detect inflammatory conditions on the uterine lining, most commonly associated with endometriosis and may be the cause of failed implantation or recurrent pregnancy loss. Take advantage by learning more about this condition at receptivadx.com and how you can get tested and treated, providing a new pathway to achieving a successful pregnancy. ReceptivaDx, because the journey is worth it.
Susan Hudson MD (00:53)
Hello everyone, this is Dr. Susan Hudson from Texas Fertility Center with another episode of Fertility Docs Uncensored. I am here with my charismatic, caring, um, contagiously funny,
Carrie Bedient MD (01:06)
I was wondering where you were on with the contagious. I appreciate contagiously funny as opposed to just contagious full stop.
Susan Hudson MD (01:08)
Contagiously Funny Co-hosts.
Dr. Carrie Bedient from Fertility Center of Las Vegas and Dr. Abby Eblen from Nashville Fertility Center.
Carrie Bedient MD (01:19)
Hello!
Abby Eblen MD (01:23)
Hey everybody.
Susan Hudson MD (01:24)
How are y’all doing today?
Abby Eblen MD (01:27)
Doing good!
Susan Hudson MD (01:28)
Good. Well, we were talking a little bit earlier about our favorite shoes. So when you go shoe shopping, what are your faves to go to?
Carrie Bedient MD (01:39)
Like favorite brand or favorite type of shoe? Cause those are…
Abby Eblen MD (01:44)
Those are very different for me.
Susan Hudson MD (01:45)
Let’s start with what brand do you prefer and then what style within the brand? How about that?
Carrie Bedient MD (01:52)
We talking about work or play or?
Abby Eblen MD (01:54)
You go for it, Carrie.
Whatever you want to say, you tell us.
Susan Hudson MD (01:56)
Whatever you want.
Carrie Bedient MD (01:58)
Okay, so my default, somebody told me about Tieks a couple years ago and I at first looked at them, I’m like, this is a stupid price to pay for a pair of shoes. And I got a pair as a gift. And I have since like, that is all that I wear at work because T-I-E-K-S, they’re like ballet flats and they come in every possible color you could ever want. And so I’ve got a couple of the real basic colors, like a gold, a silver, a brown, a navy, and I wear those. That is all that I wear at work, pretty much, running around, if I’m not in my OR shoes.
Susan Hudson MD (02:42)
I love that when you say the basic colors, your first two colors are gold and silver.
Abby Eblen MD (02:48)
She lives in Las Vegas.
Carrie Bedient MD (02:48)
I live in Vegas. You should be lucky I didn’t say
The metals really are basic colors, they go with everything.
Susan Hudson MD (02:55)
They do, they do, they do.
Carrie Bedient MD (02:56)
And there’s no sequins on any of them, just so you know, and they’re the more matte colors, even though I have looked at the shiny silver and the shiny gold, I’m like, no, I just can’t.
Susan Hudson MD (03:06)
I remember in medical school that they said something about people in our psychiatry rotation. Do you remember this? That if they wore gold color shoes, it was actually tied to some sort of psychiatric diagnosis.
Abby Eblen MD (03:21)
Wow, that’s pretty rough, Carrie. She’s saying you have some psychiatric illness.
Carrie Bedient MD (03:22)
There’s a decent chance she’s right. It just depends on which psychiatric illness, because I mean, if you’re talking about one of the more like potential for wild and crazy ones, yeah, I think I go beyond just your general anxiety, depression, kind of psychiatric diagnosis, at least that I know of. And so maybe you guys, as the next time we all get together for a meeting, we can do a psychoanalysis session.
Abby Eblen MD (03:53)
We diagnose each other, yeah.
Carrie Bedient MD (03:55)
You guys can tell me what diagnosis I have that is meriting my gold shoes.
Susan Hudson MD (04:01)
Exactly. So Abby, what’s your favorite types of shoes?
Abby Eblen MD (04:04)
Well, these are shoes I don’t wear very often, I always, Kate Spade always has the cutest darn shoes. And so, I really try and avoid buying Kate Spade shoes, because they’re really expensive, and they’re usually not overly comfortable either, but they’re really cute. So, if you’re dressing up, they have, little bows on them. And so those are my favorite kind of shoes. But in reality at work, I wear flats, kind of like Carrie. I try and get relatively cute flat shoes, but, they’re not as cute as high heels, in my opinion.
Susan Hudson MD (04:30)
I love my Birkenstocks. I have a small Birkenstock addiction of about every type of Birkenstock you could imagine. I have boots, I have multiple types of sandals, I have dressy sandals, I have wedges.
Carrie Bedient MD (04:32)
Yeah.
Wait, wait, Birkenstock has dressy sandals?
Abby Eblen MD (04:54)
Yeah, I’d to see those.
Susan Hudson MD (04:55)
For Birkenstock. My dressiest ones are white with flowers all over them. They’re very pretty. They’re very pretty. So, I like my feet to be comfortable. and their sneakers are amazing.
Carrie Bedient MD (05:06)
Hmm. I like the, for like bumming around, like the Rothy sneakers because you can wash them.
Susan Hudson MD (05:12)
Very good. Very good.
Susan Hudson MD (05:14)
RMA of New York is a global leader in state-of-the-art reproductive medicine, serving as
Division of Reproductive Endocrinology and Infertility at the Icahn School of Medicine at Mount Sinai. Led by an integrated team of physicians and scientists, RMA of New York is renowned for its pioneering research in the field and for delivering high IVF success rates. With locations across Manhattan, Brooklyn, Westchester, and Long Island, RMA of New York has helped thousands to build the families of their dreams for more than two decades and counting.
Susan Hudson MD (05:45)
Well, let’s do a question today. Hi, Fertility Docs. I’m an avid listener and love your podcast. Thank you for all the hope, knowledge, and laughs. My partner and I are a same-sex couple. We are deep into our fertility journey. Our biggest question right now is deciding between ICI and IUI. We are in the medical field and feel like we can handle ICI but are trying to assess if it’s worth it or if we should go right to IUI. Any tips, experiences, thoughts on this would be greatly appreciated, along with any thoughts on how to have the greatest success at home with ICI. It may not help, but we are planning on taking a holistic approach and really focus on warm, warm, foods, low impact exercise, possibly seed cycling and obvious ovulation tracking. Thank you so much.
Abby Eblen MD (06:33)
Well, generally we would not participate if you’re doing ICI, because that would be at home. And so the patients that we generally see do IUI. And the thing I would say about that is, I’ve certainly had patients that have seen me that have gotten pregnant before by doing home inseminations, but the advantage of doing IUI, what we normally do, is that the sperm is cleansed and so the sperm is separated from the seminal plasma. It makes it a little less likely to cause infection, although infection’s still pretty small regardless, but less likely to cause infection. We get more concentrated sperm up closer to the uterine cavity, closer to where the egg is. Just overall, it’s little bit more successful procedure than if you do home inseminations. There’s certainly nothing wrong with starting with home inseminations and if those don’t work after, I would say, three tries, then maybe, it’s time to see your doctor and come in for IUI.
Susan Hudson MD (07:20)
What are your thoughts, Carrie?
Carrie Bedient MD (07:22)
It sounds like they really want to take the holistic approach, in which case the ICI sounds like it’s probably the way for you guys to start because there’s always the option to be more medical, technical as you need. I think some of that’s going to depend on where you’re getting your sperm from because if you are having to pay a sperm bank for every vial, that can get expensive very quickly. And so not doing more than two or three probably makes sense because it’s just logistically going to be a little bit more challenging for many couples. If you have a known donor, then that might make it easier to get those samples. But if you have a known donor, you want to make sure that all the legal loose ends are tied up and that you have a contract in place so that you are the legal parents of that child. And there have been many cases over the years where that has not ended well for the people who are parents for various reasons if there was not a contract in place. And so I would make sure cross your legal Ts and dot your I’s so that are fully set up and taken care of. You also want to make sure that the infection screening that might apply, that does apply to any sperm donor, but might be a little bit hard to demand of a person you’re staring straight in the face, or without a doctor intervening who’s going to say, you will do this, period, end of story. Making sure that the genetic carrier screening is done and that that is all worth, all checked off.
Abby Eblen MD (08:35)
Hahaha.
Carrie Bedient MD (08:46)
I think that is a worthwhile thing to do. And so there may be some components of this that just logistically are easier to do through a clinic. But of course, most of the clinics that you work with are not gonna have a terribly holistic approach. It’s gonna be a, do we get you pregnant yesterday if not sooner kind of approach. So I think it all depends on what your general circumstances are and your approach to it. Your age is gonna make a difference as well. If the partner who’s receiving the sperm is 40, don’t mess around. If she’s 28, you got some time in general terms. What do think, Susan?
Susan Hudson MD (09:21)
I would say also make sure that the partner who’s trying to achieve pregnancy has monthly menstrual periods, meaning periods that happen about every 28 to 32 days, because I would hate for you to be doing inseminations on cycles that ovulation may not be happening and spending time that may not be worthwhile. But otherwise, I completely agree with y’all. And I was thinking about the age thing until you said it. So that was great.
Carrie Bedient MD (09:28)
Yeah,
Perfect.
Susan Hudson MD (09:48)
Well, today we are going to talk a little bit about gestational carriers and a little bit about when you might want to consider using a gestational carrier. So let’s start off with the simple basics. What exactly is a gestational carrier?
Carrie Bedient MD (10:04)
So gestational carriers are exactly what those two words describe, which is essentially a surrogate who is carrying the pregnancy for another person or another couple who, for whatever reason, cannot do it by themselves. Now, the phrase surrogate’s important here because many of us use gestational carrier, and from here on out, I’m gonna substitute in GC for that, but many of us use that interchangeably with surrogate. And it works when you’re talking to lay people, but there’s very specific meanings attached to both of those. Surrogate is typically someone who has genetic material of at least one of the parents in the child that they are carrying. And so, for example, you might have a woman who goes through an insemination cycle, it’s her egg, and she’s carrying the pregnancy and it’s the intended father’s sperm. And so that provides a genetic link which is where surrogates kind of come from.
Susan Hudson MD (11:03)
And that is usually nowadays referred to as a traditional surrogate versus a gestational surrogate, which is someone who has no genetic link to the baby. And so why do we make such delineations between traditional surrogates and gestational surrogates?
Carrie Bedient MD (11:13)
Exactly.
Abby Eblen MD (11:21)
Well, generally in our practices, we don’t use traditional surrogates, we use gestational carriers. So that would mean the egg comes from the intended parent or egg donor. The sperm can come from the intended parent or sperm donor. And then the third person that’s involved is actually the carrier. So the carrier like Carrie was saying doesn’t have any genetic material that makes up the child. And so in some states, traditional surrogacy, in fact, I would say probably most states, traditional surrogacy is illegal. Many, many years ago, maybe 20 plus years ago, there were several court cases where there were traditional surrogates that wanted to keep the baby. I remember there were a lot of things on the news about that. And so generally most people don’t do that anymore. And so therefore we don’t have to worry about that issue as much as we used to.
Susan Hudson MD (12:07)
All right, and in some fertility clinics, it’s also important to know, Abby mentioned egg donors, sperm donors, and gestational carriers that in some clinics, this is the way we practice at TFC is that you have to have either egg, sperm or uterus from someone who’s involved in parenting this future child. And so, it’s not the way it is at all clinics, but just be aware that those rules do exist in certain clinics as well. And that really makes sure that you’ve got your own skin in the game, literally. And so we wanna make sure that we have a commitment in there.
Susan Hudson MD (12:44)
Exciting news from Fertility Docs Uncensored! Our long-awaited book, The IVF Blueprint, is now on Amazon. Go now to pre-order your copy to learn everything you need to know about IVF, egg freezing, and embryo transfer.
Susan Hudson MD (12:58)
Okay, so what is a reason someone might choose to use a gestational carrier?
Abby Eblen MD (13:05)
No uterus. So somebody is born without a uterus, which sometimes happens, or if they had some sort of problem and had to have hysterectomy done, that would be a reason that somebody would want to use a gestational carrier. And that makes it a little bit more challenging to try and stimulate the patient just because that person obviously doesn’t have a menstrual cycle. And most of the times when we stimulate people, we do it based on when their period starts and stimulate them that way. So there’s some different ways we can either bring you in and check progesterone levels every week to see when you ovulate. We can also look with ultrasound or we can just randomly start you. But ultimately it makes it little more challenging, but typically not something that’s impossible to do.
Susan Hudson MD (13:42)
Some other uterine causes that would lead to somebody needing to use a GC?
Carrie Bedient MD (13:47)
Sometimes people have really massive fibroids and sometimes they’re not really amenable to being removed or she can’t undergo surgery for whatever reason or she has undergone surgery and there’s a huge chunk of the uterus that is effectively missing that had to be sewn back together. And so even though the fibroids are gone, it’s not really a safe uterus to use. That’s one potential reason. Sometimes we will have patients who have a uterine anomaly where they were born with the uterus, but the uterus is not the kind of typical upside down pear, upside down triangle shape that we’re looking for. It might be a deep heart shape. It might be a banana. It might be T-shaped. It might be any of these other arrangements that are not really conducive to getting a baby to implant or to term or to grow appropriately throughout the course of the pregnancy.
Susan Hudson MD (14:42)
So sometimes if somebody may have a unicornuate uterus, which is essentially half of the uterus or that’s the banana or the heart shape, which is a bicornuate uterus where essentially the top part of the uterus did not fuse together. Those are some of the conditions that that Carrie is alluding to. What are some medical conditions that might lead someone to decide or be advised to use a gestational carrier?
Abby Eblen MD (15:14)
So chronic medical conditions that require medications that are not conducive to pregnancy, like for example, I’m thinking of somebody with rheumatoid arthritis that may need to be on a medication chronically like methotrexate. Also people that have cancer, every now and then people will either have embryos stored already or be in the process and find out that they have cancer and they’re not gonna be able to carry the pregnancy. So therefore they’ll ask for gestational carrier to do that.
Carrie Bedient MD (15:39)
People who’ve had radiation in the past to their pelvis that has essentially targeted the uterus, they tend to be very poor candidates for carrying their own pregnancies just because the uterus has been really affected by that radiation. So that’s often a reason why someone might have a history of a medical condition. They may be totally fine now, but the impact of that radiation can be quite large.
Abby Eblen MD (16:01)
And also to somebody who has recurrent pregnancy loss at times. Some of these things are not necessarily indicative of having to use a gestational carrier, but some patients, if they have multiple miscarriages, potentially after multiple transfers of genetically normal embryos, those are patients that may opt to do that as well.
Susan Hudson MD (16:18)
Would you consider a gestational carrier for somebody who has not only recurrent pregnancy loss, but maybe recurrent implantation failure so they just never get pregnant even with chromosomally normal embryos?
Carrie Bedient MD (16:30)
Yeah, would definitely do all that. Part of the decision to use a gestational carrier, so some of these reasons that we’ve given are very clear cut. If you don’t have a uterus, we have to work with somebody else. And that is a very clear, unequivocal decision that we have to at least talk about. For recurrent implantation failure, recurrent pregnancy loss, that is a lot more nuanced because there are many people who have recurrent losses who are able to go on and carry a baby to full term, multiple failures where they finally hit a good embryo that will implant and continue on. And so this is something where the line is not nearly as clearly demarcated. And so what you use to draw the line of, okay, if we get this far, we’re gonna call it with your own uterus and use somebody else’s is gonna vary widely from patient to patient because if you are a 41 year old and you have very few embryos and they were hard won, you might have a very different threshold than someone who is 28 who has PCOS, maybe with the uterine anomaly or something like that, where they might be able to carry their own, but they might not. And it’s a little bit more up in the air, but they have an easier time getting those embryos to work with. The financial plays a part in this as well.
Your control issues will also play a part in this. So there are quite a lot of things that are gonna factor into this for someone where the line has the potential to move based on the characteristics of the patient at hand.
Susan Hudson MD (18:06)
What are some potential heart issues that might lead to the recommendation of using a gestational carrier? Because I know we have quite a few of these people who come through our clinics and sometimes they’re caught unaware that there may be some danger.
Abby Eblen MD (18:21)
So I think if you have any kind of thing like significant, meaning it affects your ability to function normally, significant valve issues. We also have patients that have an increased risk of aortic problems, pulmonary hypertension, things like that that affect the heart because roughly about 40 to 50 % of your blood supply goes to your uterus and your blood volume increases by about 40 to 50 % when you’re pregnant.
Even things that may not bother you when you’re not pregnant may bother you once you have a baby and your heart’s having to pump a lot harder. I it truly is the pump that gets the blood to go through your system. And so if the pump is not working great, even when you’re not pregnant, when you are pregnant, that’s a reason that we would think about a gestational carrier.
Carrie Bedient MD (19:09)
Cardiomyopathies are a big deal there. If you’ve had, maybe you’ve had a pregnancy before and were diagnosed with postpartum cardiomyopathy, that can be deadly in a future pregnancy. And so nobody’s going to mess around with that. Patients with Turner syndrome who have aortic root dilation where the base of the aorta where joins the heart is not quite as tightly knit together, so to speak, where the valve just doesn’t work as well.
That can be a big issue. If you’ve got somebody who’s got congenital heart disease and has had a heart that’s been operated on multiple times, that’s something where at the very least we have to get the surgeons, the CT surgeons to weigh in and say, yes, this is something where we’re okay with the strain that pregnancy is going to put on the heart or no, this is really not okay, you need to use a GC.
Susan Hudson MD (19:58)
If somebody is considering using a gestational carrier, what’s the first major decision that they should make?
Abby Eblen MD (20:06)
Well, do you have somebody that you can use? Are you going to have to go through an agency? Is it something that financially you can even consider? Those are the initial things that think people worry about.
Susan Hudson MD (20:18)
We’ve mentioned the financial part of this. I know a lot of times when I mention this to my patients, they have a little heart palpitations. Yeah. So the reason why we keep…
Carrie Bedient MD (20:28)
Give them a heart condition. If they didn’t have it already, they’re going have it by the time that we finish the financial discussion on this one.
Susan Hudson MD (20:34)
Exactly. So, so somebody’s looking at going through an agency. And agencies are often a great option because they take care of all the little details. And there are lot of little details that go into a gestational carrier cycle. So, don’t get me wrong, but if somebody’s looking at using an agency, what kind of ballpark price are they looking at not including their IVF cycle?
Abby Eblen MD (20:45)
White Glove Service
Carrie Bedient MD (20:59)
So I don’t know that I can break this apart separately just because there are so many different types of fees that go with this. And so I’m actually going to approach that question a little bit differently in saying, all right, what would you anticipate is the all-in cost when you’re working with an agency? Because some of them will include a bunch of other things. So their agency fee might be high, but if they also include the legal fees and they include some of the medical screening and things like that, then it’s really not all that high. And so the things that need to be included by the time you get to the end of this journey, there’s the cost of the IVF cycle, which is getting the eggs out, making the embryos, doing genetic testing, if that’s, if that’s something you’re doing and then transferring the embryos. So there’s the stuff that’s going to go to the clinic.
There is the agency fee, is at a minimum, multiple thousands of dollars. That can go quite high or quite low. There’s the services that you get will greatly impact that fee and what’s included. You have to consider legal fees in there because you need a contract between the intended parents and the GC. And both of them need their own representation. So that’s a couple thousand dollars right there. You need the cost of insurance for the GC, even if she her own insurance, many insurances will not cover a GC pregnancy. And so she may need to get a separate set of health insurance for this. She will need life insurance on her because pregnancy is the most dangerous thing that most women, especially in this country, are ever gonna do. And so there needs to be a life insurance policy on her so that heaven forbid she meet a unexpected complication that her family is taken care of.
There’s the compensation for the GC. And I would say going comp right now is, I think $30,000 is the lowest that I’ve seen and most people it’s $40,000, $50,000, maybe $60,000. And so that plays into it. There’s fees for what other procedure she may have to go through. So a GC with a C-section is going to be paid differently than someone who has a vaginal delivery because there is a different level of risk that she’s going through in a different type of recovery.
There’s maternity clothes. There’s other daycare allowances or time off work for her travel companions when she has to come out to the clinic. There’s if she gets under bed rest and she has several weeks out of work, there’s covering that cost. So there’s a huge number of things that you have to think about. Insurance for the newborn is another one because the newborn won’t automatically fall necessarily under the GC’s own insurance. We need to make sure that that’s taken care of.
The hospital expenses. There’s so many things that it’s kind of hard to say.
Abby Eblen MD (23:42)
So Carrie, give us a number. All in would you say, I mean six figures for sure, but where in the six figures?
Susan Hudson MD (23:42)
But what’s number? What’s your number, Carrie?
Carrie Bedient MD (23:52)
Yeah. Yeah. And I think you can hit less than that if you are using a known GC. Like if you got a, they’re called compassionate GCs. So it’s somebody that you know, who’s willing to do it. You can knock the comp off of that, the compensation, which is, $30,000 to $60,000. And you can usually knock the agency fee off of that. But there’s a lot of emotional, psychiatric, relationship issues that need to be considered when you’re working with someone you know because that changes dynamics.
Susan Hudson MD (24:25)
What are things that people should know about considering using a GC?
Abby Eblen MD (24:30)
I think Carrie alluded to one of those things just a second ago that, it’s one thing on paper to see somebody and see their history and, but you have to decide what kind of relationship you’re going to have. Some carriers and their families, send Christmas cards every year or get together every six months or send birthday cards. Some don’t, some just see it as a service they’re providing for that couple. And from that point on, they don’t necessarily plan to have any routine contact.
I’ve definitely seen situations where there’s been a discrepancy there between the carrier and the couple. And just a couple of times over the years, I’ve seen friction because it didn’t quite meet the expectations of both parties. So you need to make sure you work that out on the front end.
Susan Hudson MD (25:10)
We’ve had this come up a number of times. It’s not something I see very frequently, but it is probably something I get every couple of years. I’ll have somebody who comes in and wants to use a GC simply because they don’t want to be pregnant. They don’t have a medical indication. They haven’t had any miscarriages. Literally, it’s I just don’t want to be pregnant. How would you advise somebody like that?
Carrie Bedient MD (25:33)
So what I normally tell these patients is most people who come to us tend to be type A very high achievers. And so those people are used to setting a goal and they just get there because they just put their nose down and they work their butt off and they get there. And they’re meticulous about everything along the way. And there is a level of control that you will never have over a GC pregnancy. And so…you doesn’t matter what you put in that contract where she eats apples on Wednesdays and oranges on Saturday morning. It doesn’t matter what you put in there. You can’t necessarily force this woman to do anything because this is her body. And so the level of control that most of our patients have and the anxiety that they have about them being pregnant, which is what I see is the most common driver of I don’t want to be pregnant that that’s not helped by having a GC. It’s different, but it’s not helped at all. And so when we go through some of the logistics of this is what you are giving up control over with your child who’s going to spend nine months with this woman. Like day in, day out, there’s no way this is, not not the first babysitter because that’s the embryologist, but it’s the second babysitter for sure. And you have to trust somebody else with that and that is a very hard thing to do. That is part of how I counsel the set of people who come in for anxiety. There’s another set of people who come in because they’re busy and they have a thriving career and they just don’t feel like they can take the time to get pregnant. And that part of the discussion is working with a GC takes a ton of time and it takes a ton of emotional energy and it’s pay me now, pay me later, you are going to spend that energy and you are going to have to do that work one way or the other. Everything is hard, choose your hard. Do you want to choose your hard working with a gestational carrier where you can’t control things, you are at the mercy of, what if a transfer doesn’t work? Are you gonna constantly think, I could have done that better, I could have done that differently, whether the GC did anything or not?
There’s a lot of that that surrounds it. And so for the people who say, well, I’m really too busy. I can’t afford to take time off. There’s a lot of the practical components of it of you’re going to spend a lot of time finding this GC, working with her, talking with her. What do you think is going to happen when a baby comes when you have to care of that kid? Like this is not going to get better. You might be able to delay it for a short period of time, but all of the things that you are trying to avoid.
You’re not avoiding, you are changing how it looks maybe a little bit, but all of those things tend to come up one way or the other. So those are probably the two most common reasons that I see when people come to me and they say, just, I can’t carry my own pregnancy. And that’s where it is. Now, to go back to the anxiety part of it, I have had patients in the past where it’s been a really clear discussion of they’re on medications that they cannot go off of, that are not conducive to pregnancy.
And so that’s a different situation. And so I’m not, I wanna make it clear that those are two different scenarios than someone who’s just really, really anxious about what pregnancy is, which is very much earned. Like pregnancy, if you’ve never done it before, it’s a totally different ball game.
Susan Hudson MD (28:43)
That’s different situation.
Another thing to know is that though gestational carriers are legal in most states in the United States, that sometimes there has to be a medical indication. And so you can go from something that is legal to something that is not legal because of maybe not having that medical indication. So that’s going to be on a state by state basis as well.
Abby Eblen MD (29:26)
And often, Carrie, wouldn’t you say, since you work with agencies probably more than I do in my practice, wouldn’t you say that many times the carrier is not in the same state as the intended parents? So they’re going to be out of state, far away from you potentially when they deliver. You can certainly, there’s ways to keep in touch now, much easier now than there used to be, but they’re not going to probably be 30 minutes away from you where they live, most likely.
Carrie Bedient MD (29:49)
Yeah, it is very common for us to have intended parents in one country, the clinic in Nevada, the agency in a different state, the surrogate herself in a totally different state. The lawyer, can be wherever it makes most sense for the legal team to be. If you’ve got a donor involved, that that can be someone from a different state and that agency from a different state. I mean, you can have several different states represented.
Fortunately, travel is relatively accessible and can make it happen. And there’s a lot of clinics that work together very well. I feel like I have called both Susan and Abby, both of you guys, and have said, hey, I have this GC. I don’t trust anybody else to look at her. Can you please look at her? And so you can make all of that work. But it is far more common to have your clinic, your IPs, your intended parents, your GC, everybody in different states. And that’s really, for the most part, fine. One thing that I will say about GC journey is that many IPs don’t necessarily think about when they’re deciding, do I do an agency or not, is the amount of time that it takes to coordinate everything. And like I said, most IPs are extraordinarily capable human beings. There’s no implication that you’re not capable. It’s just that it takes a ton of time because you got to find a clinic, you got to make sure that the results get transferred over. You have to make sure that if there’s something that happens that there’s support in place, whether that’s psychiatric support, medical support, a different type of doctor, a clinic that is closed when you need something, so you have to scramble and find another clinic. There’s really an awful lot of secretarial and detail-oriented jobs that go along with this. And so that’s…I’ve definitely had plenty of IPs who have done that over the years. It is something that you need to think about if you are undertaking this because it will play a part in how your journey goes.
Susan Hudson MD (31:34)
Good stuff, good stuff. Any last thoughts? Yes, Carrie.
Carrie Bedient MD (31:39)
One big issue that I talked to both GCs, potential GCs and IPs about is the termination of pregnancy issue. And that is something that whatever your personal decision is, you and your GC have to be very, very frank with each other and very open with each other about how you would view that. Because I’ve seen couples where they both decide they would never terminate under any circumstances. Others have it really clearly laid out of what circumstances they would terminate for. It doesn’t really matter what the ultimate decision is, but it matters intensely what kind of agreement you guys have. Because as intended parents, you cannot force her to do anything. And so even if that is an abnormality that is not compatible with life, you cannot make her have a termination if you want one. Similarly, if she were to choose to get a termination and that’s not something that the IPs want, then that can be an issue too. Now that issue comes up very infrequently. More often it’s the intended parents think there’s an indication for it and the GC does not agree with that. But have those conversations in a ton of detail before you ever sign any contract, before anything super expensive that started because if you guys don’t agree, you’re probably not a good match for each other because even though it doesn’t come up very often when it does, it is a big, big deal. And so, I think I can count on one hand with fingers left over the number of times that GC has had to terminate for, for a medical reason. But when it is, there is a ton of conversation involved between many, many different people. And so you and your GC have to agree on that one issue in particular.
Susan Hudson MD (33:25)
Well, I think we’ve had a great conversation about gestational carriers, when to think about using them, and if you’re starting thinking about using one, a little bit about the details of what you need to do from there.
So to our audience, thank you for listening and subscribe to Apple Podcasts to have next Tuesday’s episode pop up automatically for you. Also be sure to subscribe to YouTube. That really helps us to spread reliable information to as many people as possible.
Abby Eblen MD (33:50)
Visit us on fertilitydocsuncensored.com to submit specific questions you have and sign up for our email list.
Carrie Bedient MD (33:56)
And as always, this podcast is intended for entertainment and is not a substitute for medical advice from your own physician. Subscribe, sign up for emails, and we’ll talk to you soon. Bye.
Susan Hudson MD (34:06)
Bye.
Carrie Bedient MD (34:07)
This podcast is sponsored by ReceptivaDx. ReceptivaDx is a powerful test that can help detect inflammatory conditions on the uterine lining that might be preventing you from becoming pregnant or staying pregnant. If you have experienced implantation failure or recurrent pregnancy loss, ask your doctor about ReceptivaDx testing. If found, uterine inflammation can be treated, providing a new pathway to achieving a successful pregnancy. ReceptivaDx because the journey is worth it.