Abstract
ObjectiveCompare the efficacy of surrogate or gestational carrier (GC) cycles to that of autologous in vitro fertilization (IVF)/intracytoplasmic sperm injections (ICSI) in patients with gynecologic or medical co-morbidities contraindicative to pregnancy.DesignRetrospective cohort study.SettingInfertility patients from a single university hospital-based program from 1998-2009.Intervention(s)128 GC cycles from 80 intended parents were identified and compared with 15,311 IVF or ICSI cycles.Main Outcome Measure(s)The peak estradiol (E2), number of oocytes retrieved, cycle cancellation, ongoing pregnancy, and live-birth were compared between GCs and autologous IVF carriers. Indications for GC use were also identified. Multiple cycles contributed by the same patient were accounted for using multivariable generalized estimating equations and two-sided Wald p-values.ResultsUterine factors (67%) was the most common indication for using a GC, followed by non-gynecologic medical conditions including coagulopathies (13%), end stage renal disease (10%), cardiovascular disease (5%) and cancer (5%). Adjusting for age, ovulation induction in GC cycles had similar peak E2 levels and number of oocytes retrieved relative to IVF cycles (p = 0.23 and 0.43, respectively). Clinical pregnancy (49% vs. 42%, p = 0.28) and live-birth rates (31% vs. 32%, p = 0.74) were also comparable. A sub-analysis of GC cycles in those women with uterine factor indications, demonstrated significantly higher clinical pregnancy rates (OR = 2.0; CI = 1.2 - 3.5) with 60% greater odds of live-birth relative to IVF/ICSI cycles, however this odds was not statistically significant for differences in live-birth (CI = 0.9 - 2.9). Conclusions: GCs are a viable alternative to start families for patients with medical co-morbidities precluding pregnancy.
Highlights
The physiologic changes and demands associated with pregnancy place significant stress on women
In this study we examine the increasing practice of gestational carrier (GC) pregnancies and evaluate the efficacy of GCs in assisted reproductive technology
A total of 128 GC cycles from 80 intended parents and 15,311 comparison in vitro fertilization (IVF) cycles from 7780 women were included in the study population
Summary
The physiologic changes and demands associated with pregnancy place significant stress on women. In addition to increased demands on cardiovascular output, renal function and glucose metabolism, physical stresses associated with labor and delivery are better tolerated if the patient is healthy at conception. Childbearing is often deferred to later stages of life for a variety of reasons including primary or secondary infertility, iatrogenic infertility, non-obstetrical medical morbidity and socioeconomic conditions [1-12]. There is a need for alternatives to conventional childbearing for establishing one’s family to address many of the age related physiologic changes women undergo. By definition a surrogate mother is one who provides her oocytes as well as uterus for the pregnancy [1, 13], while a gestational carrier is an individual who carries a non-biologic child for another intended parent (IP)
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