OUTCOMES FOR GESTATIONAL CARRIERS VERSUS KNOWN CARRIERS, INCLUDING SAME-SEX COUPLES

Abstract

To assess clinical outcomes in gestational carriers (GC) when comparing known carriers to carriers from an agency as well as those in same-sex couple relationships desiring to act as a surrogate. All GC patients from 2004-2018 having undergone single frozen embryo transfer (FET) at a large, assisted reproduction center were analyzed. Known GCs were compared to agency-recruited GCs and to those in same-sex relationships, where an embryo from one woman’s egg was transferred to her partner’s uterus (‘Co-IVF’). All blastocysts vitrified and warmed for transfer were grade BB or higher. Statistical analysis using univariate and multivariate analysis were used, with a p<0.05 considered statistically significant. We compared clinical outcomes based on the type of gestational carrier used in 1,153 cycles. An agency-recruited GC was more likely to have a full-term birth compared to known GC and Co-IVF pregnancies (89.2% vs. 86.2% vs 60.5%, p<0.001). The average age of the GC was also statistically significant. Average age of a GC at transfer was 36 y.o. for Co-IVF vs. 33 y.o. for agency recruited GCs, and 34 y.o. for known GCs. GCs in the setting of Co-IVF had higher mean BMI (p<0.001) and fewer prior term births (p<0.001). Agency-recruited GCs were most likely to have had term birth(s), with a mean of 2.7 births. When looking at medical comorbidities, there was an increased rate of comorbidities in the known and same-sex couple GCs. Using a multivariate analysis, BMI and history of C-section were not predictive of term birth. However, the use of an agency GC was predictive of a full-term birth for that pregnancy. Research remains limited on differences in GC birth outcomes, particularly when considering if the GC meets recommended ASRM criteria. Very little research exists regarding the clinical outcomes of strictly-screened gestational carriers versus known/same sex carriers. Our data suggests that a prior term delivery strongly predicts a future full-term delivery when using gestational carriers. It appears medically reasonable to allow properly-screened known and same-sex GCs to proceed with treatment, with the caveat that there may be potential medical complications for both carrier and infant. The findings should help guide our clinical decision making when counseling patients who desire a gestational carrier.