The Time has come: Gestational Carrier and the Use of Pre-implantation Genetic Testing (PGT)

Abstract

Purpose of review: Gestational carrier reproduction is restricted in much of the industrialized world due to complex ethical issues between the intended parents (IP) and the gestational carrier (GC), as well as safety concerns for the GC. Over 3% of all embryo transfers done in the United States involve GCs. Recent review has revealed high perinatal risks associated with assisted reproductive technologies (ART) for GCs. Compared to spontaneous conception, which the GC is familiar with, GCs using IVF have increased risk for twins and triplets of 20 and 46 fold, respectively. The resultant perinatal mortality rates are increased 4-6 fold. Costs in the first year of life for multiples are 5 to 20 times greater than for singletons. As GC cycles continue to increase, we must develop strategies to reduce perinatal risks for GCs and their offspring.Recent findings: Recent advances in IVF with pre-implantation genetic testing allow detection of euploidy for all 24 chromosomes. Elective single embryo transfer has reduced the risk of multiple pregnancy, preterm delivery and perinatal morbidity for women across the age spectrum.Summary: Elective euploid single embryo transfer, through the use of PGT, allows for very high pregnancy rates while reducing perinatal morbidity to natural levels. Both multiple gestation and miscarriage are dramatically reduced. Implementation of this technology in GCs will greatly enhance the safety of pregnancies, protecting this vulnerable population of altruistic women.