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Trends and outcomes of gestational surrogacy in the United States

      Objective

      To evaluate trends and reproductive outcomes of gestational surrogacy in the United States.

      Design

      Retrospective cohort study.

      Setting

      Infertility clinics.

      Patient(s)

      IVF cycles transferring at least one embryo.

      Intervention(s)

      Use of a gestational carrier.

      Main Outcome Measure(s)

      Trends in gestational carrier cycles during 1999–2013, overall and for non-U.S. residents; reproductive outcomes for gestational carrier and nongestational carrier cycles during 2009–2013, stratified by the use of donor or nondonor oocytes.

      Result(s)

      Of 2,071,984 assisted reproductive technology (ART) cycles performed during 1999–2013, 30,927 (1.9%) used a gestational carrier. The number of gestational carrier cycles increased from 727 (1.0%) in 1999 to 3,432 (2.5%) in 2013. Among gestational carrier cycles, the proportion with non-U.S. residents declined during 1999–2005 (9.5% to 3.0%) but increased during 2006–2013 (6.3% to 18.5%). Gestational carrier cycles using nondonor oocytes had higher rates of implantation (adjusted risk ratio [aRR], 1.22; 95% confidence interval [CI], 1.17–1.26), clinical pregnancy (aRR, 1.14; 95% CI, 1.10–1.19), live birth (aRR, 1.17; 95% CI, 1.12–1.21), and preterm delivery (aRR, 1.14; 95% CI, 1.05–1.23) compared with nongestational carrier cycles. When using donor oocytes, multiple birth rates were higher among gestational carrier compared with nongestational carrier cycles (aRR, 1.13; 95% CI, 1.08–1.19).

      Conclusion(s)

      Use of gestational carriers increased during 1999–2013. Gestational carrier cycles had higher rates of ART success than nongestational carrier cycles, but multiple birth and preterm delivery rates were also higher. These risks may be mitigated by transferring fewer embryos given the higher success rates among gestational carrier cycles.

      Key Words

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      References

        • American Society for Reproductive Medicine
        Consideration of the gestational carrier: a committee opinion.
        Fertil Steril. 2013; 99: 1838-1841
        • Utian W.H.
        • Sheean L.
        • Goldfarb J.M.
        • Kiwi R.
        Successful pregnancy after in vitro fertilization and embryo transfer from an infertile woman to a surrogate.
        N Engl J Med. 1985; 313: 1351-1352
        • Soderstrom-Anttila V.
        • Wennerholm U.B.
        • Loft A.
        • Pinborg A.
        • Aittomaki K.
        • Romundstad L.B.
        • et al.
        Surrogacy: outcomes for surrogate mothers, children and the resulting families-a systematic review.
        Hum Reprod Update. 2016; 22: 260-276
        • Utian W.H.
        • Goldfarb J.M.
        • Kiwi R.
        • Sheean L.A.
        • Auld H.
        • Lisbona H.
        Preliminary experience with in vitro fertilization-surrogate gestational pregnancy.
        Fertil Steril. 1989; 52: 633-638
        • Marrs R.P.
        • Ringler G.E.
        • Stein A.L.
        • Vargyas J.M.
        • Stone B.A.
        The use of surrogate gestational carriers for assisted reproductive technologies.
        Am J Obstet Gynecol. 1993; 168 (discussion 61–3): 1858-1861
        • Meniru G.I.
        • Craft I.L.
        Experience with gestational surrogacy as a treatment for sterility resulting from hysterectomy.
        Hum Reprod. 1997; 12: 51-54
        • Parkinson J.
        • Tran C.
        • Tan T.
        • Nelson J.
        • Batzofin J.
        • Serafini P.
        Perinatal outcome after in-vitro fertilization-surrogacy.
        Hum Reprod. 1999; 14: 671-676
        • Corson S.L.
        • Kelly M.
        • Braverman A.M.
        • English M.E.
        Gestational carrier pregnancy.
        Fertil Steril. 1998; 69: 670-674
        • Brinsden P.R.
        Gestational surrogacy.
        Hum Reprod Update. 2003; 9: 483-491
        • Goldfarb J.M.
        • Austin C.
        • Peskin B.
        • Lisbona H.
        • Desai N.
        • de Mola J.R.
        Fifteen years experience with an in-vitro fertilization surrogate gestational pregnancy programme.
        Hum Reprod. 2000; 15: 1075-1078
        • Soderstrom-Anttila V.
        • Blomqvist T.
        • Foudila T.
        • Hippelainen M.
        • Kurunmaki H.
        • Siegberg R.
        • et al.
        Experience of in vitro fertilization surrogacy in Finland.
        Acta Obstet Gynecol Scand. 2002; 81: 747-752
        • Duffy D.A.
        • Nulsen J.C.
        • Maier D.B.
        • Engmann L.
        • Schmidt D.
        • Benadiva C.A.
        Obstetrical complications in gestational carrier pregnancies.
        Fertil Steril. 2005; 83: 749-754
        • Raziel A.
        • Schachter M.
        • Strassburger D.
        • Komarovsky D.
        • Ron-El R.
        • Friedler S.
        Eight years’ experience with an IVF surrogate gestational pregnancy programme.
        Reprod Biomed Online. 2005; 11: 254-258
        • Smotrich D.B.
        • Ross R.J.
        • Arnold L.L.
        • Batzofin D.
        Gestational surrogacy—ART's stepchild.
        Fertil Steril. 2008; 90: S387-S388
        • Dermout S.
        • van de Wiel H.
        • Heintz P.
        • Jansen K.
        • Ankum W.
        Non-commercial surrogacy: an account of patient management in the first Dutch Centre for IVF Surrogacy, from 1997 to 2004.
        Hum Reprod. 2010; 25: 443-449
        • Check J.H.
        • Katsoff B.
        • Brasile D.
        • Wilson C.
        • Summers-Chase D.
        Comparison of pregnancy outcome following frozen embryo transfer (ET) in a gestational carrier program according to source of the oocytes.
        Clin Exp Obstet Gynecol. 2011; 38: 26-27
        • Dar S.
        • Lazer T.
        • Swanson S.
        • Silverman J.
        • Wasser C.
        • Moskovtsev S.I.
        • et al.
        Assisted reproduction involving gestational surrogacy: an analysis of the medical, psychosocial and legal issues: experience from a large surrogacy program.
        Hum Reprod. 2015; 30: 345-352
        • James S.
        • Chilvers R.
        • Havemann D.
        • Phelps J.Y.
        Avoiding legal pitfalls in surrogacy arrangements.
        Reprod Biomed Online. 2010; 21: 862-867
      1. Fertility Clinic Success Rate and Certification Act of 1992 PL-, 1063 Stat 146–3152.

        • Centers for Disease Control and Prevention, American Society for Reproductive Medicine, Society for Assisted Reproductive Technology
        2012 Assisted Reproductive Technology Fertility Clinic Success Rates Report.
        Centers for Disease Control and Prevention, Atlanta (GA)2014
        • Bromfield N.
        • Rotabi K.
        Global surrogacy, exploitation, human rights and international private law: a pragmatic stance and policy recommendations.
        Glob Soc Welf. 2014; 1: 123-135
        • Kawwass J.F.
        • Monsour M.
        • Crawford S.
        • Kissin D.M.
        • Session D.R.
        • Kulkarni A.D.
        • et al.
        Trends and outcomes for donor oocyte cycles in the United States, 2000–2010.
        JAMA. 2013; 310: 2426-2434
        • Yeh J.S.
        • Steward R.G.
        • Dude A.M.
        • Shah A.A.
        • Goldfarb J.M.
        • Muasher S.J.
        Pregnancy rates in donor oocyte cycles compared to similar autologous in vitro fertilization cycles: an analysis of 26,457 fresh cycles from the Society for Assisted Reproductive Technology.
        Fertil Steril. 2014; 102: 399-404
        • Creative Family Connections
        Surrogacy Law by State.
        2015 (Available at:http://creativefamilyconnections.com/surrogacy-law-by-state/#. Accessed November 13, 2015)
        • Armour K.L.
        An overview of surrogacy around the world: trends, questions and ethical issues.
        Nurs Women’s Health. 2012; 16: 231-236
        • Burrell C.
        • Edozien L.C.
        Surrogacy in modern obstetric practice.
        Semin Fetal Neonatal Med. 2014; 19: 272-278
        • Malizia B.A.
        • Hacker M.R.
        • Penzias A.S.
        Cumulative live-birth rates after in vitro fertilization.
        N Engl J Med. 2009; 360: 236-243
        • Schieve L.A.
        • Peterson H.B.
        • Meikle S.F.
        • Jeng G.
        • Danel I.
        • Burnett N.M.
        • et al.
        Live-birth rates and multiple-birth risk using in vitro fertilization.
        JAMA. 1999; 282: 1832-1838
        • Pantos K.
        • Athanasiou V.
        • Stefanidis K.
        • Stavrou D.
        • Vaxevanoglou T.
        • Chronopoulou M.
        Influence of advanced age on the blastocyst development rate and pregnancy rate in assisted reproductive technology.
        Fertil Steril. 1999; 71: 1144-1146
        • Practice Committee of the American Society for Reproductive Medicine, Practice Committee of the Society for Assisted Reproductive Technology
        Recommendations for practices utilizing gestational carriers: a committee opinion.
        Fertil Steril. 2015; 103: e1-e8
        • Jack B.W.
        • Culpepper L.
        Preconception care. Risk reduction and health promotion in preparation for pregnancy.
        JAMA. 1990; 264: 1147-1149
        • Conde-Agudelo A.
        • Belizan J.M.
        • Lindmark G.
        Maternal morbidity and mortality associated with multiple gestations.
        Obstet Gynecol. 2000; 95: 899-904
        • Spiliopoulos M.
        • Kareti A.
        • Jain N.J.
        • Kruse L.K.
        • Hanlon A.
        • Dandolu V.
        Risk of peripartum hysterectomy by mode of delivery and prior obstetric history: data from a population-based study.
        Arch Gynecol Obstet. 2011; 283: 1261-1268
        • Francois K.
        • Ortiz J.
        • Harris C.
        • Foley M.R.
        • Elliott J.P.
        Is peripartum hysterectomy more common in multiple gestations?.
        Obstet Gynecol. 2005; 105: 1369-1372