An estimated 1 in 6 couples will experience difficulty conceiving and may turn to a medical professional to test and diagnose the possible causes of infertility. The U.S. Department of Health & Human Services describes “infertility” as being unable to become pregnant after one year of trying (for women age 35 and older, this time frame decreases to six months). According to the Centers for Disease Control and Prevention (CDC), approximately 10% of women in the U.S. (ages 15-44) experience difficulty becoming pregnant.
An Obstetrician-Gynecologist or a reproductive Endocrinologist can help to diagnose the cause of infertility. While both physicians will perform an initial fertility test, a reproductive Endocrinologist will generally provide a more substantive infertility diagnosis.
The Cost of Infertility
Infertility testing and diagnosis can be very expensive. Hawaii law requires insurers to cover the cost of one cycle of IVF treatment so long as patients meeting certain criteria:
- The patient and the patient’s spouse must have a 5-year history of infertility (unless the infertility is associated with the following medical conditions: endometriosis, in utero exposure to diethylstilbestrol (commonly called “DES”), blockage or surgical removal of one or both of the fallopian tubes, or abnormal male factors resulting in infertility);
- The patient must have been unable to attain pregnancy or carry a successful pregnancy through other applicable fertility treatments that are covered under the insurance plan;
- The IVF procedure must be performed at a medical facility or clinic that conforms to IVF guidelines established by the American College of Obstetrics and Gynecology or the American Society for Reproductive Medicine.
Here is a list of the most commonly used terms relating to infertility and surrogacy:
- Gestational Carrier (GC) – A woman who carries a fertilized egg of another woman to bear a child (or children) on behalf of someone else. A Gestational Carrier has no biological relationship to the child.
- Surrogate – A women who donates her own egg and subsequently carries the child. A Surrogate is biologically related to the child.
- Intended Parents (IP) – Two people who enter into an agreement with a Surrogate or a Gestational Carrier whereby they agree to be the parents of any child born to the Surrogate or Gestational Carrier through assisted reproductive technology regardless of the genetic relationships between the intended parents, the Surrogate/GC, and the child.
- Surrogacy Agency – A professional agency in the business of helping parties coordinate the surrogacy process. Services generally include matching IPs with a Surrogate or a GC, screening services to ensure all parties are mentally, physically and emotionally ready for the surrogacy process, coordination of information and services between clinics and surrogacy attorneys, and counseling and support services throughout the process.
COMMON SURROGACY TERMS
- Gamete – The reproductive cell of a male (sperm) or a female (ovum/oocyte). When a male gamete is combined with a female gamete, a zygote (fertilized egg) is created.
- Ovum – The female reproductive cell, also called an egg. An immature egg cell in its earliest stages is called an oocyte, which eventually matures to become an ovum.
- Embryo – The earliest state of development of an unborn baby. It is an egg that has been fertilized by a sperm and undergone one or more divisions.
- Blastocyst (Blast) – An embryo that has developed for 5 to 7 days after fertilization. This is the last stage of development an embryo must reach before it is implanted into the uterus.
- Fetus – After the eighth week of gestation, an embryo is considered to have matured to become a fetus.
- Cryopreservation – The process of freezing biological material (gametes, embryos, or ovarian or testicular tissues) at extreme temperatures for potential future use.
- Gestational Surrogacy – Pregnancy whereby the surrogate is genetically unrelated to the baby. The embryos are created using the eggs from the intended mother or an egg donor and sperm from the intended father or a sperm donor. Today, this is the most common type of surrogacy.
- Traditional Surrogacy – Pregnancy whereby the surrogate donates her own egg and subsequently carries the child with the intent of turning the child over to the intended parents after birth. The surrogate’s egg can be combined with the intended father’s sperm, or that of another sperm donor.
- Altruistic Surrogacy – Pregnancy whereby the surrogate receives no compensation for carrying the baby, except for reimbursement of costs, expenses, and loss of income.
- In Vitro Fertilization (IVF) – The process of fertilizing an egg with sperm outside of the body and implanting it into the uterus. IVF is the most common type of assisted reproductive technology
- Embryo Transfer – The process of placing an embryo into the body after IVF. More than one embryo can be placed into the body at the same time, frequently leading to twin or triplets. Unused embryos can be frozen and implanted at a later date.
- Intrauterine Insemination (IUI) – A medical procedure that involves placing sperm directly into a woman’s uterus to facilitate fertilization. IUI is not considered an ART procedure because it does not involve the use of eggs.
- Amniocentesis – A test used to detect any chromosomal abnormalities, neural tube defects, and genetic disorders by examining the cells in the amniotic fluid. It is commonly done between the 14th and 20th week of pregnancy.
- Hysterosalpingogram (HSG) – A radiology procedure which determines the condition of the fallopian tubes and uterus.
- Chorionic Villus Sampling (CVS) – A diagnostic test for identifying chromosome abnormalities and other inherited disorders. It is commonly performed between the 10th and 12th week of pregnancy.
- Gestational Carrier Agreement (GCA) – An agreement between the IPs, the GC and the GC’s partner/spouse (if any). A GCA addresses procedures and agreements regarding GC genetic testing, life and health insurance, costs and compensation, access to medical records, attendance at medical appointments, selection of physicians and delivery hospital, parental rights, custody issues, and many other aspects of the surrogacy process. It will also specify agreements regarding control over medical decisions during the pregnancy, payment of bills, liability for any complications during the pregnancy, and IPs’ presence during doctor’s visits and at the time of delivery. The GCA is a critical legal document in the surrogacy process and should only be handled by experienced legal counsel.
- Known Donor Agreement – An agreement with a sperm or egg donor whose identity is known and the individual receiving the sperm or egg.
- Second Parent Adoption – A legal procedure whereby a child who already has one parent is adopted by another parent, without terminating the first parent’s existing legal rights.
- Pre-Birth Order – A court issued order that is obtained before birth which assigns parentage of a child to the Intended Parents and removes any rights or obligations from the Surrogate/GC. Some states (such as Hawaii) do not allow pre-birth orders. In those cases, the parties will have to wait until after the child is born to obtain a post-birth order.
- Post-Birth Order – A court issued order that is acquired after birth which assigns parentage of a child to the Intended Parents and removes any rights or obligations from the Surrogate/GC.