Family members serving the gestational carrier needs of women lacking a uterus: a report of two cases

Case report: In two instances, a designated relative served as a gestational carrier for a woman who no longer had a uterus. In the first case, a 38-year-old woman underwent an emergency cesarean hysterectomy due to worsening fatty degeneration of the liver in the third trimester, culminating in massive hemorrhage, consumptive coagulopathy and the loss of twins at 28 weeks gestation following successful in vitro fertilization. In the second case, a 28-year-old had congenital absence of the uterus and vagina. Both surrogates volunteered for service and were carefully screened medically, reproductively, and psychosocially prior to proceeding. All parties were required to execute informed consent and contracts with private attorneys before entry. Both gestational carriers conceived following the initial embryo transfer; one as the result of previously cryopreserved embryos, the other from embryos obtained following the synchronized in vitro fertilization of newly aspirated oocytes. Gestational carriers were prescribed oral estradiol and vaginal progesterone to prepare the uterus for implantation, and maintained this regimen throughout the first trimester of pregnancy. The pregnancies proceeded uneventfully and resulted in the delivery of singleton births at term. Both infants were formally adopted after delivery by the genetic parents in compliance with the advice of counsel under New York State law. Conclusion: Family members serving as gestational carriers provide women with functional ovaries but no uterus, the opportunity to have genetic offspring, while avoiding much of the high cost and social uncertainty of commercial surrogates.