The proper pre-IVF assessment of the uterine cavity is discussed in the IVF patient preparation section. If a significant anatomic abnormality is identified during this assessment, surgical repair is generally recommended. If surgical repair is not successful or impossible, then consideration of a surrogate pregnancy program is often considered.
Reportedly, within large gestational surrogacy programs the common (acceptable) indications for the use of a surrogate uterus include prior surgical removal (hysterectomy), congenital (existing at birth) abnormalities that are not surgically repairable (such as congenital absence of the uterus), abnormalities of the uterus (such as a uterine septum, fibroids, intrauterine adhesions) that have been unsuccessfully treated surgically, and immunologic abnormalities (such as the antiphospholipid syndrome or persistent abnormalities in immunophenotype involving helper and killer cells) that have apparently resulted in infertility or recurrent pregnancy loss. The use of a surrogate carrier for convenience (or lifestyle reasons) is not considered medically appropriate.
The technology available within the field of In Vitro Fertilization, including synchronization of the endometrial (uterine) lining of one woman who is intended to carry a pregnancy created using the eggs developed within another woman (the basis of donor egg IVF), easily allows the IVF center to (medically) incorporate gestational surrogates. However, legal issues are also VERY important to consider.
In some countries (England and Australia) the use of gestational surrogates has been considered a criminal offense. In the USA, the laws on surrogacy vary from state to state.
In California, state laws (2002) have not specifically provided guidelines for surrogacy. When these (surrogacy) laws have been challenged in California (such as in the Anna Johnson case during which the gestational carrier sought custody of the child) the (California) courts have awarded custody to the genetic (rather than the gestational) mother. In other states, contracts with gestational surrogates are not considered to be legally binding and custody has been awarded to the gestational surrogates. The legal rights of the involved parties are generally not well understood in the USA and “new” court rulings may change these rights dramatically.
A full detailed discussion (with an experienced lawyer) of the intricate legal issues that are involved in surrogacy should precede any plans to engage this treatment option.