Intro: The Reproductive Science Center of New Jersey combines a commitment to sensitive care with a state-of-the-art program. We proudly present Fertility talk with RSCNJ. Here's Melanie Cole.

Melanie Cole, MS (Host): Are you looking to start a family and you really are not sure where to go, but you know that you want to consider surrogacy? What even is that? We're going to talk about that today. Welcome to Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey. I'm Melanie Cole. We're going to learn all about surrogacy today with Dr. Alan Martinez. He's a specialist in reproductive endocrinology and infertility at the Reproductive Science Center of New Jersey.

Dr. Martinez, always a pleasure. Thank you so much for joining us today. When we think about starting that conversation and the fertility journeys that some people go through, tell us a little bit about what gestational surrogacy is. In what situations might people look for a surrogate? Tell us a little bit about that.

Alan M. Martinez, MD: Yeah. Thank you for having me today. Appreciate it. So, gestational surrogacy is when you have a patient that serves to carry a pregnancy, and that pregnancy or that embryo is derived from either what we call the intended parents. So, it could be egg and sperm from the couple themselves. It could be donor egg, it could be donor sperm or any variation of that. You have two general terms. You have intended parents, which are the patients that are attempting to have a child and they need assistance in someone carrying the pregnancy, and that's a gestational carrier.

Melanie Cole, MS : It's really such a fascinating thing. And it's lovely to do for someone if you're being the surrogate. Now, how do patients typically find a surrogate? How do they select one? Tell us about the process, because that would seem to be the biggest part of it, is to find someone to do this for you.

Alan M. Martinez, MD: Yes. So luckily, this is an identified and streamlined process as possible that involves multiple entities. So, the first part of it is that the patients or the intended parents need to recognize that they're going to be working with an agency that specializes in gestational carriers. So, there's much counseling that's involved regarding the whole process.

So, what we work with our patients is to help them and assist them and guide them in finding an agency that is, one, reputable, experienced, and an agency that is really going to be responsible in taking care of the gestational carrier, taking care of the patient or the intended parents, both leading up to the process after an embryo transfer, after pregnancy, and they're going to help them navigate that process. So, they're involved in many steps along the way.

Melanie Cole, MS : Yeah. That's good to know. So, some people consider using someone that they know. Dr. Martinez, in your vast experience, tell us a little bit about some of the challenges and possible benefits in using a surrogate that's maybe a good friend or within the family or a friend of the couple. Tell us about what happens in that situation.

Alan M. Martinez, MD: The same process for selection and criteria exist. whether it's a gestational carrier that comes from an agency that is known to the intended parents after they select them, or whether it is a friend or some sort of family member, all parties need to undergo the same testing. So, there is both laboratory testing. There's physical exams that must be done for a carrier. There are both counseling for psychology and mental health, and then everybody is screened. So, there are also aspects of the legal contract that exists. So whether it's a known friend that serves as a carrier or a carrier obtained That is from an agency from say another part of the country, they undergo the same legal contract to protect both the carrier and to protect the intended parents.

Melanie Cole, MS : Well then, expand a little bit since you brought up the legal contract. And certainly, there's going to be emotional considerations that happen as well. So, what would you like patients to know about some of those legal and the psychosocial aspects of that. You mentioned counseling. And if they're going to have a legal contract, especially with somebody that they know, then tell us a little bit about what's involved. What are some of those terms that go on in that legal contract so that we know it's binding, and even if it's somebody that you know, that things aren't going to get messed up?

Alan M. Martinez, MD: The contract is structured in such a way that the gestational carrier agrees to carry the pregnancy. And the gametes from egg, from sperm, they can come from the intended parents. It could be donor egg, donor sperm, it does not matter. But they're serving as a carrier. Once they deliver, they have no rights or protections or concerns. Should they have any concerns about being considered a parent thereafter. They're providing a service. So, it varies a lot with both the intended parents and gestational carriers as to their future goals after they deliver a child.

It's important for the patients to discuss this. And this is where an agency can guide you and the counselors can guide them in understanding what kind of a relationship do you want with this individual after delivery of the child. Do you want to be involved throughout the whole process? Do you want to know about all the appointments? Do you want daily communication? Do you want an ongoing relationship after delivery? In a case of somebody you know, that probably will go in that direction. But both sides need to understand they're entering into a relationship that may be long-term. So, it's especially important for the intended parents and the carriers to come to an agreement and match their expectations because we have other patients that want a gestational carrier. But after delivery, they want infrequent or no contact with the carrier. And so, the wishes of each group needs to be matched appropriately. And when the expectations do not align, that's when you have potential conflict, and that's why our practice at RSCNJ is going to guide our patients that the agency we're going to have help them find is going to be a reputable experience agency that provides those services so that we can minimize any potential issues.

Melanie Cole, MS : So, walk us through the steps a little bit, Dr. Martinez, because we're covering a lot of things, and this is really a big topic. Tell us a little bit about the process itself. So, you mentioned finding a reputable surrogacy company and all the contracts and everything. But where does one start? How does it actually work? And how long? If you were to give us a timeline of actually starting the process and finding a surrogate, how long does that process typically take?

Alan M. Martinez, MD: Patients are surprised at the length of time. Average to match a patient, whether the patient is single patient, partnered male-female patients with a carrier, the average time is about 12 months. So, patients are given realistic expectations. The timeline depends on the type of patient. So, we have patients that go through fertility treatment, and they may fail multiple IVF attempts. They may have something medically that precludes them from carrying the pregnancy. They may be a single parent, they may not have a uterus to carry a pregnancy. They may be of a male gender. So, the timeline of when patients present to the office and make the decision to proceed with searching for a gestational care varies depending upon their fertility course. Some patients come in and they know they're going to go down that path immediately. Others have to navigate the journey earlier. Once they decide that they want to use a gestational carrier, it's recommended at least that the patients start with the process of in vitro fertilization and assisted reproductive technology in order to procure embryos. So, we bring together egg and sperm. We have embryos that are frozen. And when patients do that first, sometimes that one-year average timeline may shorten and become more like six months, for instance.

So once the decision is made, then they undergo the fertility treatment most commonly, they will then search for a carrier. At the same time, they will be guided by our practice step by step to find the right match. And part of this screening involves us becoming involved. So, we do a physical exam on potential carriers. We meet them, we look at their medical history. We make sure that this is the right fit based on expectations. And then, once they have embryos and these embryos are cryopreserved, then we prepare the gestational carrier either within our community and our practice or remotely throughout the United States, timing out their preparation so that they can receive an embryo and carry the pregnancy.

Melanie Cole, MS : Dr. Martinez, you specifically, when you think about what families look like today, which maybe they didn't say 10, 20 years ago or whenever you got into this field, you work with so many different types of families, Dr. Martinez. You just inspire me so much and so many of us that watch these videos and listen to you talk about all of these options for family building, what inspires you when you think about the families you've helped to build, whether it's single parents by choice, the LGBTQ+ community, I mean, you really have seen and done it all. What inspires you at this point?

Alan M. Martinez, MD: I love helping patients through this journey, because the medical technology and their options are greater than ever. Our ability to use donor sperm when maybe a male patient doesn't have sperm; maybe we have two female patients that desire to start a family; my patients that are male that need a gestational carrier, need gametes outside of their relationship; single patients. The technology that we have is amazing. The ability to counsel them and the trust that the patients elicit from us, it's a very honorable thing that I'm so happy to navigate through that journey with them. And when they achieve pregnancy, when they have a child, through this process of gestational carrier, it is an amazing gift that they're parents. And to be a part of that, it never gets old.

Melanie Cole, MS : Thank you so much for joining us as always, and sharing your incredible expertise and experience for couples that are dealing with infertility and looking to start a family. You always just give us so much great information. And thank you again for joining us. And for more information, you can always visit fertilitynj.com to schedule an appointment and speak to one of our fertility specialists. That concludes this episode of Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey. I'm Melanie Cole.