Since the inception of ConceiveAbilities 25 years ago, there have been incredible advances in third party reproduction, especially in surrogacy. More and more families are turning to surrogacy to build their families and with good reason. Not only are people more open about how surrogacy has allowed them to fulfill their dream of building a family, more women are becoming surrogates. Dr. Ashley Tiegs with the Atlanta Center for Reproductive Medicine and winner of the ASRM 2021 Investigator Achievement award shared her own fertility journey, what inspired her to become a Reproductive Endocrinologist and how surrogacy has helped her patients build their families on our podcast All Things Conceivable: A Surrogacy Podcast with Nazca Fontes.
NF:You have been very open about your own infertility journey. Tell us about how your path to parenthood inspired you to become a Reproductive Endocrinologist.
My husband and I met when we were in medical school. He was very open with me pretty immediately that he had Hodgkin’s lymphoma as a teenager and he had alkylating chemotherapy, a pretty severe type of chemotherapy which basically kills sperm and eggs. He didn’t think that we could have kids. I started my OB/GYN rotation and I learned about the subspecialty of reproductive endocrinology and infertility. It’s how I found this field of medicine. I knew that this was the only thing I wanted to do. We waited to attempt to start a family until my last year of residency. His first semen analysis showed zero sperm and we were really devastated. We repeated the same analysis and it showed two sperm. Infertility patients know that normal analysis will show tens of millions of sperm, and it only had two. I knew that we could use Assisted Reproductive Technology and succeed with an intracytoplasmic sperm injection. So there was some hope for us to have our own biological child. And, we had our first child that way with IVF. Perseverance is really the biggest key in infertility. You have to find the treatment that’s right for you. I then did three more IVF cycles really to bank embryos because the embryo development rate was always poor and the embryos were of borderline quality. We now have two perfect children.
NF: Congratulations on your beautiful family. Perseverance absolutely pays off. We’ve used that perspective a lot in our agency, whether it’s one egg, one surrogate, or one sperm. Sometimes all it takes is one, so don’t give up. When is surrogacy a viable option for your patients?
We recommend a gestational carrier for patients with repeated history of embryo transfer failures in the setting of good quality embryos. because we feel that the embryo factor there is controlled. Alternatively, we may recommend a gestational carrier for women where pregnancy is contraindicated; they may have a poor obstetric history or medical history where pregnancy would be too dangerous to them or to the potential baby and it would not be prudent to put them through pregnancy. We’ll also use gestational carriers for unpartnered individuals and same sex couples that do not have any fertility factors.
NF: When you have a conversation with them about surrogacy, what reaction do you get?
It’s not always greeted with open arms. This can be a very low point and may be a hard thing to accept for couples. No one thinks about their journey to build a family as including perhaps a third person outside of their immediate couple. The good news is that it can be highly successful and it typically is extremely successful.
NF: For those struggling with infertility, the partnership with a surrogate is a uniquely good answer for couples who have been down a road of previous failures.
This is a new treatment, so it gives couples hope and a solution. That’s what we all want is a solution to infertility. I think that can be really exciting for a couple.
NF: How have advances allowed surrogacy to earn a title of being one of the most successful fertility treatments out there?
Careful selection of the gestational carriers has made it a really successful treatment for sure. The parents can feel very comfortable knowing that we have very strict criteria for who can become a gestational carrier. So it’s looking at their obstetric history, psychological and medical evaluation, and screening of the gestational carriers. Additionally we really recommend single embryo transfer to gestational carriers. Technological advances allow for pre-implantation genetic testing for aneuploidy allowing for that single embryo transfer and that helps the surrogate or the gestational carrier have a safe pregnancy.
NF: Why is it a requirement that a surrogate not only have a healthy uterus, but a proven obstetrical history of being able to carry healthy, uncomplicated pregnancies?
Obstetric histories tend to repeat themselves. We often see that. So we really don’t know what someone’s pregnancy is going to be like until they have one. So at least one pregnancy that is healthy, is a really good indication that another one will be healthy as well.
NF: What makes a good gestational carrier?
All the gestational carriers I’ve ever met really desire to make a major difference in people’s lives. They enjoy pregnancy. So there’s that emotional and social aspect of it. As the intended parents’ and the gestational carrier’s physician, my goal is primarily to make sure it’s a safe pregnancy.
NF: Surrogacy used to be viewed as a last resort for patients undergoing fertility treatment. We are now seeing physicians speeding up that conversation about partnering with a surrogate faster than ever before. Why do you think that is?
I think it’s multifaceted. The technologic advances in our field: we have more advanced embryo diagnostics. If we find that we’ve got good quality embryos and we’re not having success, perhaps surrogacy is the best option. We’ve also solidified the connections between infertility clinics and the gestational carrier agencies. We have more access to gestational carriers. It’s only become more and more widespread and more common and socially acceptable when we’ve got celebrities sharing their experience. It’s becoming more accessible as well and so that makes it an easier option to offer to patients.
NF: Surrogacy has become normalized, but there are still some myths about surrogacy.
The most common surrogacy myth I encounter is that perhaps the surrogate is a traditional surrogate and that they would donate eggs and carry a pregnancy. Gestational carriers have no genetic relation to the child they are carrying for the intended parent.
NF: Let’s pivot a little bit and talk about the advancements in care of the surrogate like fourth trimester support for the healing and recovery after a woman who is a gestational carrier gives birth.
The fourth trimester is absolutely extremely important and is probably the most important trimester. It really is a full 12 weeks of healing. It’s very important for the body to regain its nutrients. Emotionally too. I’m so glad that this is part of ConceiveAbilities’ program and care, because the attention that is given to the gestational carriers during this time is extremely important.
NF: What’s your advice to a woman who might be considering becoming a surrogate?
I feel like women who are considering becoming a surrogate or a carrier, they don’t need advice. These are some of the most caring, generous people I’ve ever met. My advice is to take care of yourself. And that’s really the best way to take care of the baby that you’re carrying and to help the intended parents.
NF: I couldn’t agree more. They are remarkable women: truly incredible, generous giving, tough, tenacious, and persevering. They’re really something.