title: Gestational carriers: A viable alternative for women with medical contraindications to pregnancy.
abstract: OBJECTIVE
  Compare the efficacy of surrogate or gestational carrier (GC) cycles to that of autologousin vitrofertilization (IVF)/intracytoplasmic sperm injections (ICSI) in patients with gynecologic or medical co-morbidities contraindicative to pregnancy.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Infertility patients from a single university hospital-based program from 1998-2009.
  
  
  METHODS
  128 GC cycles from 80 intended parents were identified and compared with 15,311 IVF or ICSI cycles.
  
  
  METHODS
  The peak estradiol (E2), number of oocytes retrieved, cycle cancellation, ongoing pregnancy, and live-birth were compared between GCs and autologous IVF carriers. Indications for GC use were also identified. Multiple cycles contributed by the same patient were accounted for using multivariable generalized estimating equations and two-sided Wald p-values.
  
  
  RESULTS
  Uterine factors (67%) was the most common indication for using a GC, followed by non-gynecologic medical conditions including coagulopathies (13%), end stage renal disease (10%), cardiovascular disease (5%) and cancer (5%). Adjusting for age, ovulation induction in GC cycles had similar peak E2 levels and number of oocytes retrieved relative to IVF cycles (p = 0.23 and 0.43, respectively). Clinical pregnancy (49% vs. 42%, p = 0.28) and live-birth rates (31% vs. 32%, p = 0.74) were also comparable. A sub-analysis of GC cycles in those women with uterine factor indications, demonstrated significantly higher clinical pregnancy rates (OR = 2.0; CI = 1.2 - 3.5) with 60% greater odds of live-birth relative to IVF/ICSI cycles, however this odds was not statistically significant for differences in live-birth (CI = 0.9 - 2.9). Conclusions: GCs are a viable alternative to start families for patients with medical co-morbidities precluding pregnancy.
authors: Department of Obstetrics, Gynecology and Reproductive Biology, Brigham & Women's Hospital and Harvard Medical School, Boston, USA.
authors: Raymond M
authors: RM
authors: Anchan
authors: Department of Obstetrics, Gynecology and Reproductive Biology, Brigham & Women's Hospital and Harvard Medical School, Boston, USA.|Channing Laboratory, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, USA.|Department of Epidemiology, Harvard School of Public Health, Boston, USA.
authors: Stacey A
authors: SA
authors: Missmer
authors: Department of Obstetrics, Gynecology and Reproductive Biology, Brigham & Women's Hospital and Harvard Medical School, Boston, USA.
authors: Katharine F
authors: KF
authors: Correia
authors: Department of Obstetrics, Gynecology and Reproductive Biology, Brigham & Women's Hospital and Harvard Medical School, Boston, USA.
authors: Elizabeth S
authors: ES
authors: Ginsburg
keywords: Donor Egg; Gestational Carriers; Gestational Surrogacy; IVF; Infertility; Medical Comorbidities