ART and Gestational Carriers

Key Findings: Use of Gestational Carriers in the United States

image of a smiling infant
A gestational carrier is a woman bearing a genetically-unrelated child for another person or couple. Typically, in vitro fertilization is used to fertilize the intended parent’s egg, and then the resulting embryo is placed in the gestational carrier’s uterus. People who may decide to use a gestational carrier may include women with ovaries and no uterus or women who cannot carry a pregnancy because of a serious health problem. Because of limited information on the use of gestational carriers in the United States, data from CDC’s National ART Surveillance System were used to describe trends and outcomes of gestational carrier cycles. These findings provide important information on the potential risks and benefits of gestational surrogacy for intended parents, babies, and gestational carriers.

Has the use of gestational carriers changed over time?

  • Between 1999 and 2013, about 2% (30,927) of all assisted reproductive technology cycles used a gestational carrier.
  • The number of gestational carrier cycles increased from 727 (1.0%) in 1999 to 3,432 (2.5%) in 2013.

What were the characteristics and outcomes of gestational carrier cycles?

  • Between 1999 and 2013, gestational carrier cycles resulted in 13,380 deliveries and the birth of 18,400 infants. The data shows 9,819 (53.4%) of these infants were twins, triplets, or higher order multiples.
  • Intended parents using a gestational carrier tended to be older than parents who did not. Most gestational carriers were less than 35 years of age.
  • Approximately 16% of intended parents using a gestational carrier were not US residents.
  • Gestational carrier cycles had higher rates of implantation, pregnancy, and live births when compared to non-gestational carrier cycles. However, multiple birth and preterm delivery rates were higher among gestational carrier cycles—largely due to the frequent transfer of two or more embryos per cycle.

More about These Findings

Elective single embryo transfer was performed in only 15% of gestational carrier cycles. Transferring fewer embryos during ART cycles, including gestational carrier cycles, can reduce the risk for multiple births.  

Key Findings References

  1. Perkins KM, Boulet SL, Jamieson DJ, Kissin DM; National Assisted Reproductive Technology Surveillance System (NASS) Group. Trends and outcomes of gestational surrogacy in the United States. Fertil Steril. 2016; 106(2):435-442  Accessed August 1, 2016.