High live birth, low preterm delivery rates with gestational carriers
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Key takeaways:
- Gestational carrier cycles were more likely to have live births vs. nongestational carrier cycles.
- Preterm and very preterm rates were lower with gestational carriers vs. nongestational carrier cycles.
NEW ORLEANS — Live birth rate was higher and preterm delivery risk lower with gestational carriers, or surrogates, compared with assisted reproduction cycles not using a gestational carrier, according to study findings.
“The use of gestational carriers has continued to increase, possibly due to increased visibility of assisted reproductive technology services for LGBTQ patients, evolving state laws around gestational carrier arrangements and increased visibility in the general media,” Lisa M. Shandley, MD, MSCR, a third-year fellow in the division of reproductive endocrinology and infertility at the Emory Reproductive Center, said during the presentation at the ASRM Scientific Congress & Expo. “A focus on safety in assisted reproductive technology in general, including elective single embryo transplant compliance, may have contributed to changes in outcomes in those cycles that use a gestational carrier.”
Shandley and colleagues used data from the Society for Assisted Reproductive Technology (SART) Clinic Outcomes Reporting System on 1,008,205 assisted reproductive technology cycles between 2014 and 2020 that involved transferring an embryo to a uterus. Researchers evaluated national trends in gestational carrier use and differences in outcomes between assisted reproductive technology cycles with and without a gestational carrier.
Researchers also evaluated miscarriage risk among all resulting pregnancies and gestational age at delivery and multiple gestation risk among live births in this study.
Overall, 4% of assisted reproductive technology cycles used gestational carriers. The number and proportion of gestational carrier cycles increased from 2.7% in 2014 to 5.2% in 2019 and 4.6% in 2020. Geographically, 47 U.S. states reported at least one gestational carrier cycle, with more than 15,000 cycles reported from California alone.
Gestational carrier cycles had a higher likelihood of involving older intended parents (aged > 42 years, 28.7% vs. 9.6%), use of a donor oocyte (51.1% vs. 11.3%), a younger oocyte (aged < 30 years, 40.8% vs. 19.7%) and parents who reported no prior pregnancy (46% vs. 37.6%). More gestational carrier cycles used preimplantation genetic testing compared with nongestational carrier cycles (63.2% vs. 30.7%).
Compared with nongestational carrier cycles, gestational carrier cycles were more likely to use frozen embryo transfers (90% vs. 66%) and were more likely to utilize preimplantation genetic testing (63% vs. 31%).
Gestational carrier cycles were also more likely to have live births compared with nongestational carrier cycles when adjusting for oocyte age, infertility, intracytoplasmic sperm injection, donor oocyte use, assisted hatching, fresh vs. frozen cycle, preimplantation genetic testing, embryo transfer day and the number of transferred embryos (adjusted RR = 1.11; 95% CI, 1.1-1.12).
Both preterm (aRR = 0.8; 95% CI, 0.78-0.82) and very preterm (aRR = 0.76; 95% CI, 0.7-0.83) birth rates were lower in gestational carrier cycles vs. nongestational carrier cycles when adjusting for pregnancy plurality. Double embryo transfer rates were also high in gestational carrier cycles (27.6%). Gestational carrier cycles had an increased multiple gestation risk compared with nongestational carrier cycles (aRR = 1.15; 95% CI, 1.11-1.18), even when adjusting for embryo transfer day, the number of transferred embryos and preimplantation genetic testing.
“Further characterization of the cycles in which multiple embryos were transferred could better elucidate the degree of compliance or lack thereof with ASRM recommendations,” Shandley said.