A hysterectomy, the surgical removal of the uterus, does not end the possibility of having a biological child through surrogacy. For individuals who have undergone this procedure but retained at least one functional ovary, their own eggs can still be retrieved and used to create embryos. This provides a viable option for becoming a parent, even without the ability to physically carry a pregnancy. Surrogacy offers a way to maintain a genetic connection to the child, provided the intended mother’s ovaries are still producing viable eggs, or if donor eggs are used. The process relies on advanced reproductive technology and a gestational carrier to carry the pregnancy to term.
Hysterectomy and Ovarian Function
A hysterectomy removes the uterus, the organ where a pregnancy develops and is sustained. The procedure may or may not include the removal of the ovaries and fallopian tubes, depending on the medical reason for the surgery. If the ovaries are preserved, they continue their endocrine function, which includes the monthly maturation and release of eggs and the production of hormones like estrogen and progesterone.
The ovaries, not the uterus, are the source of genetic material for reproduction. Even without a uterus, the eggs remain accessible and viable for use in assisted reproductive procedures. The eggs can still be retrieved through a minimally invasive process. While a hysterectomy can sometimes slightly diminish ovarian function by disrupting blood flow, the ovaries often remain healthy enough to produce eggs for fertilization.
In Vitro Fertilization (IVF) for Intended Parents
The creation of a biological child after a hysterectomy requires in vitro fertilization (IVF) in a specialized laboratory setting. The process begins with controlled ovarian hyperstimulation, where the intended mother receives injectable hormones, typically follicle-stimulating hormone (FSH), for approximately 8 to 14 days. These medications prompt the ovaries to mature multiple eggs simultaneously, rather than the single egg matured in a natural cycle.
Monitoring takes place through regular blood tests to check hormone levels, such as estradiol, and transvaginal ultrasounds to measure the size and number of developing follicles. Once the follicles reach a predetermined size, a final injection of human chorionic gonadotropin (hCG), known as the “trigger shot,” is administered to induce the final maturation of the eggs. The egg retrieval procedure is performed about 36 hours later, involving the transvaginal aspiration of the eggs using a fine needle guided by ultrasound imaging.
Following retrieval, the mature eggs are fertilized in the laboratory with the intended father’s sperm or donor sperm. This fertilization step can be achieved through conventional insemination or intracytoplasmic sperm injection (ICSI), where a single sperm is injected directly into each egg. The resulting fertilized eggs, now called embryos, are cultured for three to seven days, assessed for quality and viability. The embryos are either cryopreserved for later use or prepared for immediate transfer into the gestational carrier’s uterus.
The Role of the Gestational Carrier
A gestational carrier is a woman who carries a pregnancy to term for the intended parents. They are necessary because the intended mother, having had a hysterectomy, no longer has the uterus required to house and nourish a developing fetus. The carrier provides the biological environment for the embryo to implant and grow, but she has no genetic link to the child.
The use of a gestational carrier is distinct from traditional surrogacy, where the carrier’s own egg is fertilized, creating a genetic relationship between the carrier and the child. In a gestational arrangement, the embryo is created using the intended parents’ or donor gametes, making the carrier solely a host for the pregnancy.
Before the embryo transfer, the gestational carrier’s uterus is prepared with a precisely timed regimen of hormones, typically estrogen and progesterone. Estrogen is administered first to thicken the uterine lining (the endometrium), which is necessary for implantation. Progesterone is then added to mature the lining, signaling that the uterus is receptive to the incoming embryo. The pre-implantation embryo is then transferred into the carrier’s uterus using a thin catheter. The carrier continues to take hormonal support until the placenta is established and can produce the necessary hormones to sustain the pregnancy.
Medical Criteria for Intended Parents and Surrogates
The journey to surrogacy involves medical and psychological evaluations for both the intended parents and the gestational carrier. Intended parents providing the eggs must undergo hormonal evaluations and ovarian reserve testing to assess the likelihood of a successful egg retrieval. These tests, including measuring anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH) levels, confirm that the ovaries are producing eggs of sufficient quality and quantity.
The gestational carrier must meet strict health guidelines to ensure a safe pregnancy for both her and the fetus. Medical screening includes a comprehensive physical examination, blood tests to check for infectious diseases like HIV and hepatitis, and a uterine evaluation via ultrasound to confirm the health and normalcy of the uterus. The American Society for Reproductive Medicine (ASRM) guidelines suggest the carrier should be between 21 and 45 years of age and have had at least one uncomplicated, full-term pregnancy previously.
Both parties must complete psychological evaluations with a mental health professional specializing in third-party reproduction. This screening ensures that the carrier understands the emotional commitment of the process and that the intended parents are psychologically prepared for a non-traditional path to parenthood. The carrier is also screened for mental health conditions, with some programs requiring that they are not currently taking certain psychotropic medications.