Ask An Expert: Dr. Kathy Salari Answers Medical Questions on Surrogacy

Dr Kathy Salari

In 2021, Growing Generations announced its partnership with Mitera, a group of California-based maternal-fetal subspecialist and reproductive health counselors operating via telehealth. Dr. Kathy Salari, co-founder and Chief Medical Officer of Mitera, kindly answered some commonly asked questions on surrogacy. She is a maternal-fetal medicine subspecialist, specializing in caring for high-risk pregnancies. Reproductive genetics and fetal imaging are the primary focus of her clinical work.

What is Maternal-Fetal Medicine (MFM)? How does it help with the surrogacy process?

Maternal-Fetal Medicine is a subspecialty of Obstetrics & Gynecology that focuses on the complications of pregnancy. As the expert in conditions that can negatively affect the fetus and the pregnant individual, an MFM physician is uniquely qualified to assess the medical profile of a surrogacy candidate. Furthermore, involvement of an MFM in the surrogacy process allows for a more robust dialogue and an educational opportunity for all those involved in third party reproduction.

As a first-time intended parent, what should I look for in a surrogacy agency? What questions should I ask when talking to each agency?

First-time intended parents are likely to feel overwhelmed when searching for a surrogacy agency. An agency that is transparent and forthcoming about their surrogacy selection and matching process is more likely to exercise prudence in ensuring appropriate candidates are selected to serve as surrogates. Intended parents should inquire about specifics regarding the medical and psychological clearance process and what type of healthcare professionals are involved in determining a candidate’s health profile. Furthermore, intended parents should inquire as to the nature of medical oversight provided for their pregnancy and to what medical experts, they will have access should complications arise.

What are some of the most common misconceptions about surrogacy?

When starting their surrogacy journey, many intended parents assume that surrogates have undergone extensive medical and obstetrical screening and are considered good candidates with a low risk for pregnancy complications.

What recommendations can you share with first time surrogates?

As advocates of women’s health, we generally encourage surrogates to ask questions about pregnancy, the IVF process, and to have any concerns about their own medical history addressed. We also encourage surrogates to have open discussions with their intended family regarding their expectation for the surrogacy journey.

What are factors that can disqualify you from being a surrogate?

Factors that can disqualify an individual from surrogacy are varied but may include current or past health conditions that may impact the health of the pregnancy as well as a prior history of obstetrical complications.

How does early genetic screening help in the surrogacy process?

Early genetic screening, either at the time of embryo formation or early in the pregnancy provides early information regarding the health of the fetus. Genetic screening of embryos (also known as preimplantation genetic testing) allows for identification of chromosomally normal embryos; therefore, ensures that the healthiest embryos are transferred to the surrogate. However, genetic screening of embryos is not universally recommended, and it is best for intended parents to discuss pros/cons with their fertility specialist. It is recommended that intended parents have a discussion regarding genetic screening and testing early in their pregnancy. Genetic testing modalities have significantly evolved over the last decade and intended parents should consider what information they value knowing early in their pregnancy.

What are some challenges surrogates and intended parents face during the surrogacy process?

Meeting expectations of both parties in third party reproduction can be challenging. A transparent matching process that promotes open dialogue and discussion among surrogate candidates, intended parents, and healthcare providers helps ensure that a relationship based on mutual trust and respect continues to build as the pregnancy progresses. Unforeseen challenges including medical complications and changes to delivery planning may cause frustration or anxiety for either or both parties involved. In such circumstances, it is best for both surrogates and intended parents to turn to their medical experts for guidance..

What successes have you seen?

The most successful surrogacy journeys we have seen are among well-screened and prepared surrogates who are matched with well-informed intended parents where the mutual goal is to achieve a healthy singleton pregnancy. Agencies with dedicated case workers that are available and attendant to the concerns of both parties usually ensure that the surrogacy journey meets the medical and emotional expectations of all those involved.

What are some common misconceptions about egg donation?

Many intended parents believe that because egg donors are young, there is no risk for a genetic abnormality in the fetus and that egg donors have all undergone extensive medical and genetic screening. Prior to an egg retrieval cycle, egg donors undergo intensive medical screening.

What are the risks involved in becoming an egg donor?

Egg donation is generally considered very safe. However, it does have small procedure-related risks for the egg donor including a small risk of infection, bleeding, and ovarian hyperstimulation. Risks of using an egg donor are largely related to inheriting the genetic health burden of another individual.

How does a surrogacy agency get certified by Mitera? What are the requirements?

Certification by Mitera is a commitment to medical transparency and responsibility in third-party reproduction. Becoming a Mitera certified agency provides intended parents with the assurance that their surrogate has undergone a comprehensive medical evaluation by a Mitera Maternal-Fetal Medicine subspecialist and that the pregnancy will continue to be under Mitera’s obstetrical surveillance as it progresses. Mitera certification requires that an agency commit to pre-match medical screening of all surrogate candidates with Mitera and that Mitera’s determination of suitability for surrogacy or stipulations for surrogacy be acknowledged and upheld by the agency.