Surrogacy and Genetic Disorders: What you need to know
There are numerous genetic or congenital disorders that can make carrying a pregnancy unsafe or impossible. While many conditions can be managed under the close supervision of a doctor, others are considered high risk. If your doctor has told you a pregnancy carries a substantial risk for death or disability, or may be unsafe for a potential fetus, surrogacy can be a great option.
Some medical conditions that affect pregnancy safety and outcomes include:
Heart defects:
Certain structural abnormalities in the heart can increase the risk of complications during pregnancy, such as heart failure or heart rhythm disorders. The risks associated with pregnancy is based on several factors such as the type of defect, the presence of pulmonary hypertension (high blood pressure in the lungs), or previous heart surgeries. Some heart defects carry a higher risk of complications, such as heart failure, arrhythmias, or worsening of the defect during pregnancy. If you’ve gone through a comprehensive evaluation by a cardiologist and he/she expressed concern that pregnancy may be high risk for you due to the severity of your defect, surrogacy can be a great option.
Kidney disorders:
Kidney disorders can be structural or functional abnormalities of the kidneys. These disorders can have varying impacts on pregnancy depending on the specific condition and its severity. Some of the most common disorders include:
Polycystic kidney disease (PKD): This is a common inherited kidney disorder characterized by the growth of multiple fluid-filled cysts in the kidneys. In women with PKD, pregnancy can lead to complications such as preeclampsia, worsening kidney function, urinary tract infections, and an increased risk of preterm birth.
Renal agenesis: Renal agenesis is a condition where one or both kidneys fail to develop. The impact on pregnancy depends on whether both kidneys are affected or if the other kidney compensates for the missing one. If both kidneys are absent or non-functional, pregnancy is not recommended due to the risks posed by compromised kidney function and its impact on maternal health.
Renal dysplasia: Renal dysplasia refers to abnormal kidney development, resulting in kidney tissue that is structurally abnormal and may not function properly. The impact on pregnancy varies depending on the severity and extent of the dysplasia.
Other congenital kidney disorders: Various other congenital kidney disorders, such as medullary sponge kidney or renal tubular acidosis, can also impact pregnancy. The specific risks and complications vary depending on the disorder and its effects on kidney function.
In general, it is crucial for women with congenital kidney disorders to consult with their healthcare team, including nephrologists and obstetricians, before considering pregnancy. A thorough evaluation of kidney function, blood pressure, and overall health is important to assess the potential risks and determine the best approach.
Uterine abnormalities:
Certain congenital abnormalities of the uterus make it impossible to carry a pregnancy or increase the risk of miscarriage or preterm labor. A uterine septum is a condition where a fibrous or muscular wall (septum) divides the uterus partially or completely. This abnormality can increase the risk of miscarriage and preterm birth. It can also cause difficulties with implantation. A bicornuate uterus is characterized by a heart-shaped or two-horned uterus. It occurs when the uterus fails to fuse properly during fetal development. Women with a bicornuate uterus may have an increased risk of miscarriage, preterm labor, and breech presentation. The severity of these risks can vary depending on the degree of uterine fusion. In a unicornuate uterus, one side of the uterus fails to develop properly, resulting in a smaller uterus with a single fallopian tube. This condition is associated with an increased risk of pregnancy complications, such as miscarriage, preterm birth, and fetal growth issues. A didelphys uterus, also known as a double uterus, is characterized by the presence of two separate uterine cavities, each with its own cervix. This condition is associated with an increased risk of preterm birth, miscarriage, and fetal malpresentation.
Uterine fibroids, a noncancerous growth that develop within or on the uterus, can also impact pregnancy. While many fibroids can be treated to allow pregnancy, fibroids cannot be removed in all cases. Large fibroids or fibroids located deep within the uterine wall may be more challenging to remove surgically. When there are multiple fibroids present, removing all of them may not be feasible or may carry higher risks. Additionally, some women may have underlying health conditions that make surgery risky or contraindicated. The impact on pregnancy depends on the size, location, and number of fibroids. Small fibroids generally do not cause significant problems, but larger or multiple fibroids can increase the risk of miscarriage, preterm birth, placental abruption, and fetal growth restriction.
Women with Asherman’s Syndrome may also consider surrogacy as an option to become a parent. Asherman’s Syndrome occurs when scar tissue forms within the uterine cavity due to uterine surgery or infection. This condition can increase the risk of miscarriage and lead to implantation difficulties.
Blood disorders:
Inherited blood disorders can increase the risk of complications during pregnancy, including anemia, blood clotting disorders, and increased strain on the heart.
Here are a few examples of congenital blood disorders with potential effects on pregnancy:
Sickle Cell Disease (SCD) is an inherited disorder where the red blood cells become rigid and assume a sickle shape, leading to impaired oxygen delivery and increased risk of complications. Pregnancy in women with SCD can be higher risk due to the increased demands on the cardiovascular system, potential exacerbation of anemia, increased risk of blood clots, and higher chances of complications like preeclampsia or preterm labor.
Thalassemia is characterized by abnormal hemoglobin production. The impact of thalassemia on pregnancy can vary depending on the type and severity of the condition. Women with severe thalassemia may experience cardiac complications during pregnancy.
Hemophilia is a genetic disorder characterized by a deficiency in clotting factors, resulting in prolonged and excessive bleeding. Pregnancy in women with hemophilia have increased risk of bleeding during childbirth and postpartum.
Von Willebrand Disease (VWD) is a common inherited bleeding disorder caused by a deficiency or dysfunction of von Willebrand factor, a protein involved in clotting. Pregnancy in women with VWD can present challenges due to an increased risk of bleeding, particularly during childbirth.
Factor V Leiden is a genetic mutation that increases the risk of abnormal blood clotting. Women with Factor V Leiden may be at a higher risk of developing blood clots during pregnancy which can have serious implications for both the mother and the developing fetus.
Neurological conditions:
Spina Bifida can increase the risk of complications during pregnancy, such as increased susceptibility to infections or difficulties with mobility. Women with epilepsy taking anti-seizure medications pose risks to a developing fetus. The impact of Parkinson’s disease on pregnancy can be complex. Women with Parkinson’s disease often take medications to manage their symptoms, however, medications used for Parkinson’s carry potential risks to the developing fetus. Women with Parkinson’s disease may have a higher risk of certain pregnancy complications, such as gestational diabetes, preeclampsia, and preterm birth. Women with a history of stroke or other cerebrovascular events are at increased risk during pregnancy. Some neuromuscular disorders, such as amyotrophic lateral sclerosis (ALS) or muscular dystrophy, can affect respiratory function. These conditions may increase the risk during pregnancy due to the physiological changes that occur.
Congenital genetic disorders:
High-risk congenital genetic disorders encompass a wide range of conditions. Examples include Turner syndrome, a chromosomal disorder where one of the X chromosomes is either missing or incomplete, and cystic fibrosis, an inherited disorder affecting the respiratory and digestive systems, which can complicate pregnancy due to potential lung and nutritional issues. Women with high-risk congenital genetic disorders often turn to surrogacy to start or complete their family.
If you are considering surrogacy instead of undergoing a high-risk pregnancy, it’s important that you speak with healthcare providers that specialize in high-risk pregnancies to fully understand the risks associated with your specific condition. If are you deemed too high risk, talk to Reproductive Endocrinologists experienced in surrogacy. They can guide you through the surrogacy process and help you understand the associated costs of surrogacy and potential challenges. An assisted reproduction attorney can help you understand the ethical and legal aspects of surrogacy, including the local requirements.
FAQ: Surrogacy and Genetic Disorders
What are some high-risk genetic or congenital disorders that can make carrying a pregnancy unsafe?
High-risk genetic or congenital disorders refer to conditions that increase the risk of complications during pregnancy and pose potential risks to the health of the mother and/or a developing fetus. Some examples include heart defects, kidney disorders, uterine abnormalities, blood disorders, neurological conditions, and congenital genetic disorders.
Is surrogacy a suitable option for women with potential high-risk pregnancies?
If a woman has been advised by her doctor that pregnancy carries a substantial risk of death or disability, or may be unsafe for the potential fetus, surrogacy can be a viable alternative. Surrogacy allows another woman, known as a surrogate, to carry the pregnancy on behalf of the intended parent(s). This option provides a safer environment for the baby’s development and reduces risks to the intended mother’s health.
What are some of the most severe potential outcomes in a high-risk pregnancy?
In high-risk pregnancies, there are several severe outcomes that can pose risks to both the mother and the developing fetus. These include maternal complications like gestational diabetes, preeclampsia, and placental abnormalities, as well as preterm birth, fetal growth restriction, birth defects, stillbirth, and, in extreme cases, maternal mortality.
