Surrogacy 101

Addressing Vaccine Hesitancy in Surrogates by Gad Lavy From the GOSTORK.COM Blog

Addressing Vaccine Hesitancy in Surrogates

Dr. Gad Lavy

Medical Director and Founder of New England Fertility

For a third-party reproduction specialist like myself, the sharp rise in surrogacy inquiries in the past year is gratifying. The demand for gestational carriers is so high it can hardly keep up with supply. Most of the intended parents who come to our clinic, however, want a vaccinated carrier — and therein lies the problem: A fair percentage of surrogates don’t want the COVID-19 vaccine.

With the Delta variant of COVID-19 spreading rapidly and showing no signs of slowing down, the human cost of remaining unvaccinated is greater than ever. We’ve seen that the variant is far more easily spread than previous strains, and for those who are unvaccinated and infected with the variant, hospitalization (or worse) is far more likely.

Unfortunately, the news becomes even more dire: Without curbing the current rate of infection, we could soon be looking at a vaccine-resistant strain of COVID. According to Dr. Vaughn Cooper from the American Society for Microbiology, “The more infections, the more chance that mutations will occur.”

Fortunately, the CDC has now released data to support the safety of COVID-19 vaccines in pregnant people and is recommending that everyone over the age of 12 get vaccinated against COVID-19. In spite of such compelling evidence, it’s clear from speaking daily with surrogates (and hearing the stories from surrogacy agencies) that vaccine hesitation is fueled by misinformation. Whether you’re an intended parent or a surrogate yourself, you should have a few facts:

• Pregnant women are more likely than non-pregnant women to become severely ill from COVID-19. They are more likely to be admitted to an ICU, be put on a ventilator, or, most tragically, not survive. They are also more likely to suffer complications such as preterm labor.
• Pregnant women in any trimester can safely receive the vaccine. Data so far shows no adverse effects on carriers or the babies they’re carrying. The vaccine is even safe for lactating women and beneficial because their breast milk will carry the antibodies.
• The vaccine helps protect the fetus by providing it with antibodies. While the virus rarely crosses the placenta to infect the fetus, and there’s been no evidence that it causes birth defects, the antibodies may continue to protect the baby after the birth.
• There’s no evidence showing that the vaccine affects fertility in men or women, so if you personally are looking to become pregnant, don’t hesitate to get the vaccine.
• While the COVID-19 vaccines are new, mRNA technology is not. Research to develop mRNA vaccines has been in progress for more than 20 years.
• mRNA vaccines (Pfizer and Moderna) do not alter your DNA. mRNA stimulates your body’s own immune response to produce antibodies but doesn’t enter the nucleus of your cells, so it won’t affect your DNA.
• The Johnson & Johnson vaccine is also shown to be safe for pregnant women and those trying to become pregnant. The concept of the J&J vaccine is more traditional: It uses adenovirus (which doesn’t contain a live virus) to instruct your cells to produce antibodies.
• The vaccines do not seem to affect pregnancy outcomes. There’s no evidence to support a higher incidence of outcomes such as premature birth, congenital defects, pregnancy loss, or gestational diabetes.
• The vaccine offers greater protection than previous COVID-19 infection. Antibody levels are higher in vaccinated people than in those who’ve previously been infected.

It’s only natural that anyone looking to carry a pregnancy or planning to become a parent through surrogacy would want to be careful. But we now have evidence to support the safety of the vaccine. Studies are ongoing but thus far there’s no indication, in human or animal studies, that the vaccine can cause pregnancy complications or birth defects.

Acceptance of the vaccine isn’t just about the availability of gestational carriers; it’s about the health of your community and the world around you.

Young Survivors of Breast Cancer: Motherhood Options post Health Crisis Guest Post by Kristin Shadick

We’ve just wrapped up Breast Cancer Awareness Month and have been reflecting on this topic extensively -  but it is of course a conversation that is important year round. At GoStork, we’re here to talk about the complexities that survivors can face after breast cancer while trying to build a family. Before we delve deeper, there are a number of unfortunate, yet important, statistics one should be aware of:

> According to BreastCancer.org 1 in 8 women or 13% of women will be diagnosed with breast cancer.

> According to Healthline 5% of all breast cancer cases happen in women under 40. 

> According to Young Survival Coalition, in 2015 it was estimated that 12,150 cases of breast cancer would be diagnosed in women under 40. 26,393 cases were approximated in women under 45 years of age.

With a sharp increase in women delaying pregnancy and birth, worldwide but especially in the United States, breast cancer interrupts thousands of women’s lives and plans for motherhood. Additionally, and as noted by the Young Survival Coalition, it is estimated that some 30% or more of breast cancer in young women is diagnosed in the few years after she has a baby, creating a deeper crisis of mothering while enduring months of chemotherapy, radiation, surgery and irreparably changing the course for her having more children. 

For younger women, a breast cancer diagnosis often brings with it the complex challenges involving issues around sexuality, fertility and pregnancy risks, early menopause and enduring sexual dysfunction post treatment. 

When a woman is facing a cancer diagnosis, especially a younger woman, the medical community may rush to save her life, literally. This rush includes rapid movement into critical but also life altering treatments, including surgeries, radiation, chemo-therapy and immediate endocrine therapy treatments to suppress hormones that may fuel cancer’s growth. While many medical institutions do their very best to help young women understand the fertility challenges they face with this diagnosis and the immediate treatment to come, their medical priority is to save this woman’s life and every day of delay in treatment is of great concern. In an ideal world (though the situation is already far from ideal), there will be time for the young woman to preserve her fertility before starting treatment, but this is often not a viable option.   

I personally am alive today thanks to a dedicated team of oncologists and surgeons working tirelessly to provide aggressive, effective treatments so that I can hopefully see my children grow to be adults. 

For many, this diagnosis brings immediate shock and terror. For women who have a cancer diagnosis put into remission, at some point down the road many of us are met with a harsh new reality: cancer has fundamentally changed our motherhood options forever. 

It is well known that the majority of cancer cases in younger women (under 40 years old) are also linked to known cancer genes and genetic mutations in these genes. These mutations significantly increase a woman’s “life-time risk” of developing breast cancer. The mutations that are best known and most studied at this time are on the BRCA1, BRCA2, and PALB2 genes. 

Once you’re in the young and surviving cancer club, that group that you never wanted to belong to in the first place, you frequently face the challenges in this new reality. For women with genetic mutations that drive a high-risk case of cancer or recurrence, becoming pregnant by your own body is often quite dangerous. And just when it feels like we survivors have enough on our plates, we now know thanks to research released in 2017 and subsequent research in 2021, that the BRCA genes are also linked to premature ovarian reserve. This means that for the woman who has BRCA-linked cancer, her ovarian reserve is already lower than the average woman, adding yet another complexity to her future family building. 

And, as our dear friends over at The Chick Mission say, “Having cancer isn’t a choice. Having kids still should be.” So let’s recap:

1. Young woman with a cancer diagnosis
2. If there was time and money or health coverage (by no means a guarantee), she might have been able to pursue one cycle of egg preservation prior to cancer treatments beginning (though often this is not possible.)
3. After chemo, radiation, surgeries, she’s now surviving cancer 
4. Having BRCA, she already had lower ovarian reserves and her AMH levels remain lower after chemo in comparison to non-BRCA breast cancer patients
5. Pregnancy, a 9-month long, estrogen bath for the mother and baby, is considered dangerous for a potential cancer recurrence
6. Getting to Motherhood...Could someone pull out the “WT___” banner as I and so many survivors run this marathon!

So many young survivors ask, is there any way forward to motherhood for me? And yes, the challenges feel insurmountable at times. 

Here is where those of us who have met these challenges head on while devoting our careers to the Fertility/Infertility industry, welcome a company like GoStork. How does GoStork help breast cancer survivors that want to build or grow their families?

Many of us will require a multi-stepped journey using Third Party Reproduction to build our families post cancer. The Third Party Journey can include donor oocytes (eggs), donor sperm, donor embryos, a Reproductive Medicine specialist and IVF center, as well as the possibility of a Gestational Carrier (the woman who can carry the pregnancy and give birth to the Intended Parent(s) child). 

Via GoStork, cancer survivors can utilize a medical marketplace that provides one, online location where the survivor and her partner/family can access the largest, free database of egg donors. She can find, compare and connect with Reproductive Medicine centers that she can afford and Surrogacy Agencies that meet her needs, should she require a gestational carrier. GoStork’s marketplace is even able to help survivors connect to IVF centers that take her  health insurance benefits and facilitate a match to centers based on being in or out-of-network. Finally, all users of GoStork can also apply for fertility loans through the platform itself if needed for fertility preservation or a later fertility journey post cancer treatments. 

When all is said, my sister-survivors and I need our medical odyssey with cancer to end without another difficult trek in family building beginning. For those of you on this path with me, you’ve known the lack of medical clarity, the lack of health coverage, the frustration with scores of egg donor and surrogacy companies, and the untold time consumption into research on what is safe for your body. We’ve all been left to piece together whatever parts of third-party reproduction are right for us. 

GoStork, a first of its kind solution saves you time, work and money, while giving a previously unprecedented access to options, to cost transparency and esteemed medical establishments, all while informing and supporting you on your reproductive journey post cancer. As a survivor and a user of GoStork, I can honestly say, this marketplace makes a significant difference in how we move from a devastating chapter in life to a new one filled with hope for new beginnings. 

About Kristin Shadick, GoStork CCO

Kristin Shadick has two decades of experience in the Fertility industry. She is a commercial executive & advisor to early-staged FemTech and Women's Healthcare companies. Mission driven, she shepherds best-in-class products/technologies to market, giving fertility consumers better outcomes and options for their journey.