Gestational carrier (GC) arrangements are the most complex in third-party reproduction. Counseling and evaluation by a mental health professional skilled in reproductive counseling and third-party reproduction is in keeping with the guidelines from the American Society for Reproductive Medicine. It is an important part of the medical care, helps ensure a positive outcome for all families, and should occur before treatment begins. There are three components to the counseling and evaluation process:
- Intended Parent (IP) Counseling Session: This is an opportunity for IPs to carefully and thoughtfully explore their feelings and ideas, receive education, and discuss concerns, so that they can comfortably and confidently approach their path to parenthood. Some of the topics discussed include: feelings about the loss of carrying the pregnancy; readiness of all parties to use a GC; expectations regarding the relationship and level of communication with the GC and her family during treatment and after birth; treatment issues, such as number of embryos transferred and number of cycles planned; beliefs and concerns about multiple pregnancy and multi-fetal pregnancy reduction; beliefs and concerns about termination for a fetal anomaly; preferences for prenatal care and delivery; and disclosure to the child, as well as, family and friends. This is a 90-minute counseling session.
- Psychological Evaluation of GC: The evaluation of a potential GC includes the administration of personality testing and a 3-hour structured clinical interview. Important factors considered include: the GC’s psychological functioning and emotional stability; motivation for carrying; lifestyle; previous experiences with pregnancy and motherhood; ability to separate from and relinquish the child; availability of support as the GC moves forward in the process; and the ability to provide informed consent. We also discuss various aspects of the GC arrangement including the emotional and physical risks, as well as, thoughts and feelings related to genetic testing, multiple pregnancies, pregnancy termination, and contact both during and after the pregnancy. If the GC has a spouse/partner, that individual also participates in part of the clinical interview.
- Group Interview: The 90-minute group interview includes the IPs, GC and GC’s spouse/partner. It is an opportunity to facilitate an exchange of information and for participants to express preferences and concerns about issues such as, communication, treatment, prenatal care, the birth, the relationship before and after birth, and means for resolving conflicts that may arise during the process.
A comprehensive report will be provided to the medical team and any other relevant parties.