Situation: A nurse works in a private fertility center that offers assisted reproductive technology (ART) and counsels couples about their options. The wife has no uterus but has functioning ovaries. An embryo created by in vitro fertilization (IVF) from her egg and her husband's sperm will be transferred to another woman, who will bear the pregnancy for the couple. Which arrangement is this?

In gestational surrogacy, an embryo made from the intended parents' own egg and sperm is carried by another woman, who is not genetically related to the baby. In traditional surrogacy the woman who carries the pregnancy also provides her own egg. In oocyte donation a donor's egg is used and the intended mother carries the pregnancy, and in embryo donation an embryo from other donors is transferred to the intended mother.

Definition and Core Mechanism

The arrangement described is gestational surrogacy. In this process, an embryo is created through in vitro fertilization (IVF) using the egg of the intended mother and the sperm of the intended father. The resulting embryo is then transferred into the uterus of another woman, the gestational carrier, who carries the pregnancy but has no genetic relationship to the child ^[1][2]. This is the defining feature that separates gestational surrogacy from traditional surrogacy.

Why This Case Is Gestational Surrogacy

The wife has functioning ovaries but no uterus. Because her ovaries can still produce eggs, her own genetic material can be used. The husband provides sperm. IVF is performed to create an embryo from these two gametes, and that embryo is placed into a surrogate. The surrogate contributes only the uterine environment, not an egg. Therefore, the baby is genetically the child of the commissioning couple, not the surrogate ^[1][4]. Key point! Absent uterus is one of the clearest medical indications for gestational surrogacy ^[1][2].

Differential Diagnosis of Third-Party Reproduction Options

To avoid confusion on licensure exams, compare the four options by asking two questions: Whose egg is used? and Who carries the pregnancy?

Arrangement	Egg source	Uterus / carrier	Genetic relation to intended mother
Gestational surrogacy	Intended mother	Surrogate	Yes, intended mother is genetic mother
Traditional surrogacy	Surrogate herself	Surrogate	No, surrogate is genetic mother
Oocyte donation	Donor	Intended mother	No, donor is genetic mother
Embryo donation	Donor embryo	Intended mother	No, neither intended parent is genetic parent

Clinical and Nursing Considerations

From a nursing process perspective, the nurse in a fertility center must assess the couple’s understanding of the genetic and legal implications. In gestational surrogacy, the intended mother undergoes ovarian stimulation and egg retrieval as part of routine IVF, while the surrogate undergoes endometrial preparation and embryo transfer ^[1]. Both women require medical and psychosocial screening ^[2]. The nurse should also be aware that gestational surrogacy has become a growing proportion of third-party reproduction cases over the past 30 years ^[2].

Watch out! Do not confuse gestational surrogacy with traditional surrogacy. In traditional surrogacy, the woman who carries the pregnancy also provides her own egg, making her the genetic mother. In this scenario, the wife’s own egg is used, so the carrier is not genetically related to the baby ^[1][4]. That single fact rules out traditional surrogacy.

Gestational surrogacy is indicated when the intended mother has an absent or dysfunctional uterus but retains ovarian function, allowing the couple to have a child who is genetically their own ^[1][2]. The embryo is created from the commissioning couple’s gametes and transferred to a surrogate host ^[1]. This also distinguishes it from oocyte donation, where a donor egg is used and the intended mother carries the pregnancy, and from embryo donation, where the embryo comes from other donors and is transferred to the intended mother.