Q: I'm considering volunteering for a family member, and it would be my first. Like you, I don't want children any time soon. Were you able to find resources about the possibility of losing your own fertility? I truly think I would be okay with it, but I obviously have no way of knowing for sure.

Hi there! Thanks so much for asking this question. I had frankly no idea how to answer this, so I asked for the help of Certified Nurse Midwife Colleen Kennedy, who was kind enough to offer her expertise! She writes:

As a Certified Nurse Midwife I think about only two things when it comes to fertility - age and underlying issues that cause infertility.  With that in mind, when I first heard that there was a question about future fertility when a woman chooses to be a surrogate for her first pregnancy I thought there wasn’t a whole lot tying the two together.  However, upon further thought and research these are the issues that could come up if surrogacy was chosen for your first pregnancy.

Age

The number one issue for fertility, surrogacy or not, is age.  Given that this blog is about a woman acting as a surrogate for her first pregnancy, the only issue regarding age is that she could be putting off a personal pregnancy to carry this one, thereby becoming older in the process.  Below is a chart of pregnancy and infertility rates by age.  

Source: http://www.babycenter.com/0_chart-the-effect-of-age-on-fertility_6155.bc

Pregnancy and labor and delivery

There are very rare issues that may accompany pregnancy or labor and delivery that could affect future fertility.  Incorrect placental implantation (placenta accreta) or excessive bleeding during pregnancy or after delivery (hemorrhage) could possibly lead to the removal of the uterus (hysterectomy).  Obviously hysterectomy would preclude any further pregnancies.

Ectopic pregnancy

Ectopic pregnancy (a pregnancy outside of the uterus, most often in the fallopian tubes as seen in the diagram below) can affect future fertility rates.  Ectopic pregnancies are pretty rare - about 1% of pregnancies.  However, the risk is higher with in vitro fertilization (about 1-2%), which may be the chosen method of conception for surrogacy.  Ectopic pregnancies that are caught early and are still small can often be treated with a drug (methotrexate) to help dissolve the pregnancy in the tube and avoid surgery.  Successful pregnancy rates following methotrexate range from 60-90%.  

If a pregnancy has grown too large or the tube has ruptured, surgery is necessary.  Two surgeries are available, salpingostomy and salpingectomy.  Salpingostomy attempts to open the tube at the site of the pregnancy, remove the pregnancy and repair the tube, leaving it intact.  However, the fallopian tubes are made of delicate tissue and scar tissue often forms, leaving the tube damaged and at risk for future ectopic pregnancies.  Following salpingostomy, fertility rates are similar to being treated with methotrexate.

Salpingectomy is surgery that removes the pregnancy and the rest of the tube and seals the tube closed.  Many women may initially be against this method because they believe their fertility would be affected by half.  However, if the other tube is open and normal, fertility rates should not be affected at all.  It is possible (and probable) that a woman can ovulate from her left ovary and the egg be swept into her normal right tube (Source: http://emedicine.medscape.com/article/2041923-overview).  This was the case for me after a ruptured ectopic pregnancy and salpingectomy in the spring of 2011.  I then achieved pregnancy in the first month of trying and the ultrasound showed that I had ovulated from the ovary opposite the patent tube.

Source: http://medical-dictionary.thefreedictionary.com/fallopian+tube

Underlying Fertility Issues

Infertility is defined as an inability to attain pregnancy within a year.  For some it is caused by irregular ovulation or a complete lack of ovulation.  Some women lack appropriate levels of hormones to maintain pregnancy in the early stages.  Others may have a clotting disorder that causes frequent miscarriage.  And others still may have scar tissue in their uterus or fallopian tubes from previous sexually transmitted diseases or pelvic inflammatory disease.  Males may suffer from low sperm count.  If any of these issues is at hand, one pregnancy may be all that can be had.  If that pregnancy is chosen for surrogacy it could be possible that a woman may not be able to attain a future pregnancy of her own.

Barring any of the above issues I don’t believe the act of being pregnant as a surrogate for a woman’s first pregnancy has any major effect on her ability to attain a future pregnancy.

Colleen Kennedy, CNM currently practices in Baltimore, Maryland and has recently given birth to her first child.