Medical Contraindications to Pregnancy – When to Use a Surrogate

By (embryologist) and (babygest staff).
Last Update: 03/14/2018

When a woman or couple is unable to carry a pregnancy to term due to certain diseases, they might start considering using a gestational carrier. For example, in women without a womb or with Müllerian duct anomalies, surrogacy might be their only viable option to have babies. Also, some diseases are considered medical contraindications to pregnancy, in which case the woman cannot get pregnant in spite of not having infertility issues.

Uterine diseases & anomalies

A womb is required to get pregnant and carry a baby until birth. Women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome are born without a uterus, which means that they can't get pregnant.

Uterine anomalies, also known as Müllerian duct anomalies or uterine malformations, can prevent or hinder embryo implantation. In other words, they can prevent a woman from getting pregnant. Most common anomalies include septate, bicornuate, didelphys, or arcuate uterus, among others.

On the other hand, uterine hypoplasia may be a cause that prevents a woman from carrying a pregnancy to term.

The presence of abnormal growths in the uterus may lead to female infertility as well. Alterations of any kind in the growth of tissue cells are considered tumors. Conditions such as endometriosis and adenomyosis may also prevent a pregnancy by altering the inner layer of the uterus, i.e. the endometrium.

Read more: Uterine Anomalies – Types, Impact on Fertility & Treatment.

Cell outgrowths & endometrial conditions

Also, the following conditions are caused by the presence of outgrowths in the endometrial lining and may also affect the woman by preventing pregnancy:

Uterine, ovarian or tubal cancer leads to hysterectomy or removal of the uterus in many cases. In other words, the woman won't be able to get pregnant in the future.
Asherman's syndrome or uterine synechiae
It involves the presence of adhesions in the walls of the uterus. Although it can be treated by surgery, conceiving after this surgical procedure is not possible in all cases.
The presence of fibroids (benign tumors) is rarely a concerning issue. However, if they are large and cause a malformation in the uterine cavity, they may cause the woman to miscarry or prevent embryo implantation.
The endometrial lining is a uterine layer exclusively designed for the purpose of embryo implantation. The most severe cases of endometritis (inflammation of the endometrium) could prevent a pregnancy. They are typically caused by infections.
Polyps or endometrial cysts
Even though they can usually be cured by means of surgery and/or medications, the most severe cases may cause the woman to become childless.
Endometrial tissue grows in a place other than the uterine cavity, e.g. around the ovaries or Fallopian tubes.

Contraindications to pregnancy

Before a diagnosis of some conditions, your doctor may consider whether getting pregnant is safe for you or on the contrary it would aggravate the symptoms associated. In some cases, a pregnancy can turn out to be a life-threatening event for the woman and the baby, especially if you suffer from any of the following conditions:

  • Cardiovascular diseases (CVD)
  • Blood clotting disorders, like thrombophilia
  • Autoimmune diseases, like systemic lupus erythematosus (SLE)
  • Respiratory diseases, like severe asthma
  • Chronic kidney failure, like renal insufficiency
  • Neurological disorders, like epilepsy

In any case, we strongly recommend that you consult your doctor if pregnancy is contraindicated because you suffer from a condition that could be included in the list above. The final decision should be done considering the risk-benefit ratio.

If the risks outweigh the benefits, surrogacy might be the best solution for women who suffer from a condition considered a contraindication to pregnancy.

Surrogacy is probably the most confusing of all infertility treatments. Transparency is a key value for us when it comes to recommending a clinic or agency for intended parents. You can now use this tool to receive a detailed report that will solve any question you may have, and most importantly, to help you avoid potential frauds.

Continue reading to learn more about the most common contraindications to pregnancy:

Autoimmune diseases

In the past, suffering from a systemic autoimmune disease meant being totally unable to get pregnant, as it posed a serious risk for the health of the pregnant woman and the unborn baby.

Today, with the wide number of medical advancements made, women with mild-to-moderate immunological disorders can get pregnant. However, these are considered high-risk pregnancies, and as such must be carefully monitored. Autoimmune diseases increase both the morbidity and death rates for pregnant women and babies.

In spite of all this, experts continue to consider them as contraindications to pregnancy, especially in the most severe cases of certain conditions, such as:

  • Systemic lupus erythematosus (SLE)
  • Multiple sclerosis (MS)
  • Myasthenia gravis
  • Diabetes mellitus
  • Antiphospholipid syndrome (APS)

Most of these conditions do not translate into female infertility or sterility, which is to say, in general don't prevent the woman from getting pregnant. Autoimmune diseases can be, unfortunately, life-threatening for you and the child if you get pregnant, depending on the grade of severity. The medications used to treat them can lead to fetal malformations or compromise the baby's health.

Cardiovascular diseases (CVD)

During pregnancy, a series of changes in the cardiovascular system of the mother have to occur so that the baby receives all the necessary nutrients to develop healthily and is able to eliminate his own waste. Most significant changes include an increased blood supply, increased fetal heart rate, and diminished blood pressure.

When a woman's body is unable to adapt itself to these changes, a cardiac decompensation may occur. This is precisely the reason why getting pregnant is so dangerous in women who suffer from an illness that affects the circulatory system, that is, the heart and blood vessels.

Thrombophilia or hypercoagulability

Thrombophilia or hypercoagulability is a blood clotting disorder that can trigger the development of thrombi and blood clots, which may block the blood vessels in the mother and the placenta. For this reason, a pregnancy in women with thrombophilia is considered a high-risk pregnancy.

Most common complications associated with women who get pregnant in spite of thrombophilia are miscarriage, preeclampsia, intrauterine growth restriction (IUGR), placental abruption, placental insufficiency, preterm delivery, and stillbirth.

FAQs from users

What types of autoimmune diseases cause miscarriage?

By Sara Salgado (embryologist).

Antiphospholipid syndrome (APS) and diabetes mellitus are good examples. APS is commonly associated with repeated miscarriages and fetal death.

Can pregnancy trigger lupus?

By Sara Salgado (embryologist).

Yes, pregnancy is considered a potential environmental trigger. Many women have more lupus symptoms before their menses and during pregnancy due to high estrogen production. Although there is proof that estrogen somehow regulates the severity of the disease, there is no causal effect between this hormone and lupus.

What blood clotting disorders cause miscarriage?

By Sara Salgado (embryologist).

Systemic lupus erythematosus, thrombophilia and antiphospholipid syndrome (APS) can cause recurrent miscarriages and "sticky" blood. As a matter of fact, APS has been found to cause miscarriage in between 15% and 20% of pregnancies.

How does diabetes affect the pregnancy?

By Sara Salgado (embryologist).

High sugar levels in early pregnancy, especially before 13 weeks, can cause birth defects, increase the risk of miscarriage and worsen other diabetes-related complications.

What is APAS during pregnancy?

By Sara Salgado (embryologist).

APAS stands for Antiphospholipid Antibody Syndrome and is defined as a group of clinical manifestations linked to the presence of high levels of APA (antiphospholipid antibodies) in the blood of the pregnant woman. It is associated with the formation of blood clots in the arterial or venous circulation.

Suggested for you

As you can see, the number of conditions considered contraindications to pregnancy is high and should be taken into account before planning a pregnancy. But there are other medical reasons why a woman or couple may need a surrogate to have a baby. Check this out to learn more: Infertility & Surrogacy – What Are the Medical Reasons for Surrogacy?

If you are decided to start your surrogacy journey, you may have plenty of doubts about the steps involved in the process. The following guide can help you get a much deeper insight: What Is Surrogacy & How Does It Work? – Everything You Should Know.

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 Sara Salgado
Sara Salgado
Degree in Biochemistry and Molecular Biology from the University of the Basque Country (UPV/EHU). Master's Degree in Human Assisted Reproduction from the Complutense University of Madrid (UCM). Certificate of University Expert in Genetic Diagnosis Techniques from the University of Valencia (UV). More information about Sara Salgado
Adapted into english by:
 Marie Tusseau
Marie Tusseau
Babygest Staff
Editorial Director of Babygest magazine in French and English. More information about Marie Tusseau

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