Medical Contraindications to Pregnancy – When to Use a Surrogate

By (gynecologist), (embryologist), (embryologist) and (babygest staff).
Last Update: 05/07/2020

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 despite not having infertility issues.

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.

Furthermore, any alteration or malformation of a woman's uterus will lead to problems when carrying a pregnancy to term.

Read more about uterine-related fertility problems in women here: Uterine Factor Infertility- Diseases & Anomalies.

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 pregnancy by altering the inner layer of the uterus, i.e. the endometrium.

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

Uterine malformations

Uterine malformations may hinder or cause problems in embryo implantation and therefore in pregnancy. Besides, abnormal forms may be a cause for recurrent miscarriage.

Among the most common anatomical anomalies in the uterus we can find:

Septate uterus
most frequent uterine malformation. This type of uterus is characterized by a septum and is associated with a risk of repeat abortion.
Bicornuate uterus
consists of the incomplete union of the Müllerian ducts. Therefore, women with a bicornuate uterus have two similar, symmetrical, heart-shaped uterine cavities.
Uterus didelphys
two uterine cavities are divided by a septum, which can lead to problems in childbirth.
Arcuate uterus
is said to be a variant of the septate uterus, although with a larger septum.

If you want to learn more about the types of uterine malformations, read on here: Uterine Anomalies- Types, Impact on Fertility & Treatment.

Uterine hypoplasia

A hypoplastic uterus, also known as naive uterus or infantile uterus, can also be a cause of inability to carry a pregnancy to term. In this case, what occurs is a lack of maturation and development of the uterus and, therefore, it is undersized. A uterus is considered normal when it is about 8 cm long; while a uterus is said to be hypoplastic when it is less than 5 cm in size.

There are multiple causes of uterine hypoplasia, although child malnutrition and fetal malformations are the most common.

Anormal uterus formations

Abnormal formations in the uterus can also cause female infertility. Any alteration in the growth of tissue cells is considered a tumor. Also, changes can occur in the innermost layer of the uterus, the endometrium, as occurs in endometriosis and adenomyosis.

Endometriosis
is the presence of endometrial tissue outside the uterine cavity, such as in the fallopian tubes or on the ovaries. Endometriosis is classified in different degrees depending on the severity. In particular, type IV or severe endometriosis can result in an inability to achieve a pregnancy.
Adenomyosis
is the growth of endometrial tissue in the myometrium, that is, the muscle layer surrounding the uterus. It is, therefore, internal endometriosis. Women with severe adenomyosis must have their uterus removed. Therefore, the only possibility of becoming a mother will be to resort to surrogacy.

Tumors and endometrial alterations

Other conditions that prevent pregnancy are those related to abnormal growths in the uterus. Some of these are described below:

Cancer
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.
Myomatosis
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.
Endometritis
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.
Endometriosis
Endometrial tissue grows in a place other than the uterine cavity, e.g. around the ovaries or Fallopian tubes.

In any case, it is of vital importance that the woman has regular gynecological checks and follows all the guidelines established by the doctor.

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) like pulmonary hypertension
  • 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.

Autoimmune diseases

In the past, suffering from a systemic autoimmune disease meant being 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.

Related topic: Autoimmune Diseases: -How Do They Affect Fertility?

Cardiovascular diseases (CVD)

During pregnancy, a series of changes in the cardiovascular system of the mother has to occur so that the baby receives all the necessary nutrients to develop healthily and can eliminate his waste. Among the most relevant changes are:

  • Increase in blood volume by 30-50%
  • Increased heart rate from 10 to 15 beats per minute.
  • Decrease in blood tension.

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.

Read more about high risk pregnancies due to cardiovascular diseases here: Cardiovascular Diseases and Its Risks in Pregnancy.

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, pregnancy in women with thrombophilia is considered a high-risk pregnancy.

The most common complications associated with women who get pregnant despite thrombophilia are miscarriage, preeclampsia, intrauterine growth restriction (IUGR), placental abruption, placental insufficiency, preterm delivery, and stillbirth.

Read more here: Thrombophilia during pregnancy: Diagnosis and Treatment.

Severe kidney diseases

Those women diagnosed with severe kidney disease are not recommended to carry a pregnancy to term, as this could be quite dangerous. Kidney failure in the mother could lead to growth restriction of the fetus or even a miscarriage. Also, these women often show diminished fertility.

However, if a woman has kidney disease at an early stage, she will be able to get pregnant without problems and will not pose any risk to herself or the fetus.

Other diseases

Apart from the diseases mentioned above, other chronic health conditions can worsen during pregnancy and, therefore, it is not advisable to carry a pregnancy to term.

This is the case of respiratory diseases since pregnancy causes a state of hyperventilation. For this reason, pathologies such as asthma can worsen during pregnancy and the woman will be more susceptible to suffer asthmatic crises. In addition, a pregnancy in women with epilepsy may cause an increase in attacks.

Another case in which pregnancy is not recommended is severe digestive pathologies since pregnancy could increase the risk of gallstones.

Becoming mother through surrogacy

When a woman lacks a uterus or has a serious condition where pregnancy is not indicated, the solution to achieving her desire to become a mother may be surrogacy. Besides, if her egg quality is high, the woman could provide the genetic load. So, the eggs would be fertilized in the laboratory and the embryos generated would be transferred to the gestational carrier. Once the birth takes place, the baby will be delivered to its mother.

Another option would be to use egg donation to generate the embryos that are transferred to the gestational carrier.

There is no doubt that surrogacy requires a great deal of solidarity and support from the surrogate and the legislation where it is to be carried out must always be taken into account.

FAQs from users

What is the definition of infantile or hypoplastic uterus?

By Dr. Joel G. Brasch (gynecologist).

The infantile uterus shows an abnormal relationship between the length of the cervix and the length of the uterine cavity of 1:1 or 2:1.

Uterine hypoplasia is a uterus that is abnormally small. The hypoplastic uterus shows a normal relationship between the length of the cervix and the length of the uterine cavity of approximately 1:2

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.

Our editors have made great efforts to create this content for you. By sharing this post, you are helping us to keep ourselves motivated to work even harder.

References

Authors and contributors

Dr. Joel G. Brasch
Dr. Joel G. Brasch
Gynecologist
Dr. Joel Brasch is the Medical Director of Chicago IVF, founded in 2005. He is board certified by the American Board of Obstetrics and Gynecology, and has over 25 years of direct experience in fertility treatment and reproductive care. He is also the Director of Mount Sinai Medical Center’s Division of Reproductive Endocrinology and Infertility. More information about Dr. Joel G. Brasch
 Marta Barranquero Gómez
Marta Barranquero Gómez
Embryologist
Graduated in Biochemistry and Biomedical Sciences by the University of Valencia (UV) and specialized in Assisted Reproduction by the University of Alcalá de Henares (UAH) in collaboration with Ginefiv and in Clinical Genetics by the University of Alcalá de Henares (UAH). More information about Marta Barranquero Gómez
 Sara Salgado
Sara Salgado
Embryologist
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:
 Romina Packan
Romina Packan
Babygest Staff
Editor and translator for the Babygest magazine in English and German. More information about Romina Packan

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