BRCA1 Mutation: Contraindication For Serving as a Gestational Surrogate?

September 26, 2017 12:03 PM

Basically what it says on the tin: does having a BRCA1 mutation disqualify a woman from serving as a gestational surrogate/carrier? This would be in the U.S. (Philadelphia suburbs). BRCA1 carrier in question is 36, robustly healthy in every other manner, and has already had one successful pregnancy/birth. Dr. Google and PubMed were both of zero help.
posted by julthumbscrew to Health & Fitness (7 answers total)

What do you mean by "disqualify"? There's no legal restriction, just like there's no legal restriction on women who are BRCA1 positive having their own biological children.

If you're asking if there is a medical risk to a theoretical child delivered to a gestational carrier with BRCA1, and if we're talking about IVF using sperm and egg from parties unrelated to the surrogate, the risk strikes me as extremely unlikely. I'm not aware of any evidence that supports this directly. However, knowing the general mechanism by which BRCA1 mutation is associated with increased risks of cancers (via impaired DNA repair), I can't think of any plausible mechanisms by which an unrelated fetus would be harmed in utero or after birth.

That said, another factor I would consider is whether the gestational surrogate's consent to the pregnancy is fully informed. Many BRCA1 carriers elect to undergo prophylactic oopherectomy after they complete their childbearing because of the increased risk of ovarian cancer; obviously, acting as a gestational carrier would postpone their ability do this.

Likewise, there is a small but real (and generally greater than with non-carrier surrogates) risk of this person developing cancer during the pregnancy. I would not want to start this process without having a discussion with all involved parties about how decisions would be made if that were to occur.

This is a complicated question and one that should be explored with professionals (I am not one, I am just a person on the internet). An OB/GYN is a good place to start; a clinical geneticist or genetic counselor may have valuable information as well.
posted by telegraph at 12:34 PM on September 26, 2017 [2 favorites]

Response by poster: (Note: I would be the gestational surrogate in question; let's assume I am fully informed, and that my own personal genetic specialists have been non-helpful.)
posted by julthumbscrew at 1:55 PM on September 26, 2017

Are you asking whether it would potentially be a bad idea for you vis a vis your own health, potentially a bad idea vis a vis the fetus's health, or whether an agency that facilitates such things between strangers would reject you? Or something else?
posted by needs more cowbell at 5:03 PM on September 26, 2017 [5 favorites]

I suspect that an RE might disqualify you for the risk that you may develop cancer during the course of the pregnancy, but I think it might vary from doctor to doctor. I don't know for sure if it would be on every doctor's questionnaire. It is certainly something that would need to be addressed in your contract with the couple.

Of the couples that we personally know who used a surrogate, they would definitely have rejected someone with your risk factor as a surrogate candidate. Reason being that they had been through unthinkable, statistically impossible seeming odds and circumstances that led them to consider a surrogate in the first place. If they thought there was any increased chance that cancer could occur during the pregnancy, they would have looked at it like "of course this additional terrible circumstance would occur and we would lose this pregnancy too".

I'm sorry.
posted by vignettist at 5:17 PM on September 26, 2017 [1 favorite]

...my own personal genetic specialists have been non-helpful

You need to find new "genetic specialists." A genetic counselor should be able to have a meaningful conversation about this, given some time to do a little research. Please consider finding someone else in the Philly area who could answer your question. Memail me if you'd like, I have a GC friend at CHOP who might be able to give you a few options...
posted by kuanes at 4:46 AM on September 27, 2017 [1 favorite]

A concern i would consider is that hormonal changes associated with pregnancy could increase cancer risk in someone already at elevated risk. This is something to discuss with your genetic counselor.
posted by emd3737 at 4:59 AM on September 27, 2017

My general understanding is that going through a successful pregnancy actually reduces the risk of various gynecological cancers, including breast cancer, although the biggest factor seems to be early pregnancy (before age 20, so I'm guessing does not apply to a surrogacy situation) - more details here. But I'm not sure how that would interact with the BCRA1 gene. I agree with kuanes that you need to find a different specialist, because this does not seem like an unusual/odd question to ask -- even if women in your situation aren't frequently surrogates, surely many of them are having their own children and thus will be seeking guidance on this!
posted by rainbowbrite at 6:50 AM on September 27, 2017