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Building Your Family: Options for Women Who Have Completed Cancer Treatment

Many women want to have children after cancer treatment. Some will be able to become pregnant without medical help. For those who cannot, there are other options to build your family. Understanding what is involved with each option will help you decide what is best for you.

This resource is split up into 8 different sections. Read those that interest you most. In addition, be sure to read:

  • Section 6: information on financial, legal, and emotional issues
  • Section 7: steps to get you started
  • Section 8: resources to learn more

1. How Does Cancer Treatment Affect Fertility?

To understand how cancer treatment affects fertility, it is helpful to understand some basic information about fertility. Several different organs work together to allow you to conceive and carry a child. A gland in your brain called the pituitary gland makes hormones, including follicle-stimulating hormone (FSH). This hormone allows immature eggs in your ovaries to mature. Every month, one of your ovaries releases a mature egg into your fallopian tube. If the egg is fertilized by a sperm, it may begin to form an embryo. The embryo passes into your uterus, where it may implant in the inner lining. If this happens, you will be pregnant. However, you may have a hard time becoming or staying pregnant if your cancer treatment affected any of the organs involved.

The number of eggs that you have is limited. Girls are born with about 1 million eggs. Throughout life, many of these eggs will break down naturally, so as a woman gets older, the number of eggs decreases. The fewer eggs you have, the harder it is for you to get pregnant. Once you have less than 1,000 eggs, you will stop having monthly menstrual periods and will enter menopause. Women generally become infertile some years before they develop menopause, so having monthly menstrual periods does not ensure that you are fertile.

Cancer treatment can affect fertility in several ways.

  • If your ovaries were exposed to certain types of chemotherapy or radiation, your eggs may have been damaged. How much this affects fertility depends on the type of treatment you had and your age when you received the treatment. The older you were at the time, the fewer eggs you had, and the more likely your fertility has been affected.
    • Some women will continue to have monthly menstrual periods with no impact on their fertility.
    • Some women will continue to have monthly menstrual periods and be fertile for a period of time. However, because of the loss of eggs, they will develop infertility and menopause at a younger age.
    • Some women will stop menstruating after treatment and lose their fertility at that time.
  • If you had high-dose radiation therapy to your pelvis, you may have scarring in your uterus. This makes it difficult for you to become pregnant or to carry a pregnancy to term. Women who get pregnant after this type of radiation therapy are much more likely to have miscarriages or go into labor early.
  • If you had surgery in your pelvic area, your reproductive organs may have been removed or damaged. This may affect your ability to become pregnant or carry a pregnancy.
  • If you had surgery or radiation therapy to your brain, your pituitary gland may have been affected. Without the hormones from this gland, you may stop having monthly menstrual periods, or your eggs may not mature. Medications may be able to replace these hormones.

If your oncologist has not discussed these issues with you, ask him or her how your treatment may have affected your fertility

2. How can my fertility be evaluated after treatment?

Specially trained gynecologists called reproductive endocrinologists can evaluate your fertility. We generally recommend that you wait at least 1 year after completing cancer treatment before having your fertility evaluated. This will give your body time to recover from the effects of treatment.

Your reproductive endocrinologist will do a number of tests to evaluate your ovarian reserve, a term that describes the number and quality of your eggs. The tests may include:

  • A transvaginal ultrasound, in which a thin probe is placed in your vagina. Sound waves from the probe bounce off the structures in your pelvis and make pictures of your ovaries and uterus. With this test, your doctor will evaluate the size of your ovaries and look for large developing (antral) follicles in your ovaries. Each follicle is a small sac of fluid that contains a single egg. Although most follicles in the ovary are very small, these larger follicles with maturing eggs can be seen and counted. Your doctor will also evaluate your uterus and its lining.
  • Blood tests to measure the levels of hormones related to fertility, including follicle-stimulating hormone (FSH) and antimullerian hormone (AMH).
  • A semen analysis from your male partner, if you have one. This test makes sure that he has enough healthy sperm to fertilize your eggs.
  • Other tests may be recommended by your doctor

Your reproductive endocrinologist will review the results of the evaluation with you. He or she will be able to recommend the best options for you to build your family. 

3. When is the right time to build my family after treatment?

Most women should wait at least 1 to 2 years after cancer treatment is over before trying to get pregnant. Some women need to wait longer. How long you should wait depends on the type of cancer and treatment you had. Waiting is important because it allows time:

  • For your body to recover from treatment
  • For any eggs that have been damaged from treatment to be cleared from your body
  • To pass the time in which you may be at risk for an early recurrence or relapse of your disease

Before trying to get pregnant, talk to your oncologist. Ask if the timing is right for you and if there are any medical reasons that would make it unsafe for you to become pregnant.

If you are not yet ready to start a family, but may want to in the future, ask your doctor or nurse if you are at risk for early menopause. If you are at risk, you may be interested in information about freezing your eggs or embryos for future use.

4. Do I need special care if I become pregnant after cancer treatment?

Some cancer treatments have long-term effects that can put you at risk for complications if you become pregnant.

  • Some types of chemotherapy and radiation therapy can cause long-term changes in your heart, lungs, kidneys, or liver. You may not be aware of these changes. However, because pregnancy places extra demands on your body, problems in these organs could develop.
  • Some treatments can affect your body's ability to make certain hormones. You may need to replace these hormones in order to get pregnant and carry a pregnancy.
  • If you had high-dose radiation treatment to your pelvis, you may have scarring in your uterus. This can make it difficult or impossible for you to carry a pregnancy.

If you plan to become pregnant after cancer treatment, ask your oncologist if you should see an obstetrician who specializes in high-risk pregnancies. These doctors are called Maternal Fetal Medicine (MFM) specialists. If your oncologist recommends this, you should consult an MFM specialist before you try to get pregnant.

5. What are my options based on the cancer treatment I received?

Your options for building a family are based on the effects of the specific cancer treatment you received. These options include:

  • Natural conception
  • Ovarian stimulation, with intrauterine insemination or in vitro fertilization
  • Using your own frozen eggs or embryos
  • Using donor eggs or embryos
  • Gestational surrogacy
  • Adoption

Each of these options is described below. At the end of this resource, you will find a list of resources to learn more.

Natural conception

Some women will be able to get pregnant without medical help. (See Section 3 for information about how long to wait after treatment before trying to get pregnant.) If you try to get pregnant and are not successful after 3 to 6 months, make an appointment with a reproductive endocrinologist for an evaluation. (See Section 2 for information about what is involved in this evaluation.)

Based on the results of your evaluation, your reproductive endocrinologist will be able to tell you if you can continue trying to conceive naturally or if you should consider other methods of having a child.

Ovarian stimulation

Your fertility evaluation may show that you still have healthy eggs but need medical assistance to become pregnant. If this is the case, your doctor may recommend stimulating your ovaries with hormones. Around the second day of your period, you will start giving yourself daily injections of hormones to stimulate the eggs in your ovaries to mature. This takes about 2 weeks. During this time, your doctor will carefully monitor you with blood tests and transvaginal ultrasounds to see how your body is responding to the hormones. Your doctor can change the amount of hormone you take to make sure you get the best possible response.

There are several ways to proceed once your eggs are mature. 

  • One method is intrauterine insemination (IUI). In this approach, your doctor will collect a sample of semen from your partner or a donor and place it directly into your uterus around the time you ovulate. This will increase the chance that your eggs will become fertilized.
  • Another method is in vitro fertilization (IVF). In this approach, your eggs will be removed and fertilized in a laboratory. There are several steps to this process:
    • Your mature eggs will be removed during a procedure called egg retrieval. This is done under anesthesia, so you will be asleep. Your eggs will be collected using a very thin needle that will be passed through your vagina. The procedure takes about 15 minutes and you will go home the same day.
    • Your eggs will be brought to the laboratory, where they will be fertilized with sperm from your partner or a donor. The fertilized eggs should then start to divide and form embryos. Not all eggs will fertilize, and not all fertilized eggs will develop into embryos. Therefore, the more eggs you have, the greater your chance of success.
    • After 3 to 5 days, 1 or more embryos will be transferred into your uterus using a very thin catheter (flexible tube) that will be passed through your vagina and cervix. This is usually done in an exam room while you are fully awake. You and your doctor will decide how many embryos to transfer. The remaining embryos can be frozen and stored for future use.
    • You will return in 2 to 3 weeks for a pregnancy test and to see if an embryo has implanted and started to grow.

Using your own frozen eggs or embryos

Your fertility evaluation may indicate that you do not have enough healthy eggs to become pregnant. However, if you froze eggs or embryos before your treatment, you may be able to use these to try to get pregnant. There are several steps to this process:

  • You will most likely take hormones for 2 to 3 weeks to get the lining of your uterus ready for your embryo to implant.
  • You and your doctor will decide how many embryos to transfer at one time, and that number of embryos will be thawed. If you froze your eggs, these will be thawed and fertilized with sperm from your partner or a donor to create embryos.
  • The embryos will be transferred to your uterus using a very thin catheter that will be passed through your vagina and cervix. This is usually done in an exam room while you are fully awake.
  • You will return in 2 to 3 weeks for a pregnancy test and to see if an embryo has implanted and started to grow.
  • You will continue to take hormones for several months to support the pregnancy.

Donor eggs

Many women do not have the opportunity to freeze eggs or embryos before treatment. If you do not have enough eggs to get pregnant through natural conception or ovarian stimulation, you may be able to use eggs from a donor. Although the child will not have your genes, you will be able to experience pregnancy and childbirth. Donor eggs are a form of third-party reproduction. This means that a third person helps you build your family.

Eggs are usually donated by young women who want to help other women. Donors should be carefully screened to ensure they are medically and emotionally healthy. Most donors are anonymous, but some may allow the child to contact them when they reach adulthood. Donors may be willing to have contact with the intended parents (you and your partner, if you have one) during the process.

Finding donor eggs

Your fertility center may have an egg donor program or can recommend an egg donor agency. Reproductive lawyers with experience in this area can also recommend egg donor agencies.

Sometimes, 2 people share the eggs of a single donor to lower the costs. Some agencies now have frozen eggs available for donation.

You may have a relative or friend who is willing to donate eggs for you. This is a good option for some people; however, even with the best of intentions, there can be problems if expectations are not clearly defined. Even if you know your donor well, she will need to have psychological and medical screenings before donating. It is also important to talk with a lawyer and be sure you and the donor fully understand all that is involved.

What is involved

Once you choose a donor and she has been screened, you will need to finalize the financial and legal arrangements. Then, your reproductive endocrinologist will plan the timing of the egg collection. There are several steps to this process:

  • The donor will give herself daily hormone injections to stimulate her ovaries. It takes about 2 weeks for the eggs to mature. During that time, she will be closely monitored by her doctor.
  • To prepare the lining of your uterus for implantation of the embryo, you will begin to take hormones before your donor begins her ovarian stimulation.
  • When your donor’s eggs are mature, the reproductive endocrinologist will retrieve them. This is done with anesthesia, so she will be asleep. The eggs will be collected using a very thin needle passed through her vagina. The procedure takes only about 15 minutes and she will go home the same day.
  • The eggs will be brought to the laboratory, where they are fertilized with sperm from your partner or a donor. These fertilized eggs should then start to divide and form embryos.
  • After 3 to 5 days, 1 or more embryos will be transferred to your uterus using a very thin catheter that will be passed through your vagina and cervix. This is usually done in an exam room while you are fully awake. You and your doctor will decide how many embryos to transfer. The remaining embryos can be frozen and stored for future use.
  • You will return in 2 to 3 weeks for a pregnancy test and to see if an embryo has implanted and started to grow.
  • You will continue to take hormones for several months to support the pregnancy.

Donor embryos

Many women do not have the opportunity to freeze eggs or embryos before treatment. If you do not have enough eggs to get pregnant from natural conception or ovarian stimulation, you may be able to use embryos from a donor. Although the child will not have genes from you or your partner, you will be able to experience pregnancy and childbirth. Donor embryos are another form of third-party reproduction.

Embryos are usually donated by couples who have gone through fertility treatment and have unused frozen embryos. The terms “embryo adoption” and “embryo donation” have both been used to describe this but they have different moral and legal implications. Reproductive specialists generally feel that “embryo donation” is the correct term.

Finding donor embryos

Your fertility center may have an embryo donor program or can recommend an embryo donation agency. Some agencies are nondenominational and some are faith-based.

What is involved

Once the financial and legal arrangements are finalized, your reproductive endocrinologist will plan the timing of the embryo transfer. There are several steps to this process:

  • To prepare the lining of your uterus for implantation of the embryo, you will take hormones for 2 to 3 weeks.
  • One or more embryos will be thawed and transferred to your uterus using a very thin catheter passed through your vagina and cervix. This is usually done in an exam room while you are fully awake. You and your doctor will decide how many embryos to transfer.
  • You will return in 2 to 3 weeks for a pregnancy test and to see if an embryo has implanted and started to grow.
  • You will continue to take hormones for several months to support the pregnancy.

Gestational surrogate

Some women cannot carry a pregnancy after cancer treatment. This can happen if your uterus was removed, if you had high-dose radiation to your pelvis, or if other medical issues make it unsafe for you to get pregnant. If this is the case, you can have another woman carry the pregnancy for you. This is another form of third-party reproduction called surrogacy.

In the past, a method called traditional surrogacy was commonly used. In this method, the surrogate was impregnated with sperm from a woman's partner or donor. Because the surrogate is genetically related to the child, there was a significant amount of legal risk. Traditional surrogacy is generally not used any more.

A method called gestational surrogacy (also called gestational carrier) is now more commonly used. In this method, 1 or more embryos are transferred into your surrogate’s uterus. These can be embryos you froze before starting your cancer treatment, fresh embryos created with your own or donated eggs, or donor embryos. The surrogate has no genetic relationship to the child.

Laws related to surrogacy vary from state to state. The laws in some states make the process very difficult or even illegal. Some states require that the intended parents adopt the child after he or she is born. Because of the various laws in place, we recommend that you talk with a reproductive lawyer before starting this process.

Finding a gestational surrogate

You can find a gestational surrogate through a surrogacy agency or through a reproductive lawyer who specializes in surrogacy. In some cases, you may have a relative or friend who is willing to carry a pregnancy for you. This is a good option for some people. However, even with the best of intentions, there can be problems if expectations are not clearly defined. Even if you know the woman well, she will need to have psychological and medical screenings before becoming your surrogate. It is also important to talk with a lawyer to make sure that you and your surrogate understand all that is involved.

What is involved

In order to qualify as a surrogate, a woman usually needs to have had at least one full-term pregnancy with delivery of a healthy child. Also, your surrogate should be carefully screened to make sure that she is medically and emotionally healthy. Once your surrogate has been accepted, you will need to finalize the financial and legal arrangements. This will include an agreement on how involved you will be with the surrogate.

After the agreements have been made, a reproductive endocrinologist will plan the timing of your embryo transfer to the surrogate. Throughout the pregnancy, you and your surrogate will communicate as you have agreed. You may even be allowed to be present at the birth.

Adoption

Adoption is another way of building your family after cancer treatment. Having a history of cancer does not prevent you from being able to adopt, as long as you are healthy now and have been cancer-free for at least 3 to 5 years. Regulations on adoption are there to protect the well-being of the child, so you may need a letter from your doctor confirming that you are healthy enough to raise a child. You also need to be a US citizen or legal permanent resident of the US. If you are not, it will be very difficult for you to adopt in the US.

There are several things you need to think about when considering adoption. Do you want to adopt a newborn baby, or are you comfortable adopting an older child? Do you want to adopt a child of the same race and ethnicity as you, or are you comfortable adopting outside your race? Would you consider adopting a child who has special health needs? It’s important to know what you are comfortable with before proceeding with adoption.

Adoptions can be domestic or international.

  • In a domestic adoption, the child is born in the US and is a US citizen. Private domestic adoptions provide the best chance of adopting a newborn or a child of the same race and ethnicity as you.
  • In an international or intercountry adoption, the child is born and lives outside of the US. Some of these children have lived in orphanages in their native country. They are usually at least 6 months old when they are adopted and may be of a different race or ethnicity than you. The international adoption process is highly regulated. Some countries do not allow adoption to people who have been treated for cancer. Policies vary by country and change often.

What is involved

Adoptions are arranged through an agency or with the help of an adoption lawyer.

  • Adoption agencies may be public or private. An agency caseworker is often involved in matching the birth parents with the adoptive parents. The match is based on what the birth parents are looking for in adoptive parents and in the characteristics of the child the adoptive parents are hoping to adopt.
    • Public agencies are part of the state Department of Social Services. They usually work with children who have been taken away from their birth parents due to alleged abuse or neglect.
    • Private agencies may handle domestic adoptions, international adoptions, or both. Each agency has its own standards about who they will accept as adoptive parents. Some states, including New York, do not allow agencies to discriminate against prospective parents based on a history of cancer. At the same time, some states may require a parent to be cancer-free for a specific period of time before beginning the adoption process. Children adopted through private agencies are usually younger than children adopted through public agencies. With a private agency, you can adopt a newborn child.
  • Private adoptions can also be arranged by working with a lawyer. Adoption laws vary widely by state, so it is important to work with a lawyer who specializes in adoption and is licensed in the state in which you want to adopt. With a private adoption, you can adopt a newborn child.

There are several ways to find an adoption agency or attorney.

  • To find an adoption agency, go to the National Foster Care and Adoption Directory website at www.childwelfare.gov/nfcad/. Select your state and the type of agency you are looking for (such as public, private domestic, private intercountry).
  • To find agencies that focus on international adoption, search the Intercountry Adoption website at adoption.state.gov.
  • To find an adoption lawyer, search the American Academy of Adoption Attorneys website at www.adoptionattorneys.org

The amount of information shared between birth parents and adoptive parents can vary. In the past, closed adoptions were common. In a closed adoption, birth parents and adoptive parents did not know each other’s identity and had no direct contact after the adoption. Now, open or semi-open adoptions are more common. These allow some contact between the birth parents, the adoptive parents, and the child after the adoption. Everyone involved agrees on the type and amount of contact.

Before you can adopt, a social worker will do a home study to assess your ability to care for a child. The social worker will ask you things that may seem very personal. This is to make sure you understand what is involved and are ready to proceed with an adoption. Work with your agency or lawyer to decide the best time to schedule the home study. Once the child is placed in your care, the social worker will stay in contact to help with any issues that may arise.

6. What Other Issues Should I Consider When Exploring Options for Building a Family?

Financial issues

The cost of each of these options varies based on many factors. These include:

  • Your personal health insurance coverage for fertility treatment. Fertility treatments can be expensive, so find out what coverage you have early on in the process.
  • The option you use. For example, using donor embryos is less expensive than using donor eggs. Using a gestational surrogate is usually very expensive.
  • Medical expenses of your donor or surrogate. This will depend on her personal health insurance coverage.
  • Travel expenses of your donor or surrogate
  • Compensation paid to your donor or surrogate
  • Psychological and medical screening of your donor or surrogate
  • Agency fees
  • Legal fees

Listed below are a number of programs that provide financial help or grants to cancer survivors or patients who are infertile. Some of these programs are open to applicants only once a year. With others, it may take as long as 6 months to find out whether you will receive assistance, so plan ahead.

You can also explore the following options:

  • The New York State Infertility Demonstration Project provides grants to help with medical costs. This help is based on your income. Ask your fertility center if they participate in this and if you are eligible.
  • A number of pharmaceutical companies provide medications for a reduced fee or for free to certain patients. Ask your fertility center to tell you if you are eligible and to help you apply.
  • Some banks and financing companies may loan money for family building.
  • Some fertility centers, agencies, or lawyers may be willing to work out a payment plan for you. Some offer a sliding scale based on your income.
  • Some patients have asked family or friends to organize fund raising efforts in their community, house of worship, or workplace. You can even use the Internet to set up a personal fund-raising site, for example at GiveForward (www.giveforward.com).
  • If you are considering adoption:
    • Ask your accountant if you are eligible for the Federal Adoption Expense Tax Credit. Based on your income, this may let you take a tax credit on your federal income taxes for eligible adoption expenses.
    • Some employers provide adoption benefits to help with costs.
    • Help Us Adopt (www.helpusadopt.org) provides financial grants to help with adoption costs.
    • National Adoption Foundation (fundyouradoption.org) provides grants, loans, and information about other financial resources for adoption.

Legal issues

Laws on third-party reproduction (donor eggs, donor embryos, and gestational surrogates) and adoption vary by state. Each of these options has legal issues that you need to consider. Some options, like gestational surrogacy, are particularly complicated. Ask the staff at your fertility center or agency how they address these legal issues and if they can recommend a lawyer. If not, you may want to speak with a reproductive or adoption lawyer on your own. Things to consider in selecting a lawyer include:

  • Experience in the family building option(s) in which you are interested.
  • The state in which he or she is licensed. Reproductive and adoption law varies by state. Make sure your lawyer is licensed in and knowledgeable about the states where you and your donor, surrogate, or birth parents live.
  • Other services provided. For example, if your lawyer can help you find an agency, help you find a donor/surrogate/birth parents, review legal documents, and assist with adoption if needed.
  • How the lawyer charges for his or her services. Lawyers can charge a flat fee or charge by the hour.

You can find lawyers who specialize in reproductive law through the following organizations:

  • American Academy of Assisted Reproductive Technology Attorneys: www.aaarta.org
  • American Fertility Association: www.theafa.org – under “Advice and support,” select “find a professional” select “attorney”
  • American Society of Reproductive Medicine: www.asrm.org – under “membership,” select “find a member” and then “find a health care professional” – select “legal professionals group”)
  • RESOLVE: The National Infertility Association: www.resolve.org – under “find a service provider,” select “attorneys”)

Emotional issues

If you are not able to get pregnant naturally, the process of building your family can be complicated, time- consuming, and expensive. You may experience feelings of anger, loss, or grief. These feelings are common. If you find that these emotions become overwhelming, last for weeks, or discourage you from taking the next steps, consider talking with a counselor.

Your fertility center or agency may recommend a mental health counselor for you. You can also find counselors who specialize in dealing with infertility through the following organizations:

  • American Fertility Association: www.theafa.org – under “Advice and support”, select “find a professional,” then select “mental health professional”)
  • American Society of Reproductive Medicine: www.asrm.org – under “membership,” select “find a member” and then “find a health care professional” – select “mental health”)
  • RESOLVE: The National Infertility Association: www.resolve.org – under “find a service provider” select “mental health”)

7. How Do I Get Started?

This resource provides just a brief overview of the options for building your family after cancer treatment. There is much more to learn. Below are steps to help you further explore your options.

  1. Learn more. See section 8 for a list of resources that have in-depth information on each of these options.
  2. Speak with your oncologist when you are ready to build your family. Explain what you are considering, and ask if he or she has any concerns based on your personal medical situation.
  3. Make initial appointments with specialists.
  • If you are considering becoming pregnant, and your doctor recommends you work with a maternal fetal medicine specialist, schedule a consultation before you try to become pregnant (see Section 4).
  • If you are considering assisted reproductive technology (including ovarian stimulation, IVF, or using donor eggs donor embryos or gestational surrogates), schedule an appointment with a reproductive endocrinologist. He or she will perform a fertility evaluation that will help clarify which options may be best for you. Your reproductive endocrinologist may also help you select donors, surrogates, agencies, lawyers, and mental health specialists.
    • Ask your nurse for the resource Selecting a Reproductive Endocrinologist/Fertility Center for a list of fertility centers in the New York area that have experience working with patients who have had cancer. This resource also describes how to find fertility centers in other areas of the country.
  • If you are considering adoption, see information on how to find an adoption agency or lawyer in Section 5.
  1. Plan for the financial costs. Ask your fertility center, agency, or lawyer for a detailed list of all of the expenses involved. See Section 6 for information on financial issues to consider.
  2. Consider consulting a reproductive or adoption lawyer. See Section 6 for information on legal issues and how to find a lawyer.
  3. Depending on which option you choose to build your family, you may need to meet with a mental health professional at some point. He or she will make sure that you understand what is involved and that you are ready to go through this process. Mental health professionals can also provide support as you make decisions about the options presented to you. See Section 6 for information on emotional issues and how to find a mental health professional.
  4. Talk with family and friends about what you are considering. Ask for their support.

Keep in mind that many people have gone through this before you. This process can be complicated, and it takes persistence and endurance. However, many people successfully build families after cancer treatment.

8. Where Can I Learn More?

Memorial Sloan Kettering Cancer Center (MSK) has a website with information and resources for cancer survivors. There is a section on fertility that lists many resources you may find to be helpful. Go to www.mskcc.org/cancer-care/survivorship/fertility for more information.

A number of professional organizations provide information and support on all options for building a family. Search within each of their websites for specific topics.

You may also find this publication to be helpful:  Having Children after Cancer, Gina M Shaw, Celestial Arts, Berkley, 2011

A number of organizations provide information and support on specific options for building a family.

Donor egg

Gestional surrogate

Adoption

This is a selected list of resources.

MSK makes no warranties or representations as to the accuracy or completeness, timeliness, or usefulness of any opinion expressed in this booklet. The information and opinions contained herein are not intended as a substitute for medical professional help or advice and are to be used only as an aid in understanding current medical knowledge. A physician should always be consulted for any health problem or medical condition. MSK does not warrant, endorse, guarantee, or assume responsibility for any opinions, information, products or services offered by any third party referenced within this booklet.

Notes