Revision request to the standardized pedigree nomenclature regarding surrogacy versus gestational carriers and suggestion for new nomenclature pertaining to embryo adoption

We appreciate the work done on behalf of the Pedigree Nomenclature Task Force to provide guidance to our profession and to ensure that recommendations for nomenclature are updated and align with evolving language that support our JEDI efforts for inclusivity. In keeping with this goal, we noticed a discrepancy we brought to the authors' attention in September 2023 regarding the use of and definitions of “surrogacy,” “gestational carrier,” and “gamete donor,” which were published in the following manuscript: “Practice resource-focused revision: Standardized pedigree nomenclature update centered on sex and gender inclusivity: A practice resource of the National Society of Genetic Counselors. Journal of Genetic Counseling, 31(6), 1238–1248” (Bennett et al., 2022). This publication includes updates to the previous guideline: “Standardized human pedigree nomenclature: Update and assessment of the recommendations of the National Society of Genetic Counselors. Journal of Genetic Counseling, 17(5), 424–433” (Bennett et al., 2008). As per the American Society for Reproductive Medicine (ASRM) guideline published in 2012, a gestational carrier is defined as “a woman who carries a pregnancy for another,” and a surrogate as “a woman who donates her egg and carries a pregnancy for another” (Gestational Carrier (Surrogate), 2023). The most recently published nomenclature guidelines established by the Task Force continue to use both gestational carrier and surrogate synonymously. As you know, the clinical, genetic, and social importance of distinguishing a surrogate from a gestational carrier is essential in the assessment of risk(s). We humbly offer our suggestion to clarify this distinction by defining surrogate and gestational carrier into two distinct pedigree symbols, thereby providing clarity and improving family history documentation and risk assessment. The symbols and definitions are offered below: Using the above suggested modifications, we applied them to the examples provided within the 2022 publication with the intent to demonstrate how these symbols could offer precision and/or definition to the nomenclature. Additionally, we added an example of an embryo adoption, as this appears to be utilized more frequently, and we believe it to be a distinct category from adoption. Changes are provided in the figures below. We thank you for your consideration in the matter and are interested and open to all thoughts and suggestions. We look forward to hearing from you soon. C. Rathbun conceptualized the presented idea. K. Paulyson Nuñez encouraged C. Rathbun to investigate surrogacy versus gestational carrier guidelines and supervised the findings of this work. C. Rathbun designed the figures. Both C. Rathbun and K. Paulyson Nuñez developed new nomenclature around embryo adoption, reviewed the methods and content, and contributed to the final version of the manuscript. K. Paulyson Nuñez supervised the project.