Reply to Rathbun and Paulyson Nuñez

We thank Rathbun and Paulyson Nuñez for alerting us that we inaccurately and interchangeably used the terms “surrogate” and “gestational carrier” in our previous publication (Bennett et al., 2022, figure 5 examples 3 and 4). As they point out, a “gestational carrier” is defined as a person who carries a pregnancy resulting from the transfer of a preimplantation embryo but who has no genetic relationship with the embryo. The term “surrogate” is defined as a person who donates eggs and carries the pregnancy for another. We also think their suggestion for placing “G” within the symbol of the gestational carrier can clarify some reproductively complex pedigrees. These changes have been included in a Correction in this issue of the Journal.

The pedigree's utility lies in its simplicity and thus recommends using as few abbreviations and symbols as possible. Therefore, we think that placing an “S” inside a symbol is not necessary. A surrogate should be apparent in the pedigree without using the letter “S.” Placing a “D” in the donor's symbol with the pregnancy directly beneath the symbol de facto indicates a surrogate pregnancy. However, in Rathbun and Paulyson Nuñez's examples 4A and 4B, since there is no “D” (or “S”) it is unclear if the pregnancy was conceived using a donor, or if there is an out-of-relationship pregnancy occurring.

Regarding the symbols attached to their revision request, examples 1A–1F, 2, and 5 are consistent with the nomenclature presented in our 2022 article. Regarding their example 5 and figure 5 example 5 from our 2022 article, we now recommend removing the “D” from the circle on the left, since this is an intended parent and not an egg donor. In addition, adding a “G” to the individual who is carrying the pregnancy would clarify that this person is a gestational carrier and did not contribute egg(s).

We disagree with Rathbun and Paulyson Nuñez's recommendation to introduce the term “Embryo Adoption” (their example 1G), because this may imply personhood of the embryo. As stated in the 2023 report from the Ethics Committee of the American Society for Reproductive Medicine (2023), the term “adoption” for embryos should be avoided. We suggest that the National Society of Genetic Counselors Assisted Reproductive Technology Special Interest Group continue to be consulted so that appropriate nomenclature reflecting current reproductive practices and terminology be addressed in future iterations of the Recommended Standardized Pedigree Nomenclature.

All authors contributed to the reply.