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Surrogacy or Surrogate means substitute. In medical parlance, the term surrogacy means using of a substitute mother in the place of the natural mother.

A surrogacy arrangement is one in which one woman (the surrogate mother) agrees to bear a child for a couple (the intended parents) and surrender it at birth. This provides an opportunity for those who are unable to carry a child themselves to overcome their childlessness.

The surrogate becomes pregnant via embryo transfer with a child of which she is not the biological mother. She may have made an arrangement to relinquish it to the biological mother or father to raise, or to a parent who is unrelated to the child (e. g. because the child was conceived using egg donation, sperm donation or is the result of a donated embryo). The surrogate mother may be called the gestational surrogacy carrier.

Altruistic surrogacy is a situation where the surrogate receives no financial reward for her pregnancy or the relinquishment of the child (although usually all expenses related to the pregnancy and birth by surrogacy are paid by the intended parents such as medical expenses, maternity clothing, and other related expenses).

Commercial surrogacy is a form of surrogacy in which a gestational carrier is paid to carry a child to maturity in her womb and is usually resorted to by higher income infertile couples who can afford the cost involved or people who save and borrow in order to complete their dream of being parents. This procedure is legal in several countries including in India where due to high international demand and ready availability of poor surrogacy it is reaching industry proportions. Commercial surrogacy is sometimes referred to by the emotionally charged and potentially offensive terms “wombs for rent”, “outsourced pregnancies” or “baby farms”.

Glossary

Surrogacy in general

Surrogacy is a method of reproduction and an arrangement between a woman and a couple or individual to carry and deliver a baby. It is a controversial process that is legal not in all states. The process is expensive, time consuming, and emotional one. Women or couples who choose surrogacy often do so because they are unable to conceive due to a missing or abnormal, have experienced losses, or have had multiple in vitro attempts that have failed. The advantage of gestational surrogacy to the parents is that the is created from the woman’s egg and the man’s, so it is biologically theirs.

Surrogacy is a method of reproduction whereby a woman agrees to become pregnant and deliver a child for a contracted party. She may be the child’s genetic mother, or she may, as a gestational carrier, carry the pregnancy to delivery after having been implanted with an embryo, the latter being an illegal medical procedure in some jurisdictions.

Surrogacy offers parents the ability to have biological children. The baby can be genetically yours. It simply grows inside another woman’s body.

Couples who have tried unsuccessfully for years to start a family may feel that they are running out of time. The IVF process allows for implanting more than one embryo, giving the couple a chance at more than one baby from one surrogate pregnancy.

Still surrogacy is a very controversial subject. Some religious organizations forbid their members from participating in surrogacy, no matter how desperate they are to have a child. Whatever the reason that couples might consider surrogacy, they must carefully weigh the pros and cons before proceeding. There are different factors that people who are considering surrogacy have to go through, from the time to decide whether they would go forward with it, to choosing the surrogate mother, the procedures involved, the fees required and the overall time frame. Each of these factors has its own pros and cons.

There are two different types of surrogacy. They are traditional surrogacy and gestational surrogacy. Explanations for both types can be found below.

Traditional Surrogacy

In traditional surrogacy, the surrogate mother is artificially inseminated with the sperm of the intended father or sperm donor. The surrogate’s own egg will be used, thus she will be the genetic mother of the resulting child.

Usually, the intended father’s name is put directly on the birth certificate and the intended mother will need to do a step-parent adoption, however, laws regarding this issue vary from state to state. Consult a lawyer who is knowledgable about surrogacy laws in your state to learn more.

Gestational Surrogacy

In a gestational surrogacy, the surrogate mother is not genetically related to the child. Eggs are extracted from the intended mother or egg donor and mixed with sperm from the intended father or sperm donor in vitro. The embryos are then transferred into the surrogate’s uterus. Embryos which are not transferred may be frozen and used for transfer at a later time if the first transfer does not result in pregnancy.

In many areas, the intended parents may petition the court during the third trimester of pregnancy to have both of their names placed directly on the birth certificate, however, laws regarding this issue vary from state to state. Consult a lawyer who is knowledgably about surrogacy laws in your state to learn more.

Most couples would prefer gestational surrogacy because the surrogate mother is not the supplier of the egg. The man’s sperm and the woman’s egg go through a process known as IVF, or in vitro fertilization. The surrogate mother receives the fertilized egg through implantation. The advantage of this procedure is that the surrogate mother is less likely to have an attachment similar to traditional surrogacy since she is merely a carrier and not a donor. The disadvantage mainly lies in the medically invasive procedure, which can be painful for the surrogate mother.

One of the biggest myths about surrogacy is that most surrogates will not give up the baby. In most cases, surrogates already have children of their own, and it is the love for their own children that makes women want to give other couples that same opportunity to experience parenthood. A surrogate generally enters the arrangement knowing that the baby she will carry belongs to the intended parents.

The success rate of surrogacy cannot be determined because it is dependent on many factors. The first successful gestational surrogacy took place in 1985. Other forms of surrogacy have existed since Biblical times.

Costs

Surrogacy fees include medical fees, agency fees, fees paid to the surrogate mother, fees to purchase the needs of the surrogate mother, legal fees and adoption fees. Surrogacy can put many couples through financial hardship. In addition, medical insurance may not cover the fertilization process and certainly would not cover the delivery by the surrogate mother. Some costs may be tax-deductible. To be certain, couples should consult with a tax adviser. If a family member offers to do it for free or for a minimal cost to cover the hospital charges only, the price is greatly decreased.

Time Frame

Calculating the time frame for couples does not only start from the actual pregnancy stage. Time spent on researching options, numerous attempts at fertilization and waiting for the baby to arrive all add up. Moreover, if you also add the time it takes most couples to save enough money and go through the legal process of adopting the child later, the process may take several years. The advantage through it all is that in the end, no matter how long and tedious the process is, they will finally become parents.

Policy

There is no national policy concerning the issue of surrogacy. Each country has reached its own legal approach to this comparatively new procreation procedure. The surrogacy laws differ from it being a criminal offence to states that have their own surrogacy laws. Surrogacy laws as rules are designed to protect women from exploitation and were born out of regard for the biological fathers as well as the birth mothers.

Surrogacy laws as rules are designed to protect women from exploitation and were born out of regard for the biological fathers as well as the birth mothers. Today, cases that shape the laws beg the question whether a contract or deal can be binding and can a female sign a deal for custody not yet conceived with informed consent. Also, can money be given to a female for the services of reproduction, but not for the final product of surrogacy? These problems are morally and legally bewildering at best and while legislative authority drops every thing to keep up with the ever changing needs of reproduction and its supporters, many countries are left with laws that want the parents to rake over their own child and other acts which seem to compose very little wisdom at first blush.

There is not both the legislation and the approved policy concerning surrogacy laws in most countries. The question of general surrogacy laws was considered in the Council of Europe, but only at a level of the separate states. There are complex legal questions connected to the issue of alternative reproduction technology and that is reflected in the variety of approaches to this problem on the part of the regional organizations and the national states.

The adopted national surrogacy laws and policy vary from an absolute prohibition of surrogacy up to the establishment of the complex legal base that was called on to account the rights and the interests of all parties.

In connection with the different moral, legal, and religious aspects of the given question, national legislators and a policy of most of the countries limit surrogacy. In some counties like France and Germany, it is forbidden completely. In other countries, only commercial agreements on surrogacy are forbidden and the consideration of judicial claims under some agreements is not supposed. Such situations are in Canada, Israel, Great Britain, and Australia. Lastly, the third countries limit the use of reproductive technologies in connection with surrogacy. These countries are Denmark, Norway, and Sweden.

Of course, conception in a test tube or other experimentation with human genetic materials transforms children into goods that can be bought and sold on the open market. This creates a situation in which rich people can employ women for child bearing. Therefore motherhood becomes contractual work in which the aspiration of personal benefit prevails. There is no sense of forbidding surrogacy with surrogacy laws. It is possible that such a situation as what happened with abortion will happen in these countries. If it is impossible legally, surrogacy and abortion will be conducted in secret.

Therefore, if you can’t have a baby, there are many ways to get a child. For example, there is surrogacy and adoption. But, most countries have no surrogacy laws yet.

Surrogacy in Ukraine

First of all, it is worth mentioning that surrogacy in Ukraine is legal over the whole territory.

In our country, juridical aspects of surrogacy are regulated by following legislative acts:

• Family code of Ukraine;
• Ukrainian Ministry of Justice act on “alterations to civil registration regulations in Ukraine” № 1154/5 from 22.11.2007;
• Ukrainian Ministry of Health order “on approval of reproductive technologies appliance” № 771 from 23 December 2008.

By paragraph 10 article 3 of Ukrainian Ministry of Justice act from 22.11.2007 № 1154/5 procedure for the children registration is established, meaning children who were born with the help of reproductive programs: “In case a baby is born by a woman, who was implanted an embryo conceived by a married couple, registration of birth is carried out upon application of married couple who consented implantation. In this case concurrently with the document, avowing birth of a child by this woman, verified by notary written consent on recording married couple to be parents is applied”.

Rights of birth parents are protected by law. Corresponding, children rights are protected, who are born with ART (assisted reproductive technology): genetic (biological) relationship with mother and father is considered.

In vitro fertilization (IVF)

In vitro fertilization (IVF) is a process by which egg cells are fertilized by sperm outside the womb, in vitro. IVF is a major treatment in infertility when other methods of assisted reproductive technology have failed. The process involves hormonally controlling the ovulatory process, removing ova (eggs) from the woman’s ovaries and letting sperm fertilize them in a fluid medium. The fertilized egg (zygote) is then transferred to the patient’s uterus with the intent to establish a successful pregnancy. The first “test tube baby”, Louise Brown, was born in 1978.

Indications

IVF may be used to overcome female infertility in the woman due to problems of the fallopian tube, making fertilization in vivo difficult. It may also assist in male infertility, where there is defect sperm quality, and in such cases intracytoplasmic sperm injection (ICSI) may be used, where a sperm cell is injected directly into the egg cell. This is used when sperm have difficulty penetrating the egg, and in these cases the partner’s or a donor’s sperm may be used. ICSI is also used when sperm numbers are very low. ICSI results in success rates equal to those of IVF fertilization.

For IVF to be successful it may be easier to say that it requires healthy ova, sperm that can fertilize using ICSI, and a uterus that can maintain a pregnancy. Due to the costs of the ICSI procedure, IVF is generally attempted only after less expensive options have failed.

ICSI also avails for egg donation or surrogacy where the woman providing the egg isn’t the same who will carry the pregnancy to term. This means that IVF can be used for females who have already gone through menopause. The donated oocyte can be fertilized in a crucible. If the fertilization is successful, the zygote will be transferred into the uterus, within which it will develop into an embryo.

IVF can also be combined with preimplantation genetic diagnosis (PGD) to rule out presence of genetic disorders. A similar but more general test has been developed called Preimplantation Genetic Haplotyping (PGH).

Methods

Ovarian stimulation

Treatment cycles are typically started on the third day of menstruation and consist of a regimen of fertility medications to stimulate the development of multiple follicles of the ovaries. In most patients injectable gonadotropins (usually FSH analogues) are used under close monitoring. Such monitoring frequently checks the estradiol level and, by means of gynecologic ultrasonography, follicular growth. Typically approximately 10 days of injections will be necessary. Spontaneous ovulation during the cycle is typically prevented by the use of GnRH antagonists, which block the natural surge of luteinizing hormone (LH).

Transvaginal oocyte retrieval

When follicular maturation is judged to be adequate, human chorionic gonadotropin (hCG) is given. This agent, which acts as an analogue of luteinizing hormone, would cause ovulation about 42 hours after injection, but a retrieval procedure takes place just prior to that, in order to recover the egg cells from the ovary. The eggs are retrieved from the patient using a transvaginal technique involving an ultrasound-guided needle piercing the vaginal wall to reach the ovaries. Through this needle follicles can be aspirated, and the follicular fluid is handed to the IVF laboratory to identify ova. It is common to remove between ten and thirty eggs. The retrieval procedure takes about 20 minutes and is usually done under conscious sedation or general anesthesia.

Fertilization

In the IVF laboratory, the identified eggs are stripped of surrounding cells and prepared for ICSI fertilization. In the meantime, semen is prepared for fertilization by removing inactive cells and seminal fluid. If semen is being provided by a sperm donor, it will usually have been prepared for treatment before being frozen and quarantined, and it will be thawed ready for use. The sperm and the egg are incubated together at a ratio of about 75,000:1 in the culture media for about 18 hours. In most cases, the egg will be fertilized by that time and the fertilized egg will show two pronuclei. In certain situations, such as low sperm count or motility, a single sperm may be injected directly into the egg using intracytoplasmic sperm injection (ICSI). The fertilized egg is passed to a special growth medium and left for about 48 hours until the egg consists of six to eight cells.

In gamete intrafallopian transfer, eggs are removed from the woman and placed in one of the fallopian tubes, along with the man’s sperm. This allows fertilization to take place inside the woman’s body. Therefore, this variation is actually an in vivo fertilization, not an in vitro fertilization.

Selection

Laboratories have developed grading methods to judge oocyte and embryo quality. Typically, embryos that have reached the 6-8 cell stage are transferred three days after retrieval. In many American and Australian and Ukrainian programs, however, embryos are placed into an extended culture system with a transfer done at the blastocyst stage at around five days after retrieval, especially if many good-quality embryos are still available on day 3. Blastocyst stage transfers have been shown to result in higher pregnancy rates. In Europe, transfers after 2 days are common. Preimplantation Genetic Diagnosis (PGD) procedures may be performed prior to transfer.

Embryo transfer

Embryos are graded by the embryologist based on the number of cells, evenness of growth and degree of fragmentation. The number to be transferred depends on the number available, the age of the woman and other health and diagnostic factors. In countries such as the UK, Australia and New Zealand, a maximum of two embryos are transferred except in unusual circumstances. In the UK and according to HFEA regulations, a woman over 40 may have up to three embryos transferred, whereas in the USA, younger women may have many embryos transferred based on individual fertility diagnosis. Most clinics and country regulatory bodies seek to minimize the risk of pregnancies carrying multiples. The embryos judged to be the “best” are transferred to the patient’s uterus through a thin, plastic catheter, which goes through her vagina and cervix. Several embryos may be passed into the uterus to improve chances of implantation and pregnancy.

Pregnancy rates

Pregnancy rate is the success rate for pregnancy. For IVF, it is the percentage of all attempts that lead to pregnancy, which generally refers to treatment cycles where eggs are retrieved and fertilized in vitro (using ICSI or not). Statistics referring to “pregnancy” may refer to just a positive pregnancy test, and not necessarily “viable pregnancy” which implies the detection of a fetal heart beat. Pregnancies that are delivered with a viable baby are called live birth rate. Increasingly a distinction is also made between singleton and multiple pregnancies as multiple pregnancies, specifically more than twins, should be avoided because of the associated maternal and fetal risks.

With enhanced technology, the pregnancy rates are substantially better today than a couple of years ago. In 2006, Canadian clinics reported an average pregnancy rate of 35%. A French study estimated that 66% of patients starting IVF treatment finally succeed in having a child (40% during the IVF treatment at the center and 26% after IVF discontinuation). Achievement of having a child after IVF discontinuation was mainly due to adoption (46%) or spontaneous pregnancy (42%).

Effect of stress

In a 2005 Swedish study, 166 women were monitored starting one month before their IVF cycles (including ICSI cases), and the results showed no significant correlation between psychological stress and IVF outcome. The study concluded with the recommendation to clinics that it might be possible to reduce the stress experienced by IVF patients during the treatment procedure by informing them of those findings. While psychological stress experienced during a cycle might not influence an IVF outcome, it is possible that the experience of IVF can result in stress that leads to depression. The financial consequences alone of IVF can influence anxiety and become overwhelming. However, for many couples, the alternative is infertility, and the experience of infertility itself can also cause extreme stress and depression.

Live birth rate

Live birth rate is the percentage of all IVF cycles that lead to live birth, and is the pregnancy rate adjusted for miscarriage and stillbirth. These percentages are for successful pregnancies, regardless of the number of children born, as twins and larger multiple-order births are more common in IVF cycles.

In 2006, Canadian clinics reported a live birth rate of 27%. A summary of 2006 reports from US clinics for cycles that did not involve donor eggs gave success rates varied widely by the age of the prospective mother, with a peak at 42.6% for 27-year-olds. Rates for younger patients were slightly lower, with a success rate of 35.3% for those 21 and younger, the youngest group evaluated. Success rates for older patients were also lower and decrease with age, with 37-year-olds at 27.4% and no live births for those older than 48, the oldest group evaluated. IVF attempts in multiple cycles result in increased cumulative live birth rates. Depending on the demographic group, one study reported 45% to 53% for three attempts, and 51% to 71% for six attempts.

Complications

The major complication of IVF is the risk of multiple births. This is directly related to the practice of transferring multiple embryos at embryo transfer. Multiple births are related to increased risk of pregnancy loss, obstetrical complications, prematurity, and neonatal morbidity with the potential for long term damage. Strict limits on the number of embryos that may be transferred have been enacted in some countries (e.g. England) to reduce the risk of high-order multiples (triplets or more), but are not universally followed or accepted. Spontaneous splitting of embryos in the womb after transfer can occur, but this is rare and would lead to identical twins. A double blind, randomized study followed IVF pregnancies that resulted in 73 infants (33 boys and 40 girls) and reported that 8.7% of singleton infants and 54.2% of twins had a birth weight of < 2500 g. However recent evidence suggest that singleton offspring after IVF is at higher risk for lower birth weight for unknown reasons.

Another risk of ovarian stimulation is the development of ovarian hyperstimulation syndrome.

If the underlying infertility is related to abnormalities in spermatogenesis, it is plausible, but too early to examine that male offspring is at higher risk for sperm abnormalities.

Birth defects

The issue of birth defects has been a controversial topic in IVF. Many studies do not show a significant increase after use of IVF, and some studies suggest higher rates for ICSI, whereas others do not support this finding. In 2008, an analysis of the data of the National Birth Defects Study in the US found that certain birth defects were significantly more common in infants conceived with IVF, notably septal heart defects, cleft lip with or without cleft palate, esophageal atresia, and anorectal atresia; the mechanism of causality is unclear.

Japan’s government prohibited the use of in vitro fertilization procedures for couples in which both partners are infected with HIV. Despite the fact that the ethics committees previously allowed the Ogikubo Hospital, located in Tokyo, to use in vitro fertilization for couples with HIV, the Health, Labour and Welfare Ministry of Japan decided to block the practice. Hideji Hanabusa, the vice president of the Ogikubo Hospital, states that together with his colleagues, he managed to develop a method through which scientists are able to remove the AIDS virus from sperm.

Embryo cryopreservation

The first pregnancy derived from a frozen human embryo was reported by Alan Trounson & Linda Mohr in 1983 (although the fetus aborted spontaneously at about 20 weeks of gestation); the first term pregnancies derived from frozen human embryos were reported by Zeilmaker et al. and the first human baby hatched via a rate frozen freezing process was born in 1984. Since then and up to 2008 it is estimated that between 350,000 and half a million IVF babies have been born from embryos controlled rate frozen and then stored in liquid nitrogen; additionally a few hundred births have been born from vitrified oocytes but firm figures are hard to come by.

On the safety of embryo cryopreservation, a 2008 study reported at the European Society of Human Reproduction and Embryology discovered that children born from frozen embryos did “better and had a higher birth weight” than children born from a fresh transfer. The study was conducted out of Copenhagen and evaluated babies born during the years 1995–2006. 1267 children born after Frozen Embryo Replacement (FER), via controlled-rate freezers and storage in liquid nitrogen, were studied and categorized into three groups. 878 of them were born using frozen embryos that were created using standard in vitro fertilization in which the sperm were placed into a dish close to the egg but had to penetrate the egg on their own. 310 children were born with frozen embryos created using ICSI in which a single sperm was injected into a single egg, and 79 were born where the method of creation of the embryos was not known.

17,857 babies born after a normal IVF/ICSI with fresh embryos were also studied and used as a control group or reference group. Data on all of the children’s outcomes were taken regarding birth defects, birth weights, and length of pregnancy. The results of the study showed that the children who came from frozen embryos had higher birth weights, gave longer pregnancies and produced fewer “pre-term” births. There was no difference in the rate of birth defects whether the children came from frozen embryos or fresh embryos. In the FER group, the birth defect rate was 7.7% compared to the fresh transfer group which was slightly higher at 8.8%. The scientists also found that the risk for multiple pregnancies was increased in the fresh embryo transfers.

Around 11.7% of the ICSI and 14.2% of the IVF frozen cases were multiple pregnancies. In the case of fresh embryos, 24.8% of the ICSI and 27.3% of the IVF were multiple pregnancies. It should also be noted that maternal age was significantly higher in the FER group. This is significant since based on age one would have expected a higher rate of problems and birth defects. The study adds to the body of knowledge suggesting that traditional embryo freezing is a safe procedure. It was unclear however why the frozen embryo children did better than their fresh embryo counterparts

If multiple embryos are generated, patients may choose to freeze embryos that are not transferred. Those embryos are slow frozen and then placed in liquid nitrogen and can be preserved for a long time. The advantage is that patients who fail to conceive may become pregnant using such embryos without having to go through a full IVF cycle. Or, if pregnancy occurred, they could return later for another pregnancy. Spare embryos resulting from fertility treatments may be donated to another woman or couple, and embryos may be created, frozen and stored specifically for transfer and donation by using donor eggs and sperm.

Oocyte cryopreservation

Cryopreservation of unfertilized mature oocytes has been successfully accomplished, e.g. in women who are likely to lose their ovarian reserve due to undergoing chemotherapy. The rate of thaw leading to successful pregnancies is still very low.

Embryo donation and Egg donor

There may be leftover embryos or eggs from IVF procedures if the woman for whom they were originally created has successfully carried one or more pregnancies to term. With the woman’s or couple’s permission, these may be donated to help other women or couples as a means of third party reproduction.

In embryo donation, these extra embryos are given to other couples or women for transfer with the goal of producing a successful pregnancy. The resulting child is considered the child of the woman who carries it and gives birth, and not the child of the donor, the same as occurs with egg donation or sperm donation.

Typically, genetic parents donate the eggs to a fertility clinic or embryo bank where they are cryogenically preserved until a carrier is found for them. Typically the process of matching the embryo(s) with the prospective parents is conducted by the agency itself, at which time the clinic transfers ownership of the embryos to the prospective parents.

The amount of screening the embryo has already undergone is largely dependent on the genetic parents’ own IVF clinic and process. The embryo recipient may elect to have her own embryologist conduct further testing.

Alternatives to donating unused embryos are discarding them (or having them implanted at a time where pregnancy is very unlikely), keeping them frozen indefinitely, donating them for use in embryonic stem cell research.

Acupuncture

An increasing number of fertility specialists and centers offer acupuncture as a part of their IVF protocol. Limited but supportive evidence from clinical trials and case series suggests that acupuncture may improve the success rate of IVF and the quality of life of patients undergoing IVF and that it is a safe adjunct therapy. A systematic review and meta-analysis published in the British Medical Journal found that complementing the embryo transfer process with acupuncture was associated with significant and clinically relevant improvements in clinical pregnancy (where the expected number of patients needed to be treated to produce 1 additional pregnancy was 10), ongoing pregnancy (NNT 9), and live birth (NNT 9).

Acupuncture Mechanisms

Four mechanisms by which it has been suggested that acupuncture may improve IVF outcomes are

- Neuroendocrinological modulations

- Increased blood flow to uterus and ovaries

- Modulation in cytokines

- Reduction of stress, anxiety, and depression

Treatment success versus the risk of multiple pregnancie

In order for a woman over age 35 to maximize her chances of conceiving with her own eggs and carrying a healthy pregnancy, she must have more embryos transferred than do younger women. This practice, though, increases her risk of conceiving multiple fetuses.

Because of the risks of multiple pregnancy to the babies, the American Society for Reproductive Medicine recommends that women under age 35 have no more than two embryos transferred, women age 35 to 37 have no more than three, women 38 to 40 have no more than four transferred, and women who have had repeated failed cycles or are over age 40 have no more than five embryos transferred.

Women over 40 have a high rate of embryo loss when they use their own eggs. As an alternative, older women can choose to use more viable donor eggs.

An Overview of a Typical IVF Cycle

1. Egg Donation

The IVF cycle is performed on the donor (or intended mother) using one or more fertility drugs to increase the number of eggs produced. Multiple follicles (the part of the ovary that contains the eggs) are needed to increase the number of eggs retrieved, thereby increasing the number of embryos developed and hence the chances for conception.

The process begins with the synchronization of both donor and carrier’s menstrual cycles and may require using the medication Lupron. The donor will also be taking daily injections of Fertinex, Follistim, or Gonal-f to encourage this multi-follicular development. Follicular maturation is evaluated by daily blood levels and ultrasound. At a time determined by the physician, an injection of human Chorionic Gonadatropin (hCG) is given to bring the eggs to final maturity. Approximately 35 hours after this injection, the donor will undergo the egg retrieval that is done in the clinic on an outpatient basis.

2. Preparing The Uterus For Implantation

The carrier will be hormonally synchronized to the donor using Estrogen and Progesterone. The carrier’s endometrial receptivity will be evaluated similarly using blood tests and ultrasounds. In addition, the angle and depth of the cervix and uterus will be determined using a catheter identical to the one that will be used for the actual embryo transfer.

3. Egg Retrieval

Aspiration of follicles for eggs is performed through an ultrasound guided approach under IV sedation. The retrieval consists of aspirating the ovarian follicles and identifying the eggs in the follicular fluid under a microscope. The eggs are then held in an incubator until the time of insemination in the laboratory. On this day, the sperm donor (or intended father) will be expected to produce a sperm sample that will be used to inseminate the eggs.

4. Embryo Transfer

The embryo transfer may be done 3-5 days after the retrieval. The physician performing the transfer will discuss with the carrier and the intended parents the status of the embryos and the number to be replaced. The number of embryos transferred varies according to their quantity and quality. At this point, there may be an opportunity to cryopreserve any remaining embryos that continue to develop normally, for possible transfer in future cycles.

The embryo transfer is done under sterile conditions, in a reclining position with legs up, as if having a pap smear. The transfer is easy and virtually pain free in most cases. Following the transfer the carrier is required to lie flat for a half hour and afterwards may return home to relax for the remainder of the day.

5. Testing for Pregnancy

Approximately 2 weeks after the transfer, the carrier will take a blood pregnancy test. If it is positive, the clinic will generally monitor you for several more weeks before discharging you to your own obstetrician.

Also one of the big factors in deciding to become a gestational surrogate is the amount of meds used during the IVF Cycle. Clinics use a mix of injectables, patches, pills, suppositories and nasal sprays. I am going to attempt to cover what the meds are and then give several examples of the total medicine consumption used during one IVF cycle. The examples will show you the variations of what you could expect to go through. Lets start with the meds and their purpose.

Gonadotropin releasing hormone (GnRH) agonists (Synarel, Lupron) are medications that inhibit the brain from secreting hormones that control the menstrual cycle. The ovaries enter into a state of rest, and the patient’s cycle can be completely controlled. These medications prevent premature ovulation and allow the patient’s cycle to be coordinated as needed.

Lupron is a subcutaneous injection and Synarel is a nasal spray. They are usually started one week before the gestational surrogates period is expected or in the very beginning of the cycle. These medications are usually well-tolerated, and most women do not have any side effects when taking these medications for a short time. However, some women may have hot flashes, fatigue, headaches, irritability or nausea.

Estrogen is the hormone that thickens the lining to the endometrium (inner wall of the uterus). Estrodial can be given as an oral tablet, intramuscular injection, or patch on the skin. Some women may experience vaginal irritation, dizziness, lightheadedness, headache, stomach upset, bloating, nausea, weight changes, increased or decreased interest in sex, or breast tenderness.

Progesterone is the hormone produced by the ovary after ovulation. This medication can be given to improve the uterine lining, which may improve implantation of the embryo. It is usually started in the second half of the cycle, several days before the embryo transfer. Progesterone can be given as an intravaginal suppository, oral capsule, or an intramuscular injection. Side effects can include bloating, irritability, and breast tenderness.

Antibiotics (doxycycline) and/or Steroids (methylprednisone) may be used as anti-rejection tactics.

As I have stated before, this question has several answers according to the clinic and the gestational surrogate herself. Everyone’s body reacts differently to the meds and so the total amount will vary from person to person.

Surrogate Mothers (surrogacy) may be relatives, friends, or previous strangers. Many surrogacy arrangements are made through agencies that help match up intended parents with women who want to be surrogates for a fee. The agencies often help manage the complex medical and legal aspects involved. Surrogacy arrangements can also be made independently. Careful screening is needed to assure their health as the gestational carrier incurs potential obstetrical risks. It is also advisable that the intended parents and the surrogate mothers have independent advocates to help them in the legal issues in surrogacy.

A potential surrogate mother must be in good overall health and be able to undergo a pregnancy with the minimum amount of risk to her own health. Some medical conditions will prevent a woman becoming a surrogate mother, for example, if there are any known medical problems which could lead to complications with the pregnancy, or put the woman at risk. Also those who are considerably overweight, are heavy smokers, drinkers or substance abusers are not suitable as surrogate mothers because of the associated risks both to the woman and the baby.

As the risks of illness and problems are much higher in the first pregnancy it is strongly recommended that surrogate mothers should have borne at least one child previously and preferably have completed her own family. This also means that the woman is able to give her “informed” consent to the arrangement, since a woman who has experienced pregnancy prior to the surrogacy arrangement has that knowledge on which to base her decision. Only in very exceptional cases should a woman who has not had a child herself consider becoming a surrogate mother. Because of the increased risk of chromosome abnormalities (eg. Down’s Syndrome) resulting from the eggs of an older woman, an upper age limit of 35 years is set for those donating eggs to other women. The same age should therefore apply to surrogate mothers whose own eggs are to be used, and because the risks of pregnancy increase with age, any woman over 35 should give careful consideration before deciding to become a surrogate mother.

Being a surrogate mother is an emotionally and physically demanding task. It is important that a woman considering this option has the backing of a partner, family or friends to provide emotional support and practical help throughout and after the pregnancy. Surrogacy is not something to enter into lightly. Careful consideration must be given to the medical, emotional, legal and practical issues, and to the implications of surrendering the child at birth. Thought must also be given to the effect on any existing children, the potential surrogate mother’s partner, family and friends.

BioTexCom Reproductive Medicine Center is one the leading centers for artificial insemination in Europe.

Due to the combination of long-term experience and advanced technologies, BioTexCom has shown one of the highest birth rates. Our clinic is known for attentive care for the patients, individual treatment planning and favorable conditions for reaching satisfactory results.

BioTexCom Center is widely recognized in its field of work. The clinic is equipped with advanced technological facilities and applies recent scientific research results. We have a local embryology unit, laboratories and surgeries ensuring high birth rate, care and conveniences.

BioTexCom staff is multilingual and includes legal experts, doctors, interpreters and psychologists.

The clinic offers extensive surrogate mother and egg donor database created to suit your personal needs so that you don’t have to wait too long to launch the program. Our center specializes in work with blastocysts. We perform embryo transfer on the 5th day, which highly increases chances of pregnancy. We select individual donors for each couple.

Surrogate mothers are also selected individually. It assumes that we take into account all your wishes concerning potential candidates for surrogate motherhood: her age, appearance, education, religious beliefs etc. Surrogate mother database of BioTexCom clinic represents candidates of childbearing age, nice exterior, good medical record, having minimum one healthy child of their own. You can choose a surrogate mother among several candidates we shall offer.

Psychologists of BioTexCom clinic offer consultations for surrogate mothers prior to entering the program, during and after pregnancy.

If you require infertility treatment using modern technology and various kinds of infertility therapy, our highly experienced doctors and employees may offer you the whole list of analyses and various options for male and female infertility treatment. We will discuss possible ways of infertility treatment, from the use of fertilization stimulating medication (ovulation induction) or artificial insemination to assisted reproductive treatment like IVF (in vitro fertilization), ICSI (intracytoplasmic sperm injection), pre-implantation diagnosis and egg donation. After discussion we shall develop an individual treatment plan to suit your physical, psychological and emotional needs.

The above said is based on several facts. Firstly, we witness rapid development of medicine. Infertility treatment has currently become more successful than ever before: the number of “unexplained infertility” diagnoses has decreased dramatically. Until recently in many cases one could only dream of solving the problem. Today competent infertility treatment has rendered pregnancy possible even in case of complicated diagnoses.

Secondly, we rely on our medical practice. During the existence of BioTexCom clinic the majority of couples who came to us have become parents. We could hardly believe in positive results at times, but correct infertility treatment has helped some practically hopeless couples to experience parenthood.

In the recent years BioTexCom center has accumulated unique experience of surrogate motherhood programs management and realization. High quality of our services combines with long-term experience and professionalism of our doctors who understand the problems of fertility-challenged couples.