Details On Surrogates
Screening Of Surrogates:
A detailed history is taken and thorough physical examination including a pelvic ultrasound carried out. A set of blood tests are carried out as specified later. The surrogate is monitored ultrasonographically to ensure that her endometrium develops properly. She and her spouse undergo counseling by our counselor wherein they are explained the entire procedure including its risks.
Treatment Of The Surrogate:
The surrogate needs to prepare her uterus for implantation with natural estrogen and progesterone. Because each woman is a little different; the dose, duration and method of administering these hormones may need to be individualized. This can be determined ahead of time by conducting an evaluation cycle. This is a "œdry run" where we duplicate each part of the cycle except the actual transfer of embryos ahead of time in order to determine how to maximize the chances of success. The evaluation cycle can be completed anytime before the actual procedure. In some circumstances, the evaluation cycle can be waived when the response of the uterus to hormonal stimulation is well known. This is fairly common for women who have undergone many treatment cycles in the past.
Surrogacy Cycle Synchronization
It is necessary to synchronize the menstrual cycles of the surrogate and intended Genetic mother in order to obtain mature eggs and embryos and transfer these back into a perfectly prepared endometrium (uterine lining) to maximize the chances of pregnancy success. This is done using a variety of hormonal manipulations including birth control pills, GnRh analogues. We will determine which technique will work best for each circumstance. Once both women (surrogate and intended parent) are suppressed and their cycles synchronized they can begin the process of preparing for pregnancy.
Surrogacy Treatment Cycle
On about the same day, the surrogate and intended Genetic mother will begin hormonal therapies to prepare the appropriate target for pregnancy success. The surrogate will begin taking estrogen to stimulate endometrial (uterine lining) growth and the intended parent will begin taking FSH / rFSH/ HMG to stimulate egg production. These treatments are monitored with ultrasound and blood estrogen levels until the genetic mother's eggs are ready to be retrieved and the Surrogate uterus is ready to accept an embryo. Usually these treatments will take approximately 2-3 weeks and requires 3-5 Clinic visits for ultrasounds and blood tests.
When the ultrasound monitoring of the ovaries and uterus determines that the eggs are mature and ready to be retrieved and the endometrial lining is appropriately grown, the intended Genetic Mother is scheduled for retrieval. On the same day as the egg retrieval, the husband of genetic mother (Genetic Father) provides a fresh sperm sample and the surrogate begins progesterone treatment. Once the eggs are retrieved, they are taken to the IVF laboratory and placed with sperm in the incubator. The following morning we can determine how may of the eggs have successfully fertilized into embryos.
The embryos are allowed to grow in the lab for 2 - 3 days following egg collection. The number of embryos placed into the uterus can greatly influence the success of the cycle, but also affect the risk of multiple births. The determination of how many embryos to transfer is made carefully and only after we have all the information available about embryo quality, quantity, etc. This means waiting until the day of the transfer to make our final decision about the number of embryos to place into the uterus. Typically, we will recommend transferring 2-3 embryos into the uterus.
The actual embryo transfer procedure is a gentle, painless process. A soft tube (outer catheter) is inserted by the physician to a pre-determined position in the uterus. A smaller tube (inner catheter) is then loaded with the embryos and guided into the uterus through the outer catheter. The embryos are then injected into the uterine cavity and the catheter set removed.
Success resulting in Pregnancy
In successful cycles, the hormonal supplements are continued through the first trimester (12 weeks) of the pregnancy. Once the first trimester is completed, the placenta has matured to the point where it will provide for all the hormonal needs of the pregnancy and no further supplements are required. We will monitor blood levels of estrogen and progesterone at the end of the first trimester and taper off the hormone supplements gradually. Once the hormone supplements are stopped, the rest of the pregnancy is indistinguishable from any other pregnancy!