1. What are the different types of surrogacy?
There are two types of surrogacy. Traditional and Gestational surrogacy.
Traditional surrogacy is when the surrogate is herself the egg donor, so that she is the genetic mother of the baby. In this case she can be directly impregnated with the sperm of the male partner by a process called Intrauterine insemination or will undergo the process of IVF and egg retrieval which will then be fertilized in the laboratory with the male partner's sperm.The embryos formed will then be transferred into her womb.
Gestational surrogacy is when the surrogate is only the "womb" donor and is genetically unrelated to the baby she carries.The egg comes from either the female partner of the infertile couple or from an egg donor. The process will have to essentially be an IVF technique.
As per the ICMR regulations, we can only offer Gestational Surrogacy in India.
2. What exactly does the surrogacy procedure involve? Please give overview of steps involved with time lines.
A surrogate will first be recruited. Recruitment is done by facilitating agencies, word of mouth, occasionally advertisements .These women should have had at least 1 full term delivery. We then screen them for infectious diseases, general well being, fitness for the procedure.
She also undergoes a hysteroscopy a procedure by which her uterus is visualized.
The above process can take about 1 month.
Her cycle is coordinated with that of the egg donor and she is then put on medications to develop her endometrial lining to be able to accept the embryos while the egg donor undergoes her ovarian stimulation cycle. After the egg pick up of the donor , she is put on hormones to support pregnancy. The embryo transfer is then generallyperformed on the third day. Occasionally the transfer is done on day 5.She continues to be on hormonal support thereafter. She is tested for pregnancy after 12 days.
3.How does a couple qualify for surrogacy?
As per the ICMR guidelines only women who cannot carry a pregnancy are allowed to opt for surrogacy. The tests required of the couple are the following:
Routine Semen analysis
Semen culture(SCABS) and antibiotic sensitivity
For the female partner:
The Baseline tests of the female partner are
The fertility profile include
Complete blood count
Fasting and PP blood sugar
Blood group and Rh typing
Routine urine analysis.
It is mandatory to test negative for infectious diseases screen to be accepted into the surrogacy program. The remaining tests are preferably undertaken prior to reaching Mumbai.
4. How many injections for Ovarian stimulation does one need to take for the cycle?
Generally a woman needs to take Fertility injections for 10-11 days and the egg pick up happens on day 13 of the cycle.
One should plan to be in Mumbai for a period of 15 days from the first day of the periods.
5. On what day is the embryo transfer done?
The embryo transfer is generally done on day 3.
Occasionally day 5 Blastocyst may be transferred if that is what the intended parents want.
6. How do hysterectomized patients time their cycles?
BBT charting is needed when the egg donor is not menstruating. ( even in case of women born without uterus) The temperature charting is done to time her ovulation which is needed both to time her baseline blood tests and her ovarian stimulation cycle.
In case a person cannot chart her Basal body temperature or if the same does not show a pattern, we put her on Combined oral contraceptive pills and start the ovarian stimulation 4-5 days after the cessation of the pills.
7. How many Embryos do you transfer? How do you manage multiple pregnancy?
We transfer up to 3- 5 embryos at an attempt. We have an 18% rate of multiple pregnancy. Any pregnancy which are of an order higher order than twins are subjected to embryo reduction. The highest order of pregnancy carried by the surrogate is twins
8. How is a surrogate followed up during her pregnancy?
The surrogate is registered at a well equipped tertiary care hospital .They are monitored once every fortnight. A clinical update of the same is sent to the intended parents over the email.They are subjected to ultrasounds once in 4-6 weeks. The 11 weeks scan is an anomaly scan along with which she undergoes a double marker test which helps to rule out risk of Down’s syndrome.
A triple marker test is done at 18 – 20 weeks of pregnancy and a second trimester anomaly is done at 18- 20 weeks .This is recorded on a CD and sent to the intended parents.
Amniocentesis is not routinely performed.
The intended parents are expected to reach Mumbai, by 38 weeks of pregnancy so that they can be present for the delivery. There is a nanny service available for those who wish for such services.
9.can we have more than 1 surrogate?
No, it is not possible for you to have more than 1 surrogate at any attempt.
10.Do you perform amniocentesis routinely?
We do not perform amniocentesis routinely on our surrogates. If there is a reason to do so, like an abnormal triple marker test, abnormal ultrasound, then we do the amniocentesis.
11.When can we know the gender of the baby?
We do not disclose the gender of the baby prior to the birth of the baby. We do not perform PGD for sex selection either.
12.Can we terminate the pregnancy if there is any malformation in the baby?
The pregnancy will be terminated in the event there is an anomaly found in the baby. The intended parents will be informed before any such decisions are taken. All terminations have to be done prior to 20 weeks of gestation as per Indian laws.
13.Do you have cryopreservation facilites?
We can cryopreserve both embryos and sperm samples at our facility. Men who cannot accompany their wives at each attempt can freeze their semen samples with us to be used at later dates. Success rates with frozen semen sample is almost the same as with fresh semen sample.
Embryos can also be cryopreserved at our facility. This decision is taken after embryo transfer if there are sufficient good grade embryos left over.