Surrogacy is sometimes viewed as an alternative to adopting a child if the intended mother is unable to conceive or carry a pregnancy in her uterus. It allows a couple to have a genetically linked child.
The most common reasons for surrogacy are the intended mother’s previous hysterectomy, congenital uterine malformations and medical conditions making being pregnant too risky for the intended mother.
There are two types of surrogate pregnancies. In traditional surrogacy, the surrogate is artificially inseminated with semen from the intended father. The surrogate provides both the egg(s) and carries the pregnancy for the intended parents. The baby is genetically linked only to the intended father and not the intended mother. The insemination is typically a simple, inexpensive procedure not requiring an infertility specialist.
In gestational surrogacy, the intended mother provides the egg(s), the intended father provides the sperm and in vitro fertilization is done to create their embryos. The embryos are then transferred into the surrogate’s uterus. The resulting baby is genetically unrelated to the surrogate.
At NOVA IVF, we are very concerned with the well-being of the developing baby in the surrogate’s body. A mature, emotionally stable surrogate carefully pre-screened by a surrogate agency can also be an excellent choice. There are some surrogates who may be medically better suited for a surrogate cycle, we have recommendations in selecting a surrogate.
Finding a surrogate is the first step in initiating the gestational surrogacy treatment. She can be a relative, a friend, or you may use one of the many surrogacy agencies nationwide. These agencies have a number of pre-selected surrogates. The above document lists surrogacy agencies NOVA IVF has been working most closely with. Your surrogate does not have to live locally or even in this country.
Family gender balancing/pre-implantation genetic diagnosis (PGD) can be added to the gestational surrogacy treatment.
Gestational Surrogacy Process
The gestational surrogacy procedure is similar to in vitro fertilization: after the intended mother’s ovaries have been stimulated, the eggs are aspirated, inseminated with sperm from the intended father, incubated and one or more of the resulting embryos are subsequently transferred into the surrogate’s uterus.
Below is an example of a gestational surrogacy treatment sequence. Actual treatment is individualized. All medications are given as pills, skin patches, vaginal capsules or small injections just under the skin. All stages of this treatment take place in our clinic.
1. Ovarian Stimulation of the Intended Mother
To maximize the probability of a live birth, we use FSH (follicle stimulating hormone) to stimulate production of as many high quality eggs as possible (usually 6-14 eggs). These hormones are administered as shallow, subcutaneous injections.
During the 7 to 12 day ovarian stimulation, two to four ultrasound examinations and blood estrogen determinations are used to follow the development of the eggs. When the eggs are ready for retrieval, you will take another subcutaneous trigger injection. This injection completes the maturation process of the eggs.
The ultrasound image on the left shows fully stimulated ovaries. Each of the follicles (15 to 25 millimeters in diameter) contains a microscopic egg.
2. Egg Retrieval
Thirty-six hours after the trigger injection, a non-surgical oocyte retrieval is done in our center. This is typically a 3-7 minute procedure. Using ultrasound guidance, a thin aspirating needle is passed through the top of the vagina into the follicles. Only the tip of the aspirating needle enters the pelvic area. Since the ovaries are located just above the top of the vagina, the tip of the needle is passed into the follicles without penetrating the uterus, cervix or the Fallopian tubes.
The intended father collects a semen sample by masturbation either at home or at our office and the highest quality sperm are added to the eggs several hours after the egg retrieval.
If your infertility history suggests the possibility of a male factor significant enough to keep the eggs from being fertilized using regular laboratory methods, the ICSI procedure will be recommended. ICSI or Intracytoplasmic Sperm Injection, is a micromanipulation technique in which a single sperm is inserted directly into an egg.
The next day, NOVA’s embryologist will examine the eggs for signs of fertilization. A normally fertilized egg (zygote) will show two pronuclei representing the genetic material from the egg and sperm (image at left).
4. Embryo Transfer
One to five days after the egg retrieval, the resulting embryo(s) are transferred into the surrogate’s uterus by passing a thin embryo transfer catheter through the cervix to the top of the uterus. This procedure is always done under ultrasound guidance. This dramatically increases the chance of the embryo(s) implanting and causing a pregnancy. Sometimes the ultrasound will be transabdominal and other times it is better to be transvaginal, regardless of the method, embryos are never “blindly” placed into the uterus.
Extra embryos that are not transferred at this time can be cryopreserved and stored in liquid nitrogen.
5. Establishment of Pregnancy
A blood pregnancy test is scheduled approximately two weeks after the embryo transfer. A fetal heartbeat ultrasound is done two weeks after a positive pregnancy test.
Estrogen and progesterone supplementation of the pregnancy continues for 6 to 8 weeks. By that time, the placenta produces enough of its own estrogen and progesterone so that the supplementation can stop. The following day, embryos reach 4 cells, the day after, 8 cells and by day 5 after egg retrieval, they should reach the blastocyst stage.
This ultrasound picture shows a six week pregnancy. The pregnancy sac is approximately an inch in diameter. The baby inside the sac is about 0.5 inch long, yet it is possible to already distinguish the head and the “tail” portion of the baby’s body.