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Meeting with the surrogate

Posted by on Sep.27, 2016

We usually advise you to meet the surrogate once the pregnancy test is positive. We always respect your wishes on choice of your surrogate for e.g., being vegetarian. We however do not encourage you to select the surrogate based on her physical characteristics. The surrogate’s physical attributes has no impact on the child’s features. The center would like to choose the surrogate on her overall health and the thickness of her endometrial lining (Endometrium).
Once positive you are free to meet the surrogate. We advise you to meet the surrogate at the center itself. You can also be present at the time of the ultrasound scanning. All her reports and progress will be regularly communicated to your through emails. You can also schedule a visit with our Medical Director, Dr Kaberi Banerjee, at the center to know about her progress. Our aim is to help you go through this journey in a transparent and pleasant way.

Schedule A Meeting With Surrogate

On most occasions surrogacy is done with the intended parents own eggs and sperm. This usually happens when the lady does not have a uterus (genetic or surgical removal) or has a defective uterus (septum, bicornuate, arcuate, or due to infection like Tuberculosis).   Another reason we use surrogacy is when the couple has had numerous failed IVF cycles.
The intended parents first decide to proceed with self-cycle surrogacy at our centre, they sign the contract and the tentative dates are decided. The lady is put on pills to be able to synchronize with the surrogate’s menstrual cycles. The surrogate is also prepared to build the endometrium.  Once the intended parent (lady) periods start, hormones are injected to make multiple eggs. This usually goes on for 10-12 days. The lady needs to stay in the city for minimum of 7 days provided she takes a few of these injections at home. All this is discussed and explained to the couple beforehand. There is regular communication through e-mail and telephone.
The eggs are retrieved under anesthesia, they are fertilized with the husband’s sperm, it is to be noted here that if time does not permit the husband may leave his semen sample in his earlier visits and the same can be frozen.
After fertilization of the eggs and sperm, the embryos take 2-3 days to develop. We are doing both cleavage and blastocyst transfer depending on the total no. of eggs retrieved, no. of grade A embryos formed and previous history. The embryos are then transferred into the surrogate under the ultrasound guidance. The decision regarding the no. of embryos depends on the age of the intended lady and previous treatment history. We usually transfer 2-3 cleavage stage embryos or 1-2 Blastocysts.
Following embryo transfer the surrogate is given hormonal supplements like estrogen and progesterone. She is asked to take rest and the pregnancy test is done 2 weeks later. Both her co-ordinator and the centre co-ordinator pay regular visit to ensure that the instructions are being followed.

Selection of surrogate, preparation of surrogate and after care of surrogate.

Selection:

The surrogate is selected as per the ICMR guidelines. A surrogate mother should not be over 45 years of age. Before accepting a woman as a possible surrogate for a particular couple’s child, the ART clinic must ensure (and put on record) that the woman satisfies all the testable criteria to go through a successful full-term pregnancy.

A relative, a known person, as well as a person unknown to the couple may act as a surrogate mother for the couple. In the case of a relative acting as a surrogate, the relative should belong to the same generation as the women desiring the surrogate.

The lady first indicates her willingness to become a surrogate mother. It is ensured that she understands the entire process and her involvement and responsibilities that are associated with it. She is then medically tested blood test like – Haemoglobin, TSH, Rubella, Prolactin and the viral markers like HIV, HCV, HBsAg and VDRL are carried out. The husband is also interviewed to ensure that he understands the process and is willing to co-operate with his wife. His viral markers are also tested. The surrogates’ co-ordinator and centre co-ordinator are involved in this process.

A mid cycle scan to check the endometrial thickness is carried out to ensure that she is a fit candidate for surrogacy. Our criteria for selection of the surrogate is that the mid cycle endometrial thickness should be more than 10mm and triple layer. Once selected the contract is explained to her and her husband. They are asked to sign it along with the intended parents.

Preparation: –

The preparation starts from day 21 of the previous cycle in which the surrogacy is planned. It is popularly called the Lupride + Progynova protocol (Estradiol Valerate). Inj Luprolide acetate 0.5-0.6 mg is started from day 21. She is asked to take it daily till she gets her period. This injection is quite painless and is like the daily insulin injections which the diabetic patients take. It is given to ensure that the hormones are down regulated and the surrogate can be synchronized with the intended parent (ladies ‘) menstrual cycle. It also gives a wider window of implantation.

Once the periods start, a scan is done to ensure that she is adequately down regulated (no cyst and thin endometrium). The leuprolide injection is halved and oral estrogens, usually in a dose of 6mg daily is started. This goes on for about 2 weeks. Once the endometrium reaches 10 mm vaginal progesterone is started to prepare a receptive endometrium. Embryo transfer is done under USG guidance, usually 2-3 days after egg collection.

Post Procedure: –

We don’t believe in the policy of keeping the surrogates in surrogate homes. We firmly believe that surrogates will do better if they are kept in their own homes with their families and children.

Following et the surrogate is given hormonal supplements like estrogen and progesterone. She is asked to bed rest and the preg test is advised 2 weeks later. Both her co-ordinator and the centre co-ordinator pay regular visit to ensure that the instruction are being followed.

Our director Dr. Kaberi Banerjee takes personal care of the surrogates. They are asked to visit the centre every 2-4 weeks for there ante-natal check ups. They are provided iron calcium supplements and tetanus inj. Monthly stipend is provided for healthy nourishment. Guidance on eating healthy and maintaining hygiene is given. USG are done regularly to note the growth of the baby and its weight. If at any point it is felt that the growth is sub optimal or there are any complications the surrogate is admitted in hospital.

We are proud that all our intended parents and surrogates complete this journey in a pleasant environment and with utmost satisfaction.

Assisted Reproductive Technologies (ART)

Assisted Reproductive Technology (ART) is evolving at great pace, breaking new grounds and providing couples with number of treatment options. The reproductive technology not only refers to IVF but also to several variations tailored to patients’ unique conditions. These procedures are usually paired with more conventional therapies, such as fertility drugs, to increase success rates. If your initial treatment do not bring results, we can provide latest assisted reproductive technologies and techniques. Various treatment options may include:

  • In vitro fertilization (IVF)
  • Advanced male infertility techniques, including intracyctoplasmic sperm injection (ICSI), sperm aspiration, and testicular tissue sperm extraction
  • Embryo cryopreservation
  • Frozen embryo transfers
  • Egg donor and gestational carrier programs

An Overview
In simple words infertility is defined as the inability to conceive. And this is the reason, it requires thorough diagnosis of both the partners. Once, this malady is diagnosed, there is every possibility that it could be treated successfully.

However, there are other factors as well like age, general health etc., that may affect the success of treatment.

At the same time, with technological advancements in the field of surgery and/or assisted reproductive technologies (ART), such as in vitro fertilization (IVF), majority of infertility cases can be treated successfully.

Infertility in women
The common cause of Infertility in women is disruption of ovulation symphony by disturbances in menstrual cycle. Instead of a regular cycle, the women suffering from infertility undergo irregular cycles. In the wake of this, menstrual history is considered to be the first instance of infertility, which one should seriously take care of and immediately consult the doctor.

The Menstrual Pattern is the simplest screening test to guide medical investigations.

Menstrual Patterns
The regular menstrual period: In this category, the periods are regular from month to month, beginning like clockwork every twenty-five days or every thirty-five days. The consistently irregular menstrual cycle, where one month you begin menstruating after twenty-five days, the next month after thirty-four, and the next in thirty, may indicate that you have fertility problem.
Irregular menstrual periods or Amenorrhea for six or more months: Irregular periods aren’t unusual, they affect about 30% of women in their reproductive years. The woman’s menstrual periods occur infrequently and at unpredictable intervals. Even in some of the cases, the menstruation at a period of time, may suddenly stop altogether.
Nonexistence of the menstrual period: If a women does not have menstruate even after the age of 16 years, which is considered to be the maximum limit to start menstruating, it is considered to be a serious condition. The cause of such conditions may include genetic abnormalities, congenitally deformed reproductive organs, delayed puberty, or a pituitary malfunction.
What is Ovulation?
Ovulation is the process in the menstrual cycle by which a mature ovarian follicle ruptures and discharges an ovum (also known as an oocyte, female gamete, or casually, an egg) that participates in reproduction. The entire process of ovulation is controlled by the hypothalamus of the brain and through the release of hormones secreted in the anterior lobe of the pituitary gland, Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH). A spike in the amount of FSH triggers ovulation and LH is released from the pituitary gland.
Causes of Infertility
There are various conditions that may cause infertility in the women. These conditions include the following:

Endometriosis:
It is a common medical condition in which the endometrial tissue, the tissue that normally lines the uterus, grows outside the uterus and attaches to other organs in the abdominal cavity such as the ovaries and fallopian tubes. Endometriosis is a progressive disease that tends to get worse over time and can reoccur after treatment.

The most common symptom of endometriosis is pelvic pain. The pain often correlates to the menstrual cycle, but a woman with endometriosis may also experience pain that doesn’t correlate to her cycle. The other symptoms include abnormal menstrual bleeding and pain during or after sexual intercourse. Endometriosis can also cause scar tissue and adhesions to develop, that can distort a woman’s internal anatomy.

A laparoscopy, an outpatient surgical procedure, is necessary to confirm a diagnosis of endometriosis after a medical history review and pelvic exam. After the diagnosis, our physician will classify your condition as stage 1 (minimal), stage 2 (mild), stage 3 (moderate) or stage 4 (extensive). Based on the stage of the Endometriosis, the physician may decide the best treatment plan.

Polycystic ovary syndrome (PCOS)
Polycystic ovary syndrome (PCOS) is the most common endocrine abnormality that affects six to ten percent of women, who are in the reproductive age group. PCOS is a leading cause of infertility and also affects the woman’s cardiovascular health. The causes of PCOS are unknown. Researchers believe that the causes of PCOS may be insulin resistance and an imbalance of female hormones (estrogens and progestins, those important for the menstrual cycle) contribute to the development of this condition.

The symptoms of the disorder include acne, difficulty becoming pregnant (infertility), irregular menstrual periods, obesity, skin discolorations and unwanted hair growth or loss.

New medical researches have revealed different methods of treatment including insulin-reducing ovulation medication (clomiphene, glucophage, metformin), dietary changes (low glycemic diet) and surgery (ovarian drilling). Women who undergo treatment for PCOS, but are still unable to conceive naturally, often turn to assisted reproductive technologies such as IVF.

Tubal diseases
One of the more common causes of infertility is – blocked or damaged fallopian tubes. The fallopian tubes are necessary for picking up the egg, released from the ovary. It is in the inside of the fallopian tube that natural fertilization occurs. Scar tissue resulting from endometriosis or abdominal or gynecological surgery, such as bowel surgery, cesarean section or a ruptured appendix, can block an egg from entering or traveling down the fallopian tube to meet the sperm, preventing fertilization.

Such condition may cause infections including chlamydia, can damage the cilia, the tiny hairs lining the fallopian tubes that help transport the egg, often preventing the sperm and egg from meeting. One result of damaged cilia is an ectopic pregnancy, which occurs when an egg is fertilized but, due to the damaged cilia, it is unable to travel to the uterus, growing instead in the wall of the fallopian tube. This condition can result in rupture, internal bleeding and further tubal damage.

The physician reviews the complete history and does a complete pelvic exam to diagnose the tubal disorder. For the confirmatory diagnosis, additional tests such as hysterosalpingogram and laparoscopy are required and the exact course of treatment is decided on the basis of the condition.

Unexplained
In about one –third of the couples despite an extensive battery of tests, we are unable to find the cause. These couples are termed to be suffering from ‘unexplained ‘ infertility. Perhaps there is a problem with sperm –egg interaction. These couples may benefit from superovulation and IUI or IVF.

Infertility in men
In men, infertility generally is caused by a lack of sperm in the semen (azoospermia), deformed or structurally abnormal sperm, sperm that lack the ability to reach and fertilize a female egg (immotile sperm). Genetic, infection, testicular trauma, hormonal imbalance or exposure to radiation and certain medications are all causes of sperm production disorders.

Infertility normally occurs when there is a low sperm count, or problems with the motility (movement) or morphology (appearance or shape) of the sperm. Sperms that have poor motility, are often not able to reach the egg and therefore, fertilization does not occur. Abnormal sperms are sometimes unable to penetrate and fertilize the egg. Sperm DNA damage may interfere with conception as well as lead to a greater risk of miscarriage.

Any structural or anatomical problem that may block the path of sperm can cause infertility, by preventing fertilization to occur. Infertility related to structural and anatomical problems in the male anatomy may be caused by scar tissue, varicose veins or infection or, in some cases, the problems exist from birth.

In few cases, the immune system of the men develop antibodies that may attack the sperm and destroy their ability to fertilize the egg. Antibodies bind to specific parts of the sperm, such as the head or tail and, depending on the site of attachment and interfere with the movement of the sperm.

Gynaecological Surgery

We have a panel of expert surgeons, who have years of experience in this field and have successfully

performed a number of Gynaecological surgeries & Laparoscopy surgeries. However, we do not go for

gynaecological surgery and laparoscopy surgery in the first instance, prioritize treatment on sheer merit

and go for surgery only when indicated and necessary.

This is good method of diagnosis as no other investigative tool (ultrasound, hysterosalpingogram) gives a

clearer view than this endoscopic method. These endoscopic techniques can be used to correct underlying

disorders that can hamper the possibility of a pregnancy, like, ovarian cyst, endometriosis, adhesions

(scar tissue) in the abdomen hampering tubal function, uterine fibroid, polyp or scar tissue. For more

detail visit on www.surrogacyservices.net or Free consultation call us on:+(91) – 9871250235.

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