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