Surrogacy can seem complex and confusing at first glance, but if and when you decide to work with Surrogate Parenting Services, you’ll learn a great deal more about the gestational surrogacy process, and the range of medical information available. In the meantime, however, here are just a few “up front” items that you should be aware of, if you’re not already. With any particular medical aspect of the surrogacy process, it should be understood that there is no such thing as a 100% “typical” case, and you should always expect the unexpected.
This particular article is written with a gestational carrier in mind, meaning that the surrogate mother’s eggs are not used, but instead come from either the intended mother or a third-party egg donor. These are the typical stages in a surrogacy, and, again, it’s important to remember that every journey is different and these steps are only a representative example.
Once the surrogate mother has been matched with her intended parents, she will undergo a full medical examination with a fertility doctor. At the fertility center, the surrogate will most likely be asked to have a vaginal ultrasound called a sonohysterogram, which allows the physician to examine her uterus. This will allow the doctor to evaluate the capability of her uterus to carry a pregnancy to term. If the doctor finds cysts, fibroids or endometriosis in her uterus, the process with that particular surrogate may be delayed or cancelled.
In rare cases, she may also be asked to have a hysteroscopy — in which a tiny camera painlessly examines her uterus — or other procedure to determine the general health of her uterus. Routine blood tests will be given to evaluate hormone levels and rule out the presence of infectious diseases, such as AIDS, herpes, and hepatitis. She will also be asked to provide an up-to-date pap smear, and might be requested to have a mammogram done.
The Gestational Surrogate’s Preparation
After all of the results have been assessed and they have met the required standards, the In Vitro Fertilization process can begin. The gestational surrogate mother and intended parent will consult with a fertility doctor, who will guide them through this process.
The intended mother and the gestational surrogate will receive medications – some oral, some injected – that will synchronize their menstrual cycles, stimulate the intended mother’s eggs and prepare the surrogate’s uterine lining to receive the embryos. These medications may include standard birth control pills. The surrogate will then be given estrogen at about the time the intended mother or the egg donor is being induced to ovulate if the embryo transfer cycle is a coordinated or “fresh,” one.
In Vitro Fertilization or IVF
Just before the intended mother’s eggs are harvested, the gestational surrogate will take the hormone progesterone to further prepare for implantation, and will continue to take hormones (usually by injection) even if the embryo has already been created and are frozen for future use by the intended parents.
The eggs are conveyed from the intended mother in a procedure called ‘egg retrieval.’ She’s usually sedated for about an hour while the eggs are harvested via aspiration guided by ultrasound. Then the eggs are taken to an embryologist, who combines them with 50,000 to 1,000,000 of the intended father’s sperm and are left to incubate in a laboratory for three to five days.
Fertilization occurs, and when the timing is right, the resulting embryos are transferred into the uterus of the gestational surrogate by using a very fine catheter. The procedure is not considered painful, and the surrogate is fully awake for the entire time. Medications that the surrogate has taken will cause the lining of her uterus to thicken, in order to accept the transferred embryos. The doctor will use ultrasound to help with placement of embryos, and afterward the surrogate will be instructed to remain lying-down for a period of time.
After the Transferring of the Embryos
The surrogate mother may be advised to rest for approximately 24-72 hours following the embryo transfer, in order to ensure the best opportunity for the embryos to implant in her uterine lining. Ten days after the embryos have been transferred, the gestational surrogate will have a simple blood test to determine whether pregnancy has been achieved. If the test is positive, the surrogate will be advised about what further medication or hormone support she’ll need – usually estrogen and progesterone. Blood tests will be done on a regular basis to monitor the fetus’ development.
Once the fertility doctor considers the pregnancy stable – usually after 12 weeks – the surrogate will be referred to her preferred obstetrician for monitoring for the remainder of the pregnancy and the birth. She’ll undergo regular hormone monitoring and ultrasounds during the surrogacy process to check on the status of the pregnancy and the intended parents’ baby.
If you would like to learn more about the surrogacy process or if you would like to become a surrogate, please call Surrogate Parenting Services at (949) 363-9525.