Surrogacy

Many women have health issues that make it impossible for them to carry a pregnancy themselves.  Motherhood is still possible thanks to the generosity of women who are willing to carry a fetus for another person.

Fertility Specialists of Texas works with local and national surrogacy agencies to assist couples in the opportunity to become parents. The process is very similar to those used in donor egg cycles with embryo transfer into the recipient’s uterus. The woman producing the eggs undergoes an IVF cycle.  The eggs are fertilized and the subsequent embryos are cultured to day 5 or 6 and frozen.  The gestational carrier prepares her uterus for conception with estrogen and progesterone. On the day of transfer, the embryos with the highest pregnancy potential are placed in the uterine cavity of the gestational carrier. The number of embryos transferred depends on the age of the woman producing the eggs and the quality of the cultured embryos. 

https://www.fertstert.org/article/S0015-0282(17)30227-3/pdf

Starting the Process

We have established relationships with many of the country’s most highly regarded surrogacy agencies. The surrogacy agency conducts the initial recruitment and screening of potential surrogates, provides legal referrals and offers administrative assistance during the process. The physician then meets the surrogate and performs an extensive medical screening exam to confirm a candidate’s adequacy for surrogacy. The process of being a gestational surrogate or gestational carrier involves finding a woman who has:

  • had healthy pregnancies
  • would like to participate in the joy of helping another family have a child

Finding a Carrier

We do not underestimate the issues with finding a carrier and realize that women who need this help are in some ways forgotten in the infertile population. A woman who needs to use a gestational carrier often struggles with not only the emotional issues of being unable to carry her own child but also the additional financial burden and challenge of finding a woman who is willing to do this for her.

After passing both medical and psychological screenings, a gestational carrier is available to be matched. Once the agency has matched a couple or individual with a gestational carrier and all contracts have been signed, and legal agreement is in place, medical treatment begins. Prior to delivery of the child, the surrogacy attorney files a declaration with the State Courts defining that the legal parents are the biological or intended parents and not the gestational carrier.

Cycle Coordination

Throughout this overview, the couple contributing the eggs and sperm is referred to as “The Female” and “Male Partner” or collectively as “The Couple” and the woman receiving the fertilized eggs and carrying the pregnancy is referred to as “The Carrier.” A gestational carrier cycle requires a great deal of coordination, from selecting the carrier and matching her with a couple, to performing the related medical procedures. Before the cycle begins, we focus on educating the “The Couple” and the gestational carrier. Prior to beginning this process, you will have met your carrier. The more you know prior to starting this process, the more comfortable you will be because you will know what to expect.

Candidates for the Gestational Carrier Program are usually couples in which the Female Partner has no uterus due to surgery (hysterectomy), has an abnormally shaped (malformed) uterus, has had an endometrial ablation, or has a medical condition that prevents her from carrying a pregnancy. These women are usually good candidates for ovarian stimulation with fertility drugs. Egg donation may be recommended when the woman is not a good candidate for ovarian stimulation because of age or decreased egg quality.

FDA Requirements for using a Gestational Carrier

To comply with Federal Government regulations, Intended father/Sperm Donor will need to schedule a semen analysis with cryopreservation of sperm and FDA required labs, FDA required physical exam, and complete a risk assessment questionnaire.  It is a clinic requirement to cryopreserve sperm in all cases requiring FDA clearance.

The Intended Mother/Egg Donor has the same FDA requirements with FDA required labs, FDA required physical exam, and complete a risk assessment questionnaire.  Due to time requirements from egg retrieval, the FDA testing will be done in conjunction with the IVF, egg retrieval, cycle.

Ovulation Induction and Monitoring of the Female Partner

ART (Assisted Reproductive Technology) success rates depend upon the number of eggs or embryos available for transfer. Additionally, the egg retrieval must be carefully timed so as to retrieve mature eggs. To accomplish these 2 goals, ovulation induction medications and careful monitoring are employed.

The start of the ovarian stimulation is timed using oral contraceptive pills (OCP). The Female Partner takes OCP for 2-3 weeks prior to the beginning of the stimulation. The Female Partner begins injections of gonadotropins (Follistim, Gonal-F), according to a schedule that is provided by the clinic. We call this first day of gonadotropin administration Stimulation Day 1.

Once the follicles (containing the eggs) are deemed ready or mature, often after 10-12 days of medications, The Female Partner takes an injection of human chronic gonadotropin (hCG). This hormone replaces the woman’s normal LH surge and is necessary for the final maturation of the eggs so that the sperm can fertilize them.

Egg Retrieval

At Fertility Specialists of Texas, the egg retrieval is accomplished non-surgically using a vaginal ultrasound probe to guide a needle into the ovaries. The procedure is usually performed with IV sedation. An anesthesiologist administers the sedation to maximize comfort and safety.

Sperm Processing

To comply with Federal Government regulations, Intended father/Sperm Donor will need to schedule a semen analysis with cryopreservation of sperm and FDA required labs, FDA required physical exam, and complete a risk assessment questionnaire.  It is a clinic requirement to cryopreserve sperm in all cases requiring FDA clearance.  On the day of egg retrieval, the frozen sperm sample is thawed and prepared for IVF.

In Vitro Fertilization

In vitro fertilization (IVF) literally means “fertilization in glass”. Follicular fluid removed from the ovaries is examined in our lab for the presence of eggs. These eggs are isolated and placed in culture media where they are allowed to further mature. A few hours later, the eggs are fertilized using ICSI.  The embryos are then cultured to day 5 or 6 and frozen.  If genetic testing of the embryos is requested by the intended parents, a biopsy is performed just prior to freezing the embryos. Genetic testing results are usually available 5-7 business days following biopsy.

Building the Carrier’s Lining with Hormonal Injections

The Carrier will be placed on birth control pills in preparation of the embryo transfer. This allows her cycle to be placed “on hold” for completion of legal requirements prior to embryo transfer.  Then the carrier requires a medication called Lupron (GnRH agonist) to suppress ovulation, then begins hormone stimulation with estradiol to prepare her uterine lining for implantation of the transferred embryos.

Approximately 4 to 6 days before the embryo transfer, daily injections of progesterone begin in order to optimize the gestational carrier’s endometrium for implantation.

Embryo Transfer to the Carrier’s Uterus

At Fertility Specialists of Texas, all embryo transfers are performed under trans-abdominal ultrasound guidance. We have found that ultrasound-guided transfers are easier to perform and have resulted in higher pregnancy rates. The ultrasound allows for the accurate placement of the embryos approximately 1.5 centimeters from the top of the uterus. The embryos are transferred via a thin plastic tube called a catheter. The catheter is carefully guided into the upper part of the uterus where the embryos are placed. The transfer is a painless procedure and the patient remains resting for 30 minutes, after which she is sent home.

Post Embryo Transfer Management and Follow-up

To ensure an optimal environment for implantation, The Carrier continues the hormone injections of progesterone and estradiol during the post-embryo transfer phase. Ten days after The Gestational Carrier’s transfer a pregnancy test is performed. If the test is positive, the hormone injections continue until 12 weeks gestation, when the placenta is fully functional. A second pregnancy test is obtained approximately 2-4 days after the first to confirm that the pregnancy is ongoing. Confirmation of a clinical pregnancy, indicated by presence of fetal heartbeat, is made by ultrasound at approximately 7.5 weeks gestation.  Additional ultrasound monitoring is performed 1-2 weeks later to monitor fetal growth.  Once good interval growth is documented by ultrasound, the carrier is referred back to her obstetrician for continued pregnancy care.


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