Important things to know about IVF and Gestational Surrogacy
The world of fertility and gestational surrogacy can be perplexing to many. There is more talk of gestational surrogacy in the last few years with many celebrities using a gestational surrogate to carry their child for them, which is opening up the world to being more aware of gestational surrogacy as a whole. With that said, even with more awareness, many don’t understand how the actual IVF and surrogacy process works. Often times, even when a potential surrogate comes to us who would love to help create or grow a family, she doesn’t yet understand how the full process works and what all goes into the process. That is where we come in as the agency - to help educate and bring understanding to the process!
IVF
IVF is the process that is used in gestational surrogacy to create embryos. Prior to matching the intended mother, or an egg donor, undergoes an egg retrieval which is a process where she will take medications to stimulate the ovaries. The reproductive endocrinologist then removes the eggs from the follicles and collects them to be fertilized by the intended father’s, or donors, sperm. Once fertilized in the laboratory the embryos grow for several days and are monitored during this time. Once the embryos have reached the appropriate point (typically day 5) they are frequently biopsied so they can be tested and then frozen (the biopsy is optional on the intended parents’ part). The second part of the IVF process is known as the frozen embryo transfer. The surrogate starts hormones to prepare her body to accept the embryo, but there are a number of steps that must be taken first.
Medication
The supplemental hormones that were mentioned above that are required for the gestational surrogate to take to prepare her body for the frozen embryo transfer are where we get the most questions. Yes, you most likely will have to inject yourself with hormones to prepare your body. It’s not as bad as it sounds depending on your comfortability with needles. Most commonly we hear from gestational surrogates “It was way easier than I thought it was going to be” when recalling the injections themselves. There are different medication protocols with each specific clinic, but in general a gestational surrogate is required to take a form of estrogen, (sometimes pill form in addition to a subdermal patch, sometimes estrogen injections), progesterone (usually in the form of injection and it is called PIO which stands for progesterone in oil, but they may also require vaginal progesterone suppositories). Some clinics also require a down regulation protocol, which can include using an injection called Lupron in the luteal phase of the cycle and that suppresses the ovaries to reduce the risk of ovulation during the frozen embryo transfer cycle.
Screening
There is an extensive screening process for a gestational surrogate. It is not easy to be a surrogate and for good reason! There is a long application that must be completed, all OB, maternity, and labor and delivery records must be collected and reviewed for the gestational surrogate. The surrogate has to have an OB clearance letter, have a clear recent pap smear, and meet with an MFM (Maternal Fetal Medicine) doctor to assess any risks moving forward. The gestational surrogate and her partner are interviewed, a background check is completed on anyone in the household over the age of 18, also a financial background check is done on the potential surrogate. Lastly, there is a full psychological evaluation for her and her partner. After matching with intended parents then she will have to go through an in person physical screening with the clinic the intended parents are using. Depending on the clinic that will include a height and weight check, urine sample and bloodwork for the surrogate and her partner, possibly another psychological evaluation, transvaginal ultrasound, sono-hysterogram to access the uterine cavity is suitable for pregnancy, and there may be even more testing depending on the clinic. After those results are received and the clinic gives medical clearance is when the gestational surrogate and intended parents are able to move forward to the legal process.
Legal
The gestational surrogacy agreement is a long document that includes all the terms regarding the surrogacy process and even includes after birth of the child. The gestational surrogate and the intended parents must be represented by separate legal counsel who are licensed in the state where the baby will be born. The attorneys will draft and review legal documents to make sure their client’s interests are protected and that is for both parties. Once the intended parents and gestational surrogate have agreed on terms then they and she (and her partner if she has one) will sign the contract in front of a notary to make it official.
Risks
Yes, there are risks to anyone considering surrogacy and the gestational surrogate should be aware of those potential risks. Worst case scenario would be serious medical complications, including death, even if they were extremely healthy before they became pregnant. Being a gestational surrogate is time consuming and can be very emotional. The emotions are all over. Usually a surrogate will feel such joy and pride to be able to help the intended parents to achieve their desire to have a child, but it also can be emotionally challenging at times for some. Surrogacy is not for everybody- hence the extensive screening process.
With that said, there can also be risks to the intended parent when using gestational surrogacy. An intended parent may find lack of control to be harder than they thought it would be during the pregnancy. The intended parents may also struggle if there is difficulty becoming pregnant with the gestational surrogate and it takes several transfers before there is a successful transfer. Each transfer can be costly so there are financial risks associated with gestational surrogacy as well. There is also no guarantee that the pregnancy will go to full term or that a healthy baby will be born from the journey. This is why there is usually a psychosocial consult required by the clinic to proceed in the journey to make certain all potential risks are discussed.
There is so much to learn about IVF and gestational surrogacy, and if you would like to learn more please schedule a consultation with us by clicking below!