Surrogacy

Surrogacy & IVF

• 1. The Surrogacy process

  Upon deciding to go the surrogacy route, the welfare of the potential child becomes paramount. The genetic couple must undergo an extensive investigation. This is coupled with examination of the couple and psychological assessment to determine if they will make suitable and stable parents.

  Once the genetic couple is established as suitable for the surrogacy process, they are given guidance on the selection of a surrogate. The couple may opt to select a surrogate who is known to them i.e. A Relative or Friend.

  Alternatively, a suitable host can be found for them by the Clinic or through Infertility or Surrogacy support groups.

  Once the host has been identified, she is interviewed together with her partner (if she is in a relationship). During this time, a thorough explanation of the surrogacy process and what will be required of them, is given.

  Following the initial individual assessment of the genetic couple and the host surrogate, a full psychological assessment is then carried out on them together. The detailed reports of the many psychological assessments involved are then submitted to the high court in order for the surrogacy application to be improved.

  The surrogacy application is drawn up by the clinic’s team who are skilled in the lodging and processing of surrogacy applications and agreements. The legal team ensure that the agreement drawn up is based on trust and transparency. The agreement should ensure that no party is taken advantage of or exploited. Once all parties are satisfied with the terms stipulated in the legal agreement, it may be submitted to the high court for approval. Judgement from the high court is expected after 3-4 weeks of the application being submitted. Once approval is granted, the agreement is valid for 18 months.

• 2. Counselling

  The role of counselling in the surrogacy process is imperative and serves to prepare all parties involved. The patients are made aware of all the factors involved and the impact these factors may have on their future lives. It is of utmost importance that all the parties involved are confident and comfortable with their decisions.

  During counselling, numerous points are discussed with the involved parties. The genetic couple is specifically made aware of all of them.

  The host is counselled to ensure cognisance is taken of the following:
  1. The full implications of what is required when undergoing treatment by IVF       surrogacy.
  2. Risk of multiple pregnancies resulting.
  3. The possibility of family or friends disagreeing with such treatments
  4. The need to abstain from unprotected sexual intercourse, before and during       the process.
  5. Normal medical risks associated with pregnancy and the modes of delivery.
  6. The risk of smoking or consuming alcohol, to the unborn child.
  7. The feeling of guilt if the treatment does not work or if there is a miscarriage.
  8. Feelings of a sense of bereavement when the child is given to the genetic             parents.
  9. Feelings of neglect after the baby is taken away.

  Counselling equips all parties with adequate knowledge and support throughout the process. It is advised that the genetic couple and host are open and transparent about the treatment as it is healthier to disclose this to the potential child rather than try to cover it up.

  Once the involved parties have successfully undergone counselling and understood what surrogacy entails, they may proceed to treatment.

• 3. Treatment

  Genetic Couple

  • A complete history is taken and coupled with a full examination of the patients.
  • Investigation by way of a hysteroscopy and laparoscopy is conducted to ascertain that there is no uterus but ovaries are present.
  • Hormone Profile Studies are necessary to ascertain adequate ovarian reserves.
  • Several ultrasound scans are done for ovarian activity.
  • Blood Grouping.
  • Full STD screen
  • For HIV patients: Patients must be treated with ARV’s and viral load must be zero in the case of the female. In the case of the male, a PCR wash followed by freezing must be executed. The husband is required to do short term sperm freezing. The sample must be quarantined for 6 months prior to the use of the gametes as per sperm donor protocol.

  Female patients without a uterus will still feel premenstrual symptoms during ovulation. Treatment is administered through long protocol GNRH for down regulation. This is followed by follicle stimulation with gonadotropins.

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  Egg Retrieval and Fertilisation
  The genetic mother is put under conscious sedation for a period of 15-20 minutes. During this time, Egg Retrieval is carried out through Vaginal Ultrasound. Once the eggs have been retrieved, a semen sample from the genetic father is obtained and used to fertilise the eggs 4-6 hours after egg collection. The following day, the embryos will be analysed. Only zygotes with 2 pronuclei are considered normal and will be monitored further. As the embryos develop, they may either be transferred on Day 5 or frozen depending on the individual situation.

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  Host Mother

  • The host mother must be younger than 38 years old and should ideally have at least 1 child.
  • The host must undergo a hysteroscopy and examination.
  • A full medical and psychological assessment is done.
  • It is preferable that the host is in a stable marriage, in which case the husband must be made aware of the ramifications.
  • The host and her partner must undergo a full STD screen.
  • Blood grouping

  The host mother will undergo a pilot run as seen below

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  Embryo Transfer
  There are two methods of egg transfer:

  • Natural Cycle: This is suitable for women who have a regular cycle.
  • Prepared Cycle: This is a hormone controlled cycle which is suitable for woman with irregular cycles.

• 4. Conclusion

  Generally, IVF Surrogacy works very well if all the participants involved are thoroughly screened on a physical, psychological and socio-medical level. There can be some minor variations, but the outcome is mostly rewarding. Often the couple choose to have more babies together and maintain a long professional relationship. Thereafter, eggs are collected under conscious sedation. This takes 15 – 30 minutes with. The eggs are fertilized with the genetic father’s sperm and transferred around 5-6 days later. The embryos are transferred into the host surrogate. This takes 5-10 minutes and can be done in a prepared cycle or a natural cycle. The surrogate is given Luteal Support (Hormone Support) for 12- 14 days. A pregnancy test is executed 12-14 days after Egg Transfer. On the day the baby is delivered, the genetic mother can start rooming with her baby. The surrogate is discharged on the 3rd or 4th day after the delivery. The surrogate is seen 6 weeks later for a follow up consultation.

• Who is eligible for surrogacy?

  • Patients without a uterus but functioning ovaries
  • Woman who have had a hysterectomy due to cancer
  • Woman who have had a hysterectomy due to severe haemorrhage or rupture of the uterus.
  • Patients who have suffered repeated miscarriages, even with repeated IVF
  • Patients suffering from medical conditions which are life threatening or prohibit pregnancy