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Overview

Surrogacy is an arrangement, often supported by a legal agreement, whereby a woman agrees to delivery/labour for another person or people, who will become the child’s parent(s) after birth. People may seek a surrogacy arrangement when pregnancy is medically impossible, when pregnancy risks are dangerous for the intended mother, or when a single man or a male couple wishes to have a child. Surrogacy is considered one of many assisted reproductive technologies.

Surrogacy Procedure

Surrogacy may be either traditional or gestational, which are differentiated by the genetic origin of the egg. Gestational surrogacy tends to be more common than traditional surrogacy and is considered less legally complex.

Traditional surrogacy

A traditional surrogacy (also known as partial, natural, or straight surrogacy) is one where the surrogate’s egg is fertilised by the intended father’s or a donor’s sperm.

Insemination of the surrogate can be either through sex (natural insemination) or artificial insemination. Using the sperm of the donor results in a child who is not genetically related to the intended parent(s). If the intended father’s sperm is used in the insemination, the resulting child is genetically related to both the intended father and the surrogate.

In some cases, insemination may be performed privately by the parties without the intervention of a doctor or physician. In some jurisdictions, the intended parents using donor sperm need to go through an adoption process to have legal parental rights to the resulting child. Many fertility centres that provide for surrogacy assist the parties through the legal process.

Gestational surrogacy

Gestational surrogacy (also known as host or full surrogacy) was first achieved in April 1986. It takes place when an embryo created by in vitro fertilization (IVF) technology is implanted in a surrogate, sometimes called a gestational carrier. Gestational surrogacy has several forms, and in each form, the resulting child is genetically unrelated to the surrogate.

Risk

The embryo implanted in gestational surrogacy faces the same risks as anyone using IVF would. Preimplantation risks of the embryo include unintentional epigenetic effects, influence of media which the embryo is cultured on, and undesirable consequences of invasive manipulation of the embryo. Often, multiple embryos are transferred to increase the chance of implantation, and if multiple gestations occur, both the surrogate and the embryos face higher risks of complications.

Gestational surrogates have a smaller chance of having hypertensive disorder during pregnancy compared to mothers pregnant by oocyte donation. This is possibly because gestational carriers tend to be healthier and more fertile than women who use oocyte donation. Gestational carriers also have low rates of placenta previa / placental abruptions (1.1-7.9%).

Children born through singleton IVF surrogacy have been shown to have no physical or mental abnormalities compared to those children born through natural conception. However, children born through multiple gestation in gestational carriers often result in preterm labor and delivery, resulting in prematurity and physical and/or mental anomalies.

FAQ’s

The procedure is not painful as it is done under light sedation, but may cause mild discomfort. At our clinic, we use mild anesthesia administered through an IV route which relieves discomfort.

IVF is likely to be recommended for the following fertility problems:
1. If you have blocked or damaged fallopian tubes
2. If your partner has male infertility issues like Oligozoospermia, Teratozoospermia or Athenozoospermia.
3. If you have premature ovarian failure
4. If you have been trying to conceive for at least two years and a cause hasn’t been found to explain why you have not become pregnant.

1. Women with a tubal problem
2. Women with unexplained fertility
3. Women with severe endometriosis
4. Couples with male factor infertility

Before treatment start, you will discussmedical history and the treatment processincluding risk and side effects kith your doctor.
1. Stimulation- After your baseline scans, injections will stimulate your ovaries to develop multiple eggs
2. Monitoring- Regular scans and blood test allow us to monitor your ovanan response to the drug
3. Trigger injections- When hormones are at the right levels another injection will trigger the eggs to mature
4. Egg collection and sperm collection- Eggs are collected via a needle passed through the vagina whilst you are under sedation. A semen sample is required on the day of egg collection
5. Fertilization and embryo development- Eggs and sperm are placed P an incubator to fertilize. Embryo development is monitored by CRGH embryologist
6. Embryo transfer- The best ennbryo(s) 6 /are transferred back into the uterus. Any suitable embryo not transferred can be frozen for Later use
7. Pregnancy test- Patient takes a pregnancy test 16 days after embryo transfer. At this stage we will arrange appropriate support.

So the point is that the IVF success rate could vary based on the denominator used to calculate the IVF cycle outcome. Its always preferable to always define the success rate using all the available denominators and discuss every one of them with the couple. The couple should be able to understand the sucess chances for their particular condition. There are even more denominators like age, number of embryos transfered, frozen or fresh emebto transfer, ICSI, PGD / PGS tested embryos etc. This further gets complicated when each ivf clinic or ivf doctor in the center wants to boos their success rates to showcase themselves in this highly competitive era.