This page is designed to better inform you on all of the aspects of the surrogacy process and the physical and psychological tests that accompany it.
The Surrogate Mother undergoes in vitro fertilization (IVF) and embryo transfer to become pregnant. The eggs used under a Gestational Surrogacy are not that of the Surrogate Mother. The sperm used is from the Intended Father or a sperm donor. The Surrogate Mother has no genetic relationship to the child born from a Gestational Surrogacy.
The tests that accompany Gestational Surrogacy include but are not limited to std testing, psychological evaluation, blood work to determine estrogen/progesterone levels, hysteroscopy, mock cycle, and mock transfer. The clinic used will prescribe fertility medication such as Lupron, Estrogen, progesterone, etc. We would be happy to explain the process in further detail and answer your questions.
The Surrogate Mother becomes pregnant through artificial insemination (AI)and/or home insemination. The eggs used during a Traditional Surrogacy are that of the Surrogate Mother. The Sperm is usually that of the Intended Father.
The tests that accompany Traditional Surrogacy when using a clinic include but are not limited to psychological evaluation, std testing, hysteroscopy, mock transfer, mock cycle, and blood work to determine estrogen /progesterone levels.
Gestational Surrogacy with an Egg Donor
The Surrogate Mother becomes pregnant through IFF/ET using eggs from a donor other than the Intended Mother. The Surrogate has no genetic relationship to the child born from a Gestational Surrogacy.
The tests that accompany Surrogacy with an Egg Donor include but are not limited to Hysteroscopy/HCG, STD Testing, Trial transfer, and Psychological testing.
After the Intended Parents contract with Simple Surrogacy, we provide Surrogate profiles to them based on their needs. They choose a Surrogate and that Surrogate will review their profile and decide if she would like to speak to them. Simple Surrogacy will arrange a phone conversation between all parties to make sure they are compatible. An in-person meeting can also be arranged if desired. We also conduct a background check on all parties. After the IP’s and Surrogate decide they would like to work together, we will contact legal representation on their behalf and guide them through drafting a contract between them. We will also open an escrow account on their behalf, and the IP’s will sign a escrow management agreement. After the contract is drafted, the money will be deposited into escrow and the medical process will begin.
After you are matched, you will undergo medical and psychological screening with the Intended Parents’ reproductive endocrinologist to determine that you are healthy and able to carry a pregnancy. Medical screening includes but is not limited to:
- Hysteroscopy/HCG — visualization of the uterine cavity thru a thin scope inserted through the cervix or dye introduced into the uterus and fallopian tubes to determine the shape and size of the uterus and whether or not the fallopian tubes are clear.
- Infectious Disease Testing to ensure that all parties are clear of transmittable disease such as AIDS, Herpes, Hepatitis, etc.
- Current pap smear and annual physical
- A mock cycle in which you are on all the same drugs you would be for a real transfer (except Lupron maybe), so they can check your uterine lining’s response to estrogen replacement.
- Trial transfer where they check the angle of the cervix and the length of the uterine cavity so they know how far to insert the catheter loaded with the embryos for exact placement.
- Psychological testing and evaluation by a psychologist familiar with surrogacy issues including MMPI2 test and a minimum one hour one-on-one session with the program psychologist exploring your motivations, attitudes and commitment to the surrogacy process.
Some of these tests will also be required of your partner/spouse where applicable.
When the screening process is complete, you will work with one of our agency recommended attorneys to put together your contract. Simple Surrogacy will help negotiate all fees on the contract and set up an escrow account for the Intended Parents (you will be paid your compensation and all other miscellaneous expenses from this account). After the contracts are signed, Simple Surrogacy will receive the escrow funds from the parents, and the Medical process will begin.
General Medical Process
Once the contracts are complete and testing has finished, the Surrogate and the Egg Donor (who can be the Intended Mother or a donor) synchronize their cycles. This is usually with birth control pills. About 14 days into the birth control pills, both Surrogate and Egg Donor will start Lupron. Lupron is a subcutaneous (just under the skin) injection to shut down the body’s normal hormone production used to control the cycle and ensure the Surrogate’s uterus is ready to receive the embryos at the exact time for the best chance of success.
The Surrogate is usually about a week or so ahead of the Egg Donor to ensure her uterus will be ready when the eggs are retrieved and fertilized, and because they can keep the SM in a holding pattern for up to 2 weeks once her uterine lining is at optimum.
When the menstrual cycle starts while on Lupron, the Lupron dose is usually decreased by half and the Surrogate will start adding Estrogen replacement to the mix (in the form of pills, patches, or shots depending on the doctor). Some doctors have you take other medications as well (Dexamethasone to suppress male hormones to increase implantation, antibiotics to guard against any infection that might have gone undiagnosed, etc.)
The Egg Donor starts on injectable fertility hormones on her cycle day 3 to stimulate her ovaries to produce several eggs as opposed to just 1 or 2. Fertility hormones continue anywhere from 7 to 12 days depending on the Egg Donor’s response to the hormones. The Egg Donor is checked about 3 times a week via ultrasound and blood tests to determine her response to the drugs.
Once the follicles are the right size (about 18-20mm) she is given an HCG shot which induces an LH surge which also matures the eggs. Thirty-six hours after the HCG shot the egg retrieval is performed. Up until this time, the date/time of the transfer is flexible.
The eggs retrieved are fertilized with sperm from either the Intended Father or a sperm donor and incubated for 2-5 days. Lupron usually stops the day before egg retrieval in the Surrogate. Progesterone replacement (most often in the form of intramuscular injections, but sometimes with suppositories or Crinone gel) starts the day of the retrieval and continues until the 12th week of pregnancy or a negative pregnancy test. Estrogen replacement also continues until the 12th week of pregnancy (when the placenta takes over hormone production). Because the Surrogate was on Lupron and had natural hormones were suppressed, The Surrogate will need to take external sources of these very important hormones in order to maintain any pregnancy that occurs.
When the fertilized embryos are at the proper stage, they are loaded into a special syringe with a thin flexible catheter at the end. The catheter is inserted thru the cervix into the uterine cavity (sometimes with the assistance of abdominal ultrasound to ensure EXACT placement of the embryos) where the embryos are “injected”. Most doctors will only transfer three to four 2-day old embryos or two 5-day embryos. Any unused embryos are frozen for a future attempt if a pregnancy doesn’t result from the fresh cycle. Bed rest of anywhere from 2 hours to 3 days is usually required immediately following embryo transfer.
A Quantitative HCG in which the amount of pregnancy hormone is measured is usually done 14 days post egg retrieval. At that time they are looking for the HCG level to be about 50 or better. Anything over 200 is usually indicative of a multiple pregnancy. The Surrogate will have a second quantitative HCG test two days later to verify that the pregnancy hormone numbers are going up (they should double about every 2 days). If the quantitative HCG is negative, all external hormones are discontinued and a menstrual cycle will usually start within 5 days.
If a pregnancy has occurred (Congratulations!), an ultrasound is usually done about 6-7 weeks to check for a heartbeat and again around 12 weeks before being released to a regular OB/GYN. Usually during this time, hormone levels are checked several times to ensure that the proper levels are being maintained to ensure the pregnancy continues. Once the placenta starts taking over the hormone production, the Surrogate is weaned off the hormone replacements.
The rest of the pregnancy would be the same as any other pregnancy.