Surrogacy Treatment For Infertility

SURROGACY

Introduction
Third party reproduction refers to a process where another person provides sperm or eggs or where another woman provides her uterus so that a woman can have a child.
Gestational carrier-A woman carries a baby through the pregnancy for another person. This involves the use of IVF as the embryo is implanted by embryo transfer and any combinations thereof. Theoretically a child thus could have 5 parents.
The term surrogate mother' orsurrogate’ is usually applied to the woman who carries and delivers a child on behalf of another couple. 

Types

TYPES ON THE BASIS OF METHODS
Traditional or Partial Surrogacy – the surrogate is related to one of the intended parents( a genetic link between the parents & the surrogate or the surrogate & the baby)
Gestational Surrogacy or Total Surrogacy –  the surrogate mother merely allows her womb to be used for carrying further the reproductive process
TYPES ON THE BASIS OF MONEY
Commercial surrogacy – monetary compensation to the surrogate including all the medical expenses
Altruistic surrogacy – the surrogate do not receive any monetary compensation (can be a close relative)

Types

Steps in Surrogacy
Proper patient selection
Source of surrogate (ART bank)
Proper selection & screening of the surrogate
Intensive counselling
Synchronizing the cycles of the surrogate and the genetic mother
controlled ovarian stimulation and IVF
Preparing the surrogate
Window period for embryo transfer
Taking care of the legalities and financial contracts
Transparency of the whole arrangement

Steps

Indications
Women with absence of uterus
Women with hysterectomy for various reasons
Women who suffer repeated miscarriages
Repeated IVF failure – due to nonreceptive uterus
Women with certain medical conditions – severe heart disease, kidney disease
Women for whom the prospect of carrying a baby to term is very remote
Single father GAY COUPLES..??? LESBIANS …???

Surrogacy Qualifications
Be in good physical and mental health;
Have carried and delivered at least one child;
Have had pregnancies that were all free of complications and were full-term;
Be less than 43 years of age;
Be in a stable living situation; and
Not smoke or abuse alcohol.

Screening for the surrogate

A physical examination and pap smear
Infectious disease testing
Hysteroscopy
A mock cycle
Psychological testing and evaluation

Counselling

In depth counselling of all parties engaged in surrogacy arrangements is of paramount importance and aims to prepare all parties contemplating this treatment to consider all the facts which will have an influence on the future lives of each of them.

Counselling for the couple

A review of all alternative treatment options
The practical difficulty and cost of treatment by gestational surrogacy
The medical and psychological risks of surrogacy
Potential psychological risk to the child
The chances of having a multiple pregnancy
The degree of involvement that the host may wish to have with the child
The possibility that a child may be born with a handicap
The risk that the host may wish to retain the child after birth
The importance of obtaining legal advice

Counselling for the surrogate
Improper selection of the surrogate can create problems at any stage of the procedure
The full implications of undergoing treatment by IVF surrogacy
The possibility of multiple pregnancy
The possibility of her family and friends being against her having treatment
The medical risks associated with pregnancy and delivery
The implications of guilt on both sides if the host should spontaneously abort a pregnancy
The possible effect on her own children of acting as a surrogate
The possibility that the host may feel a sense of bereavement when she gives the baby to the commissioning couple

TREATMENT OF GENETIC MOTHER
Stimulation with gonadotrophins
Oocyte retrieval
Embryos are frozen for minimum of 3 months
During the last month, host mother is further counselled, genetic parents have to undergo HIV test,if negative then go for HRT.
SURROGACY TREATMENT
Endometrial preparation with HRT.

Costs of surrogacy

Financial counselling
cost of IVF procedure
surrogate preparation cost,
Ongoing psychologic counselling costs
Pregnancy complications cost
Maternal complications
Fetal complications as multiple pregnancy/ selective fetal reduction
Genetic amniocentesis if required – Medical complications

Problems in Surrogacy

When problems arise in surrogacy it is usually because of a breakdown in communication or counselling.Issues that need to be comprehensively addressed are
Medical process
Realistic expectations for all parties
Signing the contract
Potential complications; Financial and legal matters
Establishment of parameters of acceptable conduct by the parties.

Contract
Agreement /contract: A legal agreement between a gestational carrier, her husband if married, and the intended parents, negotiated by an independent, separate legal counsel, is highly recommended.

Gestational carrier contract
A gestational carrier contract should be as comprehensive as possible, setting forth for example, the parties intentions with respect to the parentage of the child, their financial arrangements,prenatal care, delivery plans, selective reduction, abortion, future contact among the parties, and cooperation on legal steps to establish parentage.

Signing the contract
Signing the contract – Agreement of surrogacy, Contract – Semen bank and surrogate – Surrogate and patient – Semen bank and ART clinic – Patient and Surrogate international guidelines on the practice of surrogacy is the challenge of the day. Legal advice and formal and honest counselling to all the parties engaged in the surrogacy contract with a clear agreement on the terms of payment would be highly beneficial in protecting surrogacy from exploitation, avoiding legal, social, and psychological complications and further promoting the practice.