Grayce P. Storey
A surrogate mother is a woman who carries a child, usually for an infertile couple. Making a decision to become a surrogate mother or hiring a surrogate requires a lot of planning, thought, and preparation. Becoming educated will help to alleviate some of the anxiety and disappointment that may result.
There are two types of surrogacy, traditional and gestational. The traditional type of surrogacy involves the surrogate mother being (AI) artificially inseminated with the sperm of the intended father or sperm from a donor when the sperm count is low. In either case the surrogate’s own egg will be used. Genetically the surrogate becomes the mother of the resulting child.
In case of a sperm donor, cryopreserved sperm may be used. This process involves placing the sperm in liquid nitrogen and storing in an insemination facility. The sperm is thawed just prior to being used. For a better pregnancy rate the sperm collection is usually placed into the uterus or fallopian tube rather than into the cervix.
How long a sperm can remain cryopreserved is uncertain, but success has been recorded over 16 years. Cryopreservation process includes:
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- Collecting the sperm (masturbation)
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- Chemical removal of water; this process prevents the formation of ice crystals
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- A cryopreservant buffer for support and protection (glycerol)
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- Actual freezing in liquid nitrogen 196(C, in plastic straws, glass ampules, or cryovials. These vials can be transported worldwide. The preserving of the sperm allows time for the results of the donors test to be gathered.
The intended father’s name is put on the birth certificate. The couple will have to consult a lawyer and the wife will have to do a “stepmother adoption” in order for both spouses’ names to be put on the birth certificate. Laws vary from state to state and a knowledgeable lawyer will make the transition easier.
Gestational Surrogacy
In order for a pregnancy to take place, a sperm, egg, and a uterus are necessary. In gestational surrogacy, the surrogate mother has no genetic ties to the offspring. Eggs and sperm are extracted from the donors and in vitro fertilized and implanted into uterus of the surrogate. This is an expensive procedure. Again, the unused embryos may be frozen for further use if the first transfer does not result in pregnancy.
An indicator that a surrogate is needed is medical disorders that affect the ovaries. These medical disorders include: damaged ovaries caused by endometriosis, destroyed ovaries caused by previous chemotherapy, menopause (egg production ceases), severe ovulatory disorders (polycystic ovaries), wife’s genetic disorders, or premature ovarian failure. In these scenarios, the surrogate donates both the egg and the uterus. The surrogate is artificially inseminated (AI) by placing the sperm of the husband into the uterus of the surrogate at the fertile time of the cycle, which is just prior to the egg reaching the uterus. If pregnancy does occur, in the third trimester of the pregnancy the couple may petition the court to have their names put on the birth certificate. Since laws do vary from state to state the couple may want to consult a lawyer. They will have a knowledgeable attorney negotiating in their behalf and a better chance of their wishes becoming a reality.
A contributing factor as to why the gestational surrogacy is the more expensive procedure is that centers have been known to give hormones to the egg donor causing them to hyperovulate hence, enhancing the uterus for conception. Indicators for a gestational carrier are evident when the uterus and fallopian tubes are unable to perform the designed function. Some of these disorders or abnormalities include:
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- Hysterectomy – uterus and tubes absent
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- Myomectomy – surgical removal of a noncancerous tumor from muscle
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- Damage from infection or IUD (intra uterine device – a type of birth control
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- Malformed uterus
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- Pelvic adhesions causing distortion to bowel
Some physiological impediments that can be life threatening would also necessitate in considering a gestational carrier are:
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- Cardiac disease
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- Brittle diabetes
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- Potentially dangerous drugs (drugs that can harm developing fetus)
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- History of ectopic pregnancies
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- Emotional factors
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- Physical disabilities (weight gain causing stress on back and legs)
Procedure For Becoming a Gestational Surrogate
In order to become a surrogate the individual undergoes a series of tests prior to the planting of the egg, sperm, or both. Some of these tests include.
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- Hysteroscopy/HCG, this procedure determines the fallopian tubes are clear and the size and shape of the uterus
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- Infectious disease test, to ensure there are no contagious diseases present
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- A mock cycle, to see how the uterine linings will react to hormone replacements (estrogen)
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- Pap smear to check for a healthy uterus
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- A physical, to see if there are any physiological impediments that would hinder the surrogate in carrying the baby
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- Trial transfer, to check the length of uterus to find out how far to insert the catheter, which will be loaded with embryos
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- Psychological testing, to check motivations, attitudes, and commitment
Once all of the testing is completed and out of the way, the surrogate and/or egg donor are both usually given a birth control pill to synchronize their cycles and then a subcutaneous injection of Lupron, a steroid, which will shut down the production of hormones to control the cycles. Hopefully this process will ensure that the surrogate’s uterus is ready to receive the embryo. Since the surrogate’s cycle is a week or more ahead of the Egg Donor it will make the uterus more ready to receive the fertilized eggs. Once the cycle starts the Lupron dose is decreased and estrogen replacement is added.
The egg donor starts on fertility hormones on day three to stimulate her ovaries to produce more eggs than the norm. A shot of HCG is given, which includes a (LH) lutinizing hormone surge causing the eggs to mature at a rapid pace. The drugs given to stimulate the ovaries produce more than enough eggs for a single implantation. After thirty-six hours have passed, the eggs are retrieved and fertilized with waiting sperm. The fertilized eggs are then incubated for 2-5 days. When the fertilized embryos have developed to their proper stage they are loaded into a special syringe with a flexible catheter and inserted through the cervix into the uterus. Usually 3 of the 2-day-old embryos are used and the others are frozen. After the transplant has been completed, a 3-day bed rest is usually required.
After a pregnancy has been confirmed an ultrasound is done. In 6 weeks a check is done for a heartbeat. After 12 weeks the surrogate is released to a regular OB/GYN. Regular check-ups are still needed to ensure that hormone levels are maintained. Once the placenta takes over the hormone replacement is discontinued.