What is Surrogacy?
Surrogacy is a method of assisted reproduction. The word surrogate originates from Latin word surrogatus (substitution) – to act in the place of. The term surrogacy is used when a woman carries a pregnancy and gives birth to a baby for another woman.
Surrogacy is gaining popularity as this may be the only method for a couple to have their own child and also because adoption, process may be a long drawn out process.
What are the Types of Surrogacy?
- IVF / Gestational surrogacy – This is a more common form of surrogacy. In this procedure, a woman carries a pregnancy created by the egg and sperm of the genetic couple. The egg of the wife is fertilized in vitro by the husband’s sperms by IVF/ICSI procedure, and the embryo is transferred into the surrogate’s uterus, and the surrogate carries the pregnancy for nine months. The child is not genetically linked to the surrogate.
- Traditional / Natural surrogacy – This is where the surrogate is inseminated or IVF/ICSI procedure is performed with sperms from the male partner of an infertile couple. The child that results is genetically related to the surrogate and to the male partner but not to the female partner.
To whom Surrogacy is advised?
1) Primarily, IVF surrogacy is indicated in women whose ovaries are producing eggs but they do not have a uterus. For e.g., in the following cases:
- Congenital absence of uterus (Mullerian agenesis)
- Surgical removal of the uterus (hysterectomy) due to cancer, severe hemorrhage in Caesarian section or a ruptured uterus.
2) A woman whose uterus is malformed (unicornuate uterus, T shaped uterus, bicornuate uterus with rudimentary horn) or damaged uterus (T.B of the endometrium, severe Asherman’s Syndrome) or at high risk of rupture, (previous uterine surgeries for rupture uterus or fibroid uterus) and is unable to carry pregnancy to term can also be recommended IVF surrogacy.
3) Women who have repeated miscarriages or have repeated failed IVF cycles may be advised IVF surrogacy in view of unexplained factors which could be responsible for failed implantation and early pregnancy wastage.
4) Women who suffer from medical problems like diabetes, cardio-vascular disorders, or kidney diseases like chronic nephritis, whose long term prospect for health is good but pregnancy would be life threatening.
5) Woman with ‘Rh’ incompatibility.
1. Women who have no functioning ovaries due to premature ovarian failure. Here egg donation also can be an option.
2. A woman who is at a risk of passing a genetic disease to her offspring may also opt for traditional surrogacy.
Is Surrogacy right for you?
For some couples opting for surrogacy is a very straight forward decision, while, for others there are lots of things to be considered and thought about before taking the decision. There are lots of complex issues involved. It is an emotional roller coaster ride for the couple, the families and friends. It is a decision where the ‘right’ and the ‘wrong’ are very individual things. An infertility specialist or a counselor can help the couple seeing things in the right perspective. Other options such as, adoption or further infertility treatment can also be considered.
What are the screening criteria for surrogate? How is a surrogate chosen in India?
Medical Tourism’s network of hospitals in India has a very meticulous and stringent criterion for choosing a surrogate. The surrogates are between 21-35 years of age. They are married with previous normal deliveries and healthy babies. Detailed medical history, surgical history, personal history, and family history is looked into. History of blood transfusion and addiction is also taken. It is made sure that the surrogate has an uneventful obstetric history (no repeated miscarriages, no ante-natal, intra-natal and post-natal complications during previous pregnancies). The surrogate and her partner are screened for infectious diseases like sexually transmitted diseases, Hepatitis B, Hepatitis C, HIV, VDRL. Thalassemia screening is also done. Detailed pelvic sonography is done and other tests for uterine receptivity are performed to ensure maximum chances of success. A detailed financial and legal agreement is then drawn up between the surrogate and the commissioning couple.
What does India IVF surrogacy procedure involve?
For IVF surrogacy in India, matching of cycles of the genetic mother and the surrogate is done by adjusting menstruation dates by oral contraceptive pills. When the cycle starts, the surrogate is put onto estrogen tablets to prime the uterus. The protocol used for the genetic mother is day 2 protocol or day 21 protocol, depending on the age of the genetic mother and the other test results. For the day 2 protocols, called the antagon protocol, oral contraceptive pills are given in the previous month. On the 2nd day of the periods, gonadotropin injections are started. USG Monitoring is done daily.
When the size of the follicle reaches 14 mm, the genetic mother is given an antagon injection to prevent the surge of the endogenous hormones. For the day 21 protocol, called the long protocol, GnRH analogues are started on day 21 of the previous cycle. Once the genetic mother gets her periods, gonadotropin injections are started. In both the cases, the patients are monitored daily. When the follicle reaches 18 mm size hCG trigger is given. The surrogate is started onto progesterone tablets on the day of hCG injection that is given to the genetic mother. Oocyte (egg) retrieval is done 36 hours later, which is generally day 12 or 13 of the cycle. On the same day the genetic father gives his semen sample. The eggs of the genetic mother are fertilized with sperms of the genetic father in the laboratory by IVF / ICSI procedure. The resulting embryo is then transferred into the womb of the surrogate under ultrasound guidance. The surrogate is then put on luteal support using progesterone tablets / injections, and pregnancy is confirmed 15 days later.
What is the success rate of surrogacy in India?
The success rate (carry home baby) of surrogacy is around 45% in case of fresh embryos. In case of frozen embryo’s it is about 25%. High success rates and low medical costs are the highlights of surrogate pregnancy in India. No wonder many couples from the US, Australia, the UK, and other European countries seek surrogacy in India.
What are the advantages of surrogacy?
a) This may be the only chance for some couples to have a child, which is biologically completely their own (IVF surrogacy) or partly their own (gestational surrogacy)
b) The genetic mother can bond with the baby better than in situations like adoption.
It is also important to learn as much as you can about the disease. Talking with friends, family, and your doctor can help.