Does Surrogacy Pregnancy require extra medical attention?

There is no apparent difference between surrogacy and the normal conception process. It seems as the embryo is implanted into the surrogate’s uterus and the surrogate gives birth to the child after completion of the gestational development. Then the born child is relinquished to the intended parents. But medically surrogacy is a complex process and requires additional medical attention to complete the whole process successfully.

Following are the steps where extra medical attention requires to carry surrogacy pregnancy:

Surrogate Medical Screening

Every surrogate needs to go through a stringent medical screening process to check her physical and psychological eligibility. Medical screening is conducted before starts the clinical procedure to check the readiness of the surrogates.  The medical screening process includes the following steps:

Physical examination and Pap smear test

Blood tests are conducted to confirm the negative finding of HIV, hepatitis, or other infectious diseases for both the surrogate and her partner

Hysteroscopy is conducted to get a clear picture of the size and shape of the uterus and for confirmation of unobstructed fallopian tubes. During this screening, a thin camera is inserted through the cervix to get a clear interview of the uterus.

A saline sonogram is another test conducted by flushing saline solution into the uterus to find out the absence of fibroids and other complications that can interfere with pregnancy.

Apart from these physical examinations, psychological evaluations were also conducted to confirm the mental stability before move forward to a medical procedure.

Mock round

Before conducting the procedure for actual transfer cycle, some clinic prefers to conduct a mock round with selected surrogate to confirm the accuracy. During the mock round, the surrogate needs to take the same medication which is given to prepare medications. This will help to check the effect of medication on positive changes on the uterine lining and overall patient’s tolerability. During this stage, blood tests and multiple rounds of ultrasounds are conducted to check the hormonal levels and uterine lining to support the conceive of the transferred embryo.

In some clinics, the doctor conducts a trial embryo transfer round to check the uterine cavity length as well as the cervix angel. This additional step helps the doctor to pre-plan the best possible way to insert the catheter at the time of embryo implantation.

Preparation for the Embryo Transfer

After the successful conduction of the mock round, the doctor proceeds with embryo transfer preparations. But the timing varies depending upon the use of a fresh cycle or frozen cycle. The date of embryo transplantation can be adjustable with the surrogate’s menstrual cycle. Before implantation, the embryo takes five days to transfer through the fallopian tube in case of a regular pregnancy.  Therefore, embryos are generally cryopreserved after 5 days of embryo development, so the suitable date of embryo transfer is five days after the mid-cycle of the surrogate.  This calculation of day is followed the same rule as in regular pregnancy.

But in the case of a fresh cycle, more coordinated embryo transfer is necessary. In this type of embryo transfer, the embryo is developed by fertilizing the intended mother’s or donor’s eggs with the intended father’s or donor sperm. In this case, sync needs to maintain between the intended mother’s or egg donor’s cycle with the surrogate’s cycle. The doctor usually prescribes Lupron injections or birth control pills for temporary stopping of hormone production. Lupron injections also help to prepare uterine lines for receiving embryos at the specific timing. Subsequently, the intended mother or egg donor receives fertility hormones for ovarian stimulation to promote the maximum number of eggs. During the treatment, the course doctor checks her follicle size and given the shot when follicles are the right size. The medication helps in egg maturation and the eggs are retrieved after 36 hours of the shot. 

After completion of egg collection, they are fertilized and incubated for five in the laboratory set-up to match the sequence as a normal pregnancy. The healthy embryo is then transferred to the surrogate wound at the scheduled date.

Embryo Transfer Procedure

Surrogate needs to stop taking Lupron injections the day before egg retrieval procedure conducted and starts progesterone therapy to maintain the correct hormonal level to maintain the uterine environment for supporting a stable pregnancy. The preferable route of progesterone therapy is intramuscular injections, and this surrogate may need to visit clinics or else follow the self-administration process. However, some doctor prescribes oral therapy also.

Surrogate also needs to take estrogen replacement therapy in a form of pills, patches, or shots. Surrogates need to continue progesterone and estrogen therapy during the first trimester until the placenta takes over hormone production.

Single or multiple embryos are transferred depending upon the agreement with the intended parents. The embryo transferred is conducted under close medical supervision. A syringe affixed with a thin, flexible catheter at the end is inserted through the cervix into the uterus, using an abdominal ultrasound to ensure the appropriate placement of the embryo. The procedure does not require to conduct under general anesthesia, but the surrogate may advise taking for a few days after transferring the embryo.

Confirmation of Pregnancy

Surrogate needs to visit the fertility clinic after nine days of embryo transfer to do an HCG to measure pregnancy hormone levels. The count must be 50 or more to confirm a positive, stable pregnancy. In the case of multiple pregnancies, the count may over 200. However, in any case, the repeat HCG test is conducted every two days and the count must be double every two days.

During this period, the medical expert closely monitors the test report of the surrogate to check the viability of the pregnancy. Multiple embryo transfers are often required to achieve a successful surrogate pregnancy. In the sixth week, an ultrasound is conducted to check the heart-beat of the fetus.  A regular fertility medical attention is given to the surrogate during the period of six- and 12-week to check hormone levels of the surrogate and ensure the pregnancy is still stable. After the conduction of the 12th-week ultrasound, the surrogate is being released from the fertility clinic’s practice to OBGYN. Then, the same medical treatment is continued as in the case of normal pregnancy. Therefore, additional medical attentions require in different stages of surrogacy pregnancy from screening to the 12th week of pregnancy.