Gestational Surrogacy Program

Gestational surrogacy has now become an accepted option for couples experiencing fertility problems. Indications for surrogacy include:

• Women without a uterus due to congenital absence or surgical removal.
• Women who have suffered repeated miscarriages and for whom the prospect of carrying a baby to term is very remote. This group also includes those women who have repeatedly failed to achieve pregnancy following the IVF treatment.
• Women with certain medical conditions which make pregnancy life-threatening.

There are two distinct types of surrogate: the surrogate gestational mother (host uterus or gestational carrier) provides the gestational but not the genetic component for reproduction and the surrogate mother who will provide both the genetic and gestational component for reproduction (true surrogacy). Florida Fertility Institute does not offer the latter as a mode of treatment.

The surrogate will undergo an initial screening process, which involves:

• Consult and exam with our physicians
• Consult with a psychologist
• Cervical culture for gonorrhea, chlamydia, ureaplasm/mycoplasma, and pap smear
• HIV I and II antibody screen
• HIV screen by PCR
• Cytomegalovirus antibody
• Complete blood count
• Chemistry panel
• Blood group
• Hepatitis panel
• Rapid plasma reagent (syphilis)
• Saline infusion sonogram

PREPARATION FOR EMBRYO TRANSFER

The surrogate prepares her uterus for the transfer of the embryo(s) while the egg donor undergoes stimulation with fertility drugs. The goal is to re-create the hormonal changes that occur normally during a menstrual cycle by administering appropriate doses of hormones such as estradiol and progesterone. The desired effect on the uterus is the development of an appropriate endometrium (uterine lining), capable of receiving an embryo. Estrogen is usually administered orally. Progesterone is administered by injection or vaginal suppository.

The surrogate also begins subcutaneous daily injection of Lupron to suppress ovarian activities a week before her expected menses. Once the surrogate’s period begins, a baseline ultrasound and blood work is performed to ensure that Lupron has achieved its goal of suppression. Once suppression is confirmed, the surrogate begins estrogen on a determined day designated as Cycle Day 1.

After 13 days of estrogen, the surrogate visits the office for an ultrasound and an estradiol level to ensure adequate development of a uterine lining and proper levels of estradiol. If these tests are within normal limits, the recipient remains on the same dose of estrogen until the egg donor is ready for retrieval.

Once the eggs are retrieved, the surrogate begins progesterone. The fertilized eggs are left in culture to develop for 5 days to reach the stage of blastocyst.

EMBRYO TRANSFER

The number of embryos to be transferred to the uterus is usually discussed and outlined in the contract between the commissioning couple and the surrogate. The doctor and embryologist will inform the commissioning couple of the number of embryos available and their quality and give them their recommendation. The actual number of embryos to be transferred will be discussed among all parties at the time of transfer.

Transfer of embryos is performed in the office. An ultrasound is performed to verify the curvature of the cervix. The doctor places a speculum in the vagina and cleans the cervix before introducing an empty catheter. This allows the doctor place the catheter loaded with embryos with ease. Following the transfer, the patient rests for 15 – 30 minutes and then is discharged home. A pregnancy test is scheduled 2 weeks after the transfer.

The estrogen and progesterone will need to be continued through the 10th week of pregnancy. The details of this hormone replacement schedule and the testing required to monitor appropriate replacement will be provided once a pregnancy is established. The surrogate will have blood testing to monitor hormone levels. After the first trimester of pregnancy, the growing placenta produces all the necessary hormones required for sustaining fetal development. It is after this period that hormonal support can be discontinued.