Although the majority of
infertility causes can be
remedied through either
conventional medical and
surgical treatments or In
Vitro fertilization
(IVF), there are some
conditions that prevent a
woman from being able to
carry a pregnancy. In
years past, classical
surrogacy has offered
these women a chance to
raise children. This
procedure, which involves
the insemination of a
surrogate with the sperm
of the infertile woman’s
partner, raises a number
of complicated ethical
and legal issues because
the baby is the genetic
child of the surrogate.
IVF surrogacy, provided
at our Roseville
practice, near
Sacramento, allows us to
create embryos from the
eggs and sperm of the
infertile couple and
transfer them to the
uterus of a gestational
surrogate, who has no
genetic connection to the
child.
Indications for IVF
Surrogacy
In order to undergo in
vitro fertilization with
a surrogate, a woman must
have an adequate ovarian
reserve but be medically
unable to carry a
pregnancy. Absence or
congenital deformity of
the uterus, as well as
any medical condition
that makes pregnancy
potentially life
threatening, are
conditions that can be
overcome through IVF
surrogacy.
Undergoing IVF with a
Surrogate
Couples who fulfill the
necessary criteria to
undergo IVF surrogacy at
our Roseville practice in
the Sacramento area must
find someone willing to
carry a child for them.
Surrogates can be close
friends or family
members, or strangers who
have been located through
media advertising or a
surrogate agency. Because
the surrogate carries the
pregnancy to term and
gives birth to the child,
it is unrealistic and
virtually impossible for
her to be anonymous.
Couples should give
careful thought to
choosing a surrogate with
whom they can be
comfortable working with
over a period of several
months.
Screening
Prior to beginning
treatment, surrogates
must be fully screened to
ensure that there are no
conditions present that
could trigger
complication during
pregnancy. The range of
tests she must undergo
includes:
-
A careful medical
and family history
-
A thorough physical
examination
-
A psychological
evaluation
-
Specific blood tests
to exclude HIV,
hepatitis B and C,
and other diseases
-
Cervical cultures
for organisms such
as chlamydia and
urea plasma that
might interfere with
a successful outcome
-
An evaluation of the
uterus by
hysteroscopy (in
which a thin,
telescope-like
instrument is
introduced into the
uterus) to determine
if anything might
interfere with
implantation
-
Blood tests for
prolactin and
thyroid stimulating
hormone
-
Blood testing of the
surrogate's partner
for HIV, hepatitis,
and other
transmittable
diseases
The intended parents may
also be required to
undergo tests if it has
not already been
confirmed that the woman
has an adequate ovarian
reserve and that there
are no unidentified
problems with sperm
quality that could hinder
success.
Legal Agreements
Due to the legal
complexities of a
surrogate pregnancy, it
is absolutely imperative
to draft a contract that
both parties can agree on
before beginning the IVF
process. The contract
should be specific and
thorough, addressing all
aspects of the surrogacy
process in detail,
especially the matter of
who the intended parents
of the child are to be.
It is necessary for the
couple and the surrogate
to be represented by
separate attorneys, as
their interests are
inherently different.
In Vitro Fertilization
Like IVF with egg
donation, the process for
IVF surrogacy at our
Roseville practice, near
Sacramento, involves the
same basic steps as an
ordinary course of in
vitro fertilization, with
a few slight differences.
While the prospective
mother is undergoing
ovulation induction, the
surrogate will be
receiving medications to
synchronize her cycle
with that of the mother.
Once the eggs are ready,
they will be collected
from the mother through
ultrasound-guided
transvaginal aspiration
and then fertilized with
the prospective father’s
sperm. Once embryonic
development has been
confirmed, between three
and five days after
retrieval, a few healthy
embryos will be
transferred to the uterus
of the surrogate.
Remaining embryos can be
cryopreserved for later
transfer, in the event
that the first cycle is
unsuccessful.
Pregnancy
It is generally expected
that the intended parents
will stay in touch with
the surrogate throughout
the pregnancy, offering
support. The degree and
manner of their
involvement in the
pregnancy should be
discussed before the
procedure begins and
agreed upon by all
parties. The following
are some real-life
examples of conflicts
that can arise during a
surrogate pregnancy (all
names have been changed).
Medical Care
Carla: Dr. Thompson
delivered my three
children. He even
delivered me! I trust him
completely and consider
him a part of my family.
Dr. Thompson is a family
practice physician and
has delivered thousands
of babies over the years.
I never had a problem
with my previous
pregnancies and I don't
need a specialist for
this one. I couldn't
imagine going through a
pregnancy without him.
Why can't Laurie and Mike
trust me to know what is
best?
Laurie and Mike: After
months of research, we
have identified an
experienced high risk
OB/GYN with an office
twenty minutes from
Carla. We have spent nine
years trying to have a
baby on our own and will
spend over $50,000 on
this surrogacy. This baby
is so precious to us and
we're so worried
something will go wrong.
We've heard horror
stories of tragedies that
could have been
prevented. We want Carla,
and our baby, to have the
best care possible. After
all we've been through,
this doesn't seem like
too much to ask.
Solution: After much
discussion, the parties
agreed that Dr. Thompson
will continue as Carla's
primary physician. Her
care will be overseen by
the high risk OB/GYN who
will review records and
make periodic
examinations.
Activity Restriction
Jan: I lift free weights
regularly to relieve
stress and keep in shape.
In the summer my family
and I love to water ski
with our new jet boat.
During my last pregnancy
I was skiing through my
eighth month. You should
have seen the stares! I
think exercise helps
maintain a healthy
pregnancy and builds
endurance for the labor
process. I would never do
anything to hurt the
baby. I agreed to have a
baby for Steve and Sara,
but I didn't agree to
give up my whole life.
Steve and Sara: Sara
stayed in bed for ten
weeks trying to hold on
to her last pregnancy. We
think Jan should not take
any unnecessary risks.
Walking and swimming in
moderation is OK, but
what if she falls while
skiing, or drops a
weight? This is only a
temporary restriction.
Jan can get back to all
her activities after the
delivery. Taking care of
the pregnancy should be
the number one priority.
Solution: It is certainly
in everyone's best
interests for Jan to
maintain good health and
a positive attitude
throughout the pregnancy.
Jan agreed to consult
with the IVF physician as
well as her OB/GYN and to
follow medical advice
regarding activity
restriction. Steve and
Sara will let the
physician set these
parameters.
Birth of the Child
Katie: I'm a very shy
person. Only my husband
has been there at the
births of our children.
Can't Margaret and James
understand it's nothing
personal? The next thing
they'll want is for me to
have the baby on live
television! The birthing
process is a very private
one to me. Sometimes I
lose control and say
things I regret. Last
time I really screamed at
my husband for rubbing my
back the wrong way. I
also am pretty shy about
my body. I would be
embarrassed for Margaret
and James to see me this
way.
Margaret and James: We
want to be there with our
baby from the very
beginning. We want to be
able to tell him or her
about the birth. To not
share in this time would
be such a loss. This is
our baby and we think we
are entitled to be part
of the birth. We promise
to be very respectful of
Katie. We have a right to
be there. It feels very
selfish of her to exclude
us.
Solution: The parties
looked for a way to honor
Jan's need for privacy.
It was agreed that
Margaret and James will
stay outside the delivery
room during labor, but
will be called in just
before the baby is born.
They agreed to stand at
Katie's head and to not
interfere in any way.
They will be the first
ones to hold the baby.
Communication Issues
Stephanie: When I agreed
to be a surrogate, I had
no idea of the time it
would require — doctor's
appointments, meetings
with the lawyer, support
group meetings. I already
had a busy life. I work
full time, take care of
my two children, and
volunteer for the crisis
hotline. On top of all
this, Patricia calls me
every other day wanting
to know how I'm feeling.
Then she tells me all
about her life! I don't
want to be rude, but I
don't have time for this!
The relationship is
beginning to feel
intrusive. Sometimes I
don't answer the phone
just to avoid her.
Patricia: How do you
think it feels to have my
baby growing in someone
else's uterus over 2000
miles away? I get so
worried when I don't hear
from Stephanie. Hearing
her voice makes me feel
more secure. Even though
I'd like to, I don't call
every day. I want to
experience this pregnancy
as much as possible. I
don't think it's asking
too much to stay in touch
with each other.
Solution: Stephanie and
Patricia agreed to
communicate largely by
email, which feels less
intrusive to Stephanie.
The doctor's office has
agreed to fax summaries
of OB/GYN visits directly
to the intended parents.
Stephanie promised to
notify Patricia of any
change in her condition.
The parties acknowledged
that they had different
needs and that they would
try to be sensitive to
each other.
It is likely that the
previously described
conflicts could have been
avoided if, before
proceeding with a
surrogate pregnancy, the
parties had thoroughly
discussed relevant issues
and set forth all verbal
understandings in the
written surrogacy
contract. A counselor can
be quite helpful in
facilitating this
dialogue. With sufficient
commitment to the process
of communication, an
agreement that supports
the needs of all parties
can usually be reached.
Special Considerations
for Using a Family Member
as a Surrogate
Although it can be a
relief and a blessing to
have someone who is
already close to you
offer to be your
surrogate, it is
important to realize that
navigating this journey
with a family member or
close friend can actually
complicate matters unless
the proper steps are
taken to ensure the best
interests of everyone
involved are met.
First and foremost, it is
absolutely necessary to
perform all of the same
pre-treatment steps as if
you were undergoing IVF
surrogacy with a
stranger. While many
people may be tempted to
keep things informal
while dealing with a
family member, setting up
the proper legal
arrangements and
conducting the necessary
medical and psychological
evaluations ahead of time
will ultimately prove
worthwhile.
Although the surrogate
may see her participation
as an "act of love," it
must be recognized that
the financial, physical,
and emotional burdens of
pregnancy are significant
and that the
responsibilities of both
parties should be
realistically and clearly
addressed prior to the
IVF process.
Finally, without the help
of a surrogate agency to
mediate between parties,
the conflicts that can
and do arise during this
process may be extremely
difficult to resolve. At
Northern California
Fertility Medical Center,
we recommend the both
parties participate in a
counseling program before
and during the surrogacy
to help prevent or
resolve any issues that
may threaten the
relationship.
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