Surrogacy Procedure in India :
In-Vitro Fertilisation (IVF)
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What is Surrogacy?
Surrogacy is the arrangement when one woman (the surrogate mother) will bear a child for another woman or a couple (the intended parents) and surrender it at birth.
Types of Surrogacy Treatment
There are two types of treatment:
- Full or host surrogacy in which the surrogate (host) mother receives embryos that do not geneticially belong to her
- Partial or straight surrogacy in which the surrogate contributes her own eggs and therefore the surrogate mother is both the genetic and carrying mother
Indications for Surrogacy
Patients who have difficulties sustaining a pregnancy:
- Damaged lining of the womb - Asherman Syndrome
- Recurrent miscarraige in spite of all possible treatment
- Repeated failiure of IVF treatment in spite of the creation of good quality embryos
- Patients who have had a hysterectomy
- Patients born without a womb (Rokitansky Syndrome)
Recruiting a Surrogate Mother
The Surrogate Mother is recruited legally by the surrogate agencies under the ethics and guidelines of the law and under strict supervision of the partner IVF and Surrogacy Doctor. A host of tests and procedures, details of family history and physiological counseling are carried out before registering the surrogate.
Screening and Preparing for Surrogacy Treatment
The commissioning (intended) parents:
Full history and clinical examination is to establish the indications for the treatment and exclude infectious diseases that might adversely affect the surrogate mother or the potential child. The whole process including procedures and risks and legal and ethical issues are discussed
Screening blood tests for the intended mother: HIV, Hepatitis B + C, CMV, Syphilis, Haemoglobin level and blood group and RH
Screening blood tests for the intended father: HIV and Hepatitis B + C, CMV
The Surrogate Mother (Couple)
Full history and clinical examination to exclude infectious diseases that could be passed to the baby and conditions that might make pregnancy a particular risk for the surrogate mother. Procedures and risks including emotional and psychological difficulties are discussed in detail. We also discuss all the ethical and legal issues
Screening blood test for the surrogate mother include: HIV, Hepatitis B + C, CMV, Syphilis, Rubella status, Haemoglobin and blood group and RH
Both parties should see independent counselor who will submit their reports to the Internal Committee. The treatment has to be approved at the Committee meeting after the panel is satisfied with the welfare of the potential baby.
Following are the procedure for Surrogacy:
We need to synchronise two women in the same phase of the cycle so that when the intended mother produces the eggs, the surrogate's womb will be receptive for the created embryos. The surrogate mother receives an injection (Prostap) to stop the pituitary gland to control the ovaries (down regulation). The Prostap injection is given either on day 21 or Day Two of the cycle and the effect lasts for four to six weeks. The drug is fully effective in about 12 days and this is confirmed by a vaginal ultrasound scan to show a thin lining of the womb and inactive ovaries.
Once the surrogate mother is down regulated, she is on stand by waiting for the intended mother to be ready to start the treatment. The protocol of treatment of the intended mother will differ depending on several factors including age, weight, FSH level, regularity of her cycles and whether she has had a hysterectomy. Once the intended mother starts the daily injections to produce the eggs, the surrogate mother will start daily tablets of Oestrogen (Progynova tablets) to build up the lining of the womb. Both women will be monitored by vaginal ultrasound scan. It usually takes 12-14 days for both of them to be ready.
Once the eggs are collected, they are fertilised by the quarantined sperm. The embryos will be replaced two days later into the surrogate's womb.
Partial (Straight) Surrogacy
This could be by Intrauterine Insemination (IUI) or IVF using the quarantined sperm of the intended father. If there is no significant male factor infertility the treatment can be by IUI. The patency of the tubes of the surrogate mother need to be ascertained either by hysterosalpingogram, (x-ray) or laparoscopy and dye tests. IUI can be carried out in a natural cycle or preferably in a stimulated cycle aiming to produce two to three eggs. The chances of pregnancy are higher with the latter but it carries a small risk of a multiple pregnancy. If there is a sperm factor or the surrogate's tubes are not open, the treatment has to be by IVF where the surrogate mother will have ovarian stimulation treatment to produce the eggs that will be fertilised in the laboratory using the quarantined sperm of the intended father. The embryos will be transferred into her womb two days later.
Surrogacy is not legal in India. Payment from the intended parents to the surrogate mother is allowed only to cover expenses.
Intending parents are strongly advised to seek legal advice. Intending parents from abroad should also seek legal advice in their own country.
Both intended parents and the surrogate mother (couple) should agree on:
- Number of embryos to be replaced/risk of a multiple pregnancy
- Selective fetal reduction (i.e. termination of one of the fetuses) in case of triplet or higher order pregnancy
- Screening tests for chromosomal abnormalities and neural tube defects +/- amniocentesis
- Termination/continuation of pregnancy if there is an abnormality with the baby
- Whether the surrogate or the intended mother will keep the baby if there is any congenital abnormality that was not detected antenatally
- The intended parents and the surrogate mother (couple) should build up a relationship of trust and care before embarking upon any treatment
- Life insurance on the surrogate mother in favour of her family
- Change of will of the intended parents in favour of the unborn baby
Related Links >>
Stages of Surrogate Program
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