What is Surrogacy?
A surrogate is a woman who carries a pregnancy for another couple or woman.
There are two types of surrogacy arrangements:
- Traditional surrogacy in which the surrogate is inseminated with sperm from the male partner of the intended parent couple (donor sperm may be used as well).
- Gestational surrogacy in which the surrogate carries a pregnancy created by transferring an embryo created with the sperm and egg of the intended parents (Donor sperm or donor eggs may be used as well). Also called IVF surrogacy.
Much of the conflict surrounding surrogacy is a result of issues surrounding the legality of binding agreements agreed to prior to the conception or birth of a child. Traditional surrogacy is therefore an approach that carries more legal risk.
Surrogacy is both a medically and emotionally complex process that involves careful evaluation by medical professionals, and legal professionals to ensure that the procedure is successful for both the surrogate as well as the intended parents.
As such, the majority of surrogacy conducted in India involves the use of a gestational carrier.
Indications for Use of a Gestational Surrogate:
The initial indication for use of a gestational carrier is a woman who has normally functioning ovaries but who lacks a uterus.
ABSENCE OF UTERUS:
- Congenital absence of the uterus (müllerian agenesis), or
- Congenital müllerian anomalies such as a T-shaped or hypoplastic uterus with a history of infertility or repetitive pregnancy loss are also candidates
- Hysterectomy due to benign or malignant conditions.
- Untreatable intrauterine synechiae.
CONTRAINDICATIONS TO PREGNANCY
- Severe heart disease
- Systemic lupus erythematosis
- History of breast cancer
- Severe renal disease
- Cystic fibrosis
- Severe diabetes mellitus, and a
- History of severe pre-eclampsia with HELLP syndrome
Selection of a Gestational Surrogate:
Gestational surrogates may be known to the intended parents or may be anonymous. Known surrogates are typically relatives or friends who volunteer to carry the pregnancy. Anonymous surrogates are identified thorough agencies that specialize in recruiting women to become surrogates. The surrogate should be a minimum of 21 years of age and have delivered a live born child at term.Maximum age indicated by ICMR guidelines is 45yrs.The use of a gestational surrogate of advanced age is particularly challenging.The obstetric complication rate, especially the incidence of pregnancy-induced hypertension or gestational diabetes is much higher. Evaluation of a woman’s overall health and appropriate screening for underlying medical conditions that might complicate a pregnancy, as well as counseling regarding the obstetric risk should be preformed if considering an older surrogate. A written consent for each point must be taken. No woman may act as a surrogate more then thrice in her lifetime.
Evaluation of the Intended Parents and Gestational Surrogate:
- The intended parents should undergo a complete medical history and physical examination. Semen analysis should be obtained for the male partner, and an evaluation of ovarian function should be preformed for the female partner.
- The surrogate should undergo a complete medical history including a detailed obstetric history, lifestyle history, and physical examination. The surrogate should have an evaluation of her uterine cavity with hysterosalpingogram, sonohysterogram, or hysteroscopy.
- Infectious disease screening for syphilis, gonorrhea, Chlamydia, CMV, HIV, and Hepatitis B and C should be performed on the intended parents and the surrogate. The surrogate should also be screened for immunity to rubella. In addition, her blood type should be noted.
Counseling of Gestational Surrogates and the Intended Parents:
Counseling of surrogates is intended to provide the surrogate with a clear understanding of the psychological issues related to pregnancy. With the assistance of a mental health professional (MHP), the gestational surrogate, and her partner should explore issues such as managing a relationship with the intended parents, coping with attachment issues to the fetus, and the impact of a gestational surrogacy arrangement on her children and her relationships with her partner, friends and employers. The intended parents should be counseled regarding their ability to maintain a respectful relationship with the surrogate.
The surrogate, the intended parents, and the MHP should also meet to discuss the type of relationship they would like to have. In addition, expectations they have regarding a potential pregnancy should be discussed.
This includes a discussion of the number of embryos for transfer, prenatal diagnostic interventions, fetal reduction and therapeutic abortion, as well as managing the relationship while respecting the carrier’s right to privacy.
There are a number of legal issues that concern surrogacy. Written consent should be obtained for any procedure. With surrogacy arrangements, legal contracts, in addition to delineating financial obligations, may include details regarding the expected behavior of the surrogate to ensure a healthy pregnancy, prenatal diagnostic tests, and agreements regarding fetal reduction or abortion in the event of multiple pregnancies or the presence of fetal anomalies. Finally, many states allow for a declaration of parentage prior to the child’s birth obviating the need for adoption proceedings. The laws regarding third party reproduction are either non-existent or different from one state to another. Thus, all couples are advised to consult with an attorney knowledgeable in the area of reproductive law within their individual states.
What are the different types of assisted reproductive technology (ART)?
Common methods of ART include —
- In vitro fertilization (IVF) means fertilization outside of the body. IVF is the most effective ART. It is often used when a woman’s fallopian tubes are blocked or when a man produces too few sperm. Doctors treat the woman with a drug that causes the ovaries to produce multiple eggs. Once mature, the eggs are removed from the woman. They are put in a dish in the lab along with the man’s sperm for fertilization. After 3 to 5 days, healthy embryos are implanted in the woman’s uterus.
- Zygote intrafallopian transfer (ZIFT) or Tubal Embryo Transfer is similar to IVF. Fertilization occurs in the laboratory. Then the very young embryo is transferred to the fallopian tube instead of the uterus.
- Gamete intrafallopian transfer (GIFT) involves transferring eggs and sperm into the woman’s fallopian tube. So fertilization occurs in the woman’s body. Few practices offer GIFT as an option.
- Intracytoplasmic sperm injection (ICSI) is often used for couples in which there are serious problems with the sperm. Sometimes it is also used for older couples or for those with failed IVF attempts. In ICSI, a single sperm is injected into a mature egg. Then the embryo is transferred to the uterus or fallopian tube.
ART procedures sometimes involve the use of donor eggs (eggs from another woman), donor sperm, or previously frozen embryos. Donor eggs are sometimes used for women who can not produce eggs. Also, donor eggs or donor sperm is sometimes used when the woman or man has a genetic disease that can be passed on to the baby. An infertile woman or couple may also use donor embryos. These are embryos that were either created by couples in infertility treatment or were created from donor sperm and donor eggs. The donated embryo is transferred to the uterus. The child will not be genetically related to either parent.
How often is assisted reproductive technology (ART) successful?
Success rates vary and depend on many factors. Some things that affect the success rate of ART include —
- Age of the partners
- Reason for infertility
- Type of ART
- If the egg is fresh or frozen
- If the embryo is fresh or frozen
CDC collects success rates on ART for some fertility clinics. According to the 2007 CDC report on ART, the average percentage of ART cycles that led to a live birth were—
- 40% in women younger than 35 years of age
- 31% in women aged 35–37 years
- 21% in women aged 38–40 years
- 12% in women aged 41–42 years
- 5% in women aged 43–44 years
ART can be expensive and time-consuming. But it has allowed many couples to have children that otherwise would not have been conceived. The most common complication of ART is multiple fetuses. But this is a problem that can be prevented or minimized in several different ways.
What is assisted reproductive technology (ART)?
Assisted reproductive technology (ART) is a group of different methods used to help infertile couples. ART works by removing eggs from a woman’s body. The eggs are then mixed with sperm to make embryos. The embryos are then put back in the woman’s body.
What is intrauterine insemination (IUI)?
Intrauterine insemination (IUI) is an infertility treatment that is often called artificial insemination. In this procedure, the woman is injected with specially prepared sperm. Sometimes the woman is also treated with medicines that stimulate ovulation before IUI.
IUI is often used to treat —
- Mild male factor infertility
- Women who have problems with their cervical mucus
- Couples with unexplained infertility
What medicines are used to treat infertility in women?
Some common medicines used to treat infertility in women include—
- Clomiphene citrate (Clomid®): This medicine causes ovulation by acting on the pituitary gland. It is often used in women who have polycystic ovarian syndrome (PCOS) or other problems with ovulation. This medicine is taken by mouth.
- Human menopausal gonadotropin or hMG (Repronex®, Pergonal®): This medicine is often used for women who don’t ovulate due to problems with their pituitary gland—hMG acts directly on the ovaries to stimulate ovulation. It is an injected medicine.
- Follicle-stimulating hormone or FSH (Gonal-F®, Follistim®): FSH works much like hMG. It causes the ovaries to begin the process of ovulation. These medicines are usually injected.
- Gonadotropin-releasing hormone (Gn-RH) analog: These medicines are often used for women who don’t ovulate regularly each month. Women who ovulate before the egg is ready can also use these medicines. Gn-RH analogs act on the pituitary gland to change when the body ovulates. These medicines are usually injected or given with a nasal spray.
- Metformin (Glucophage®): Doctors use this medicine for women who have insulin resistance and/or PCOS. This drug helps lower the high levels of male hormones in women with these conditions. This helps the body to ovulate. Sometimes clomiphene citrate or FSH is combined with metformin. This medicine is usually taken by mouth.
- Bromocriptine (Parlodel®): This medicine is used for women with ovulation problems due to high levels of prolactin. Prolactin is a hormone that causes milk production.
Many fertility drugs increase a woman’s chance of having twins, triplets, or other multiples. Women who are pregnant with multiple fetuses have more problems during pregnancy. Multiple fetuses have a high risk of being born too early (prematurely). Premature babies are at a higher risk of health and developmental problems.
How do doctors treat infertility?
Infertility can be treated with medicine, surgery, artificial insemination, or assisted reproductive technology. Many times these treatments are combined. In most cases infertility is treated with drugs or surgery.
Doctors recommend specific treatments for infertility based on—
- Test results
- How long the couple has been trying to get pregnant
- The age of both the man and woman
- The overall health of the partners
- • Preference of the partners
Doctors often treat infertility in men in the following ways—
- Sexual problems: Doctors can help men deal with impotence or premature ejaculation. Behavioral therapy and/or medicines can be used in these cases.
- Too few sperm: Sometimes surgery can correct the cause of the problem. In other cases, doctors surgically remove sperm directly from the male reproductive tract. Antibiotics can also be used to clear up infections affecting sperm count.
- Sperm movement: Sometimes semen has no sperm because of a block in the man’s system. In some cases, surgery can correct the problem.
In women, some physical problems can also be corrected with surgery.
A number of fertility medicines are used to treat women with ovulation problems. It is important to talk with your doctor about the pros and cons of these medicines. You should understand the possible dangers, benefits, and side effects.
How will doctors find out if a woman and her partner have fertility problems?
Doctors will do an infertility checkup. This involves a physical exam. The doctor will also ask for both partners’ health and sexual histories. Sometimes this can find the problem. However, most of the time, the doctor will need to do more tests.
In men, doctors usually begin by testing the semen. They look at the number, shape, and movement of the sperm. Sometimes doctors also suggest testing the level of a man’s hormones.
In women, the first step is to find out if she is ovulating each month. There are a few ways to do this. A woman can track her ovulation at home by—
- Writing down changes in her morning body temperature for several months
- Writing down how her cervical mucus looks for several months
- Using a home ovulation test kit (available at drug or grocery stores)
Doctors can also check ovulation with blood tests. Or they can do an ultrasound of the ovaries. If ovulation is normal, there are other fertility tests available.
Some common tests of fertility in women include—
- Hysterosalpingography (HIS-tur-oh-sal-ping-GOGH-ru-fee): This is an X-ray of the uterus and fallopian tubes. Doctors inject a special dye into the uterus through the vagina. This dye shows up in the X-ray. Doctors can then watch to see if the dye moves freely through the uterus and fallopian tubes. This can help them find physical blocks that may be causing infertility. Blocks in the system can keep the egg from moving from the fallopian tube to the uterus. A block could also keep the sperm from reaching the egg.
- Laparoscopy (lap-uh-ROS-kuh-pee): A minor surgery to see inside the abdomen. The doctor does this with a small tool with a light called a laparoscope (LAP-uh-roh-skohp). She or he makes a small cut in the lower abdomen and inserts the laparoscope. With the laparoscope, the doctor can check the ovaries, fallopian tubes, and uterus for disease and physical problems. Doctors can usually find scarring and endometriosisby laparoscopy.
Finding the cause of infertility can be a long and emotional process. It may take time to complete all the needed tests. So don’t worry if the problem is not found right away.
How long should women try to get pregnant before calling their doctors?
Most experts suggest at least one year. Women aged 35 years or older should see their doctors after six months of trying. A woman’s chances of having a baby decrease rapidly every year after the age of 30.
Some health problems also increase the risk of infertility. So, women should talk to their doctors if they have—
- Irregular periods or no menstrual periods
- Very painful periods
- Pelvic inflammatory disease
- More than one miscarriage
It is a good idea for any woman to talk to a doctor before trying to get pregnant. Doctors can help you get your body ready for a healthy baby. They can also answer questions on fertility and give tips on conceiving.
How does age affect a woman’s ability to have children?
Many women are waiting until their 30s and 40s to have children. In fact, about 20% of women in the United States now have their first child after age 35. So age is a growing cause of fertility problems. About one-third of couples in which the woman is older than 35 years have fertility problems.
Aging decreases a woman’s chances of having a baby in the following ways—
- Her ovaries become less able to release eggs
- She has a smaller number of eggs left
- Her eggs are not as healthy
- She is more likely to have health conditions that can cause fertility problems
- She is more likely to have a miscarriage
What things increase a woman’s risk of infertility?
Many things can change a woman’s ability to have a baby. These include—
What causes infertility in women?
Most cases of female infertility are caused by problems with ovulation. Without ovulation, there are no eggs to be fertilized. Some signs that a woman is not ovulating normally include irregular or absent menstrual periods.
Ovulation problems are often caused by polycystic ovarian syndrome (PCOS). PCOS is a hormone imbalance problem which can interfere with normal ovulation. PCOS is the most common cause of female infertility. Primary ovarian insufficiency (POI) is another cause of ovulation problems. POI occurs when a woman’s ovaries stop working normally before she is 40. POI is not the same as early menopause.
Less common causes of fertility problems in women include—
What increases a man’s risk of infertility?
A man’s sperm can be changed by his overall health and lifestyle. Some things that may reduce the health or number of sperm include—
- Heavy alcohol use
- Smoking cigarettes
- Environmental toxins, including pesticides and lead
- Health problems such as mumps, serious conditions like kidney disease, or hormone problems
- Radiation treatment and chemotherapy for cancer
What causes infertility in men?
Men Seek Infertility Services
Many couples struggle with infertility and seek help to become pregnant; however, it is often thought of as only a women’s condition. But a CDC study analyzed data from the 2002 National Survey of Family Growth, and found that 7.5% of all sexually experienced men reported a visit for help with having a child at some time during their lifetime—this equates to 3.3–4.7 million men. Of men who sought help, 18.1% were diagnosed with a male-related infertility problem, including sperm or semen problems (13.7%) and varicocele (5.9%).
Anderson JE, Farr SL, Jamieson DJ, Warner L, and Macaluso M. Infertility services reported by men in the United States: national survey data. Fertility and Sterility 2009; (6):2466–2470.
Infertility in men is most often caused by—
- A problem called varicocele (VAIR-ih-koh-seel). This happens when the veins on a man’s testicle(s) are too large. This heats the testicles. The heat can affect the number or shape of the sperm.
- Other factors that cause a man to make too few sperm or none at all.
- Movement of the sperm. This may be caused by the shape of the sperm. Sometimes injuries or other damage to the reproductive system block the sperm.
Sometimes a man is born with the problems that affect his sperm. Other times problems start later in life due to illness or injury. For example, cystic fibrosis often causes infertility in men.
Is infertility just a woman’s problem?
No, infertility is not always a woman’s problem. Both women and men can have problems that cause infertility. About one-third of infertility cases are caused by women’s problems. Another one third of fertility problems are due to the man. The other cases are caused by a mixture of male and female problems or by unknown problems.
Is infertility a common problem?
Yes. About 10 % of women (6.1 million) in the United States ages 15–44 years have difficulty getting pregnant or staying pregnant.
What is infertility?
Infertility means not being able to get pregnant after one year of trying. Or, six months, if a woman is 35 years of age or older. Women who can get pregnant but are unable to stay pregnant may also be infertile.
Pregnancy is the result of a process that has many steps. To get pregnant—
- A woman’s body must release an egg from one of her ovaries (ovulation).
- The egg must go through a fallopian tube toward the uterus (womb).
- A man’s sperm must join with (fertilize) the egg along the way.
- The fertilized egg must attach to the inside of the uterus (implantation).
Infertility can happen if there are problems with any of these steps.
What if IVF fails? How many chances can I take?
You can go through IVF as many times as you wish. It depends on your physical, mental and financial status. However, we advise upto a maximum of 4 cycles.
Is it possible to use sperms from a donor?
Yes, in case it is required, patients can request the use of the sperm bank at our center.
What is Artificial Insemination?
Artificial insemination is also called intrauterine insemination (IUI). It is a simple OPD procedure in which the sperm which has previously been prepared in the lab is placed into uterus at the time of ovulation.
- Indications for IUI
- Low sperm count & motility
- Cervical mucus hostility
- Mild endometriosis
- Anovulatory infertility
- Unexplained infertility
- Sexual dysfunction in females e.g. vaginismus
- Anatomic defects in males e.g. hypospadias
Though IUI can be done in natural ovulatory cycles also but it is usually combined with ovarian stimulation to improve the chances of conception.
What will be the management of my infertility?
Management depends upon the cause of infertility and hence each couple is treated accordingly.
- Problem with ovulation- drugs are given to induce ovulation
- Blocked fallopian tubes – can be treated surgically or IVF can be done if not correctable by surgery
- Cervical factor- IUI or IVF may need to be done
- Male factor- minor problems can be treated with medicines or IUI. For more severe problems IVF/ICSI is required.
What are my chances of achieving a pregnancy?
The chances of fertilisation and pregnancy largely depend upon the cause of your infertility. The chances of conception through ART at our center is about 35- 45% with a carry home rate of 29% which is comparable to the best centers around the world.
What if semen report is abnormal?
If the report is abnormal, the test needs to be repeated after a gap of 6 – 12 weeks. A culture sensitivity also needs to be carried out. Semen report can be abnormal temporarily due to illness like viral fever or some medication.
What if the semen report is showing repeated infection?
Sometimes method of semen collection is not correct leading to growth in semen sample. For correct methodology, please contact the staff at IVF center.
What are the tests for female partners?
- Hormonal assessment
- Baseline pelvic scan and follicular monitoring (if required)
- Hysterosalpingography – coloured x-ray of fallopian tubes to find out whether tubes are patent or not
Besides these tests, other tests may be necessary such as:
- Endometrial biopsy
- Post coital test
- Additional hormonal assays
What are the tests for male partners?
Semen analysis is carried out to find out the characteristics of semen regarding the count, motility and shape of sperms.
Semen sample should be provided after an abstinence of 3 days and should reach the laboratory within half an hour of collection. Always get the sample tested at a reliable lab, preferably at the IVF lab.
What are the basic infertility investigations?
All tests are aimed at investigating the following:
- Ovaries – for eggs
- Tubes for patency
- Uterus for endometrial lining and cavity
- Semen for sperms
What to expect at the first visit?
Both partners should visit the IVF center together. They will meet the consultant where a detailed history will be taken and physical examination maybe carried out. Basic infertility investigations will be done, which will help to find out the cause of infertility.
What is an Assisted Reproduction /IVF clinic?
It is a medical center highly specialised in the methods of diagnosis and treatment of fertility problems with staff trained in assisted reproduction techniques.
What are the causes of male infertility?
- Problems in sperm such as sperm count, motility, morphology like azoospermia – absent sperms in ejaculate either due to testicular failure or less production of hormones at hypothalamic level or due to obstructive causes.
- Impotence or sexual dysfunction or ejaculatory failure
- Anatomic defects like hypopadias
What are the causes of female infertility?
- Failure of egg production/infrequent egg production
- Blocked or non-functional fallopian tubes which may result from infections like TB, STD. Previous surgeries and endometriosis are also responsible for this problem.
- Uterine factors like intrauterine adhesions, abnormalities in the shapef the uterus.
- Cervical factors such as fibrosed cervix (mouth of uterus) or hostile cervical mucus which prevents the sperm from passing through it.
Is infertility a problem that affects women or men?
We believe that fertility problems affect the couple as a whole and it is therefore necessary for both partners to be equally involved in all stages of diagnosis and treatment.
However, according to statistics, 40% of fertility problems are due to female partners, 40% due to male partners, 10% are attributable to both and the rest are unexplained.
Why is the incidence of infertility rising?
Currently, 10-15% couples are infertile worldwide. Infertility is rising due to the following reasons:
- Late marriages and career oriented women who put off pregnancy till they are professionally stable in their careers.
- Stress and fast paced lives
- Falling sperm counts in men
- Increasing awareness about availability of treatment
When should I seek medical advice?
- If you have not been able to conceive after trying for 1 year.
- Advice should be taken earlier if the female partner is nearing the age of 35 or has irregular periods or has history of pelvic infections
- If male partner has sexual dysfunction/ ejaculatory problem/ undescended testis
Why should I choose Southend Fertility and IVF Center?
We understand that patients undergoing treatment are under great stress and need all the support they can get. The strength of our team of specialists lies in its patient-centric approach where empathy, care & expertise are accompanied by the best of facilities.