- introduction of surrogacy - Methods of surrogacy - counselling - process of surrogacy - complications of surrogacy

2. SURROGATE MOTHER

3. INTRODUCTION
The word “surrogate” is originated from latin word “subrogare”,
which means “appointed to act in the place of”.
A surrogate/surrogate mother is a women who carries a child for
someone else, and the process is called surrogacy.
The fertility clinic offers surrogate mothers between the age
group of 23 to 40 yrs, preferably a married women with kids to
carry the baby for another women who are unable to carry the
pregnancy in their womb due to some medical conditions.

5. Methods of surrogacy
Gestational surrogacy:
In this method, the child is genetically unrelated to surrogate. The
embryo is created via in vitro fertilization (IVF), using the eggs and
sperm of the intended parents or donors, and then transferred to
the surrogate who is often referred to as a gestational carrier.
 The embryo is created using the intended father’s sperm and the
intended mother’s eggs.
 The embryo is created using the intended father’s sperm and a
donor egg.
 The embryo is created using the intended mother’s egg and
donor sperm.
 A donor embryo is transferred to a surrogate.

6. Cntd…
A traditional surrogacy (partial, natural, or straight surrogacy)
:
 In traditional surrogacy, surrogate’s egg is fertilized in vivo
by the intended father’s or a donor’s sperm.
 Insemination of the surrogate can be either through
natural or artificial insemination.
 Using the sperm of the donor results in a child who is not
genetically related to the intended parents.

7. Indication
 Absence of uterus; which may be innate or due to hysterectomy.
 Significant uterine anomaly. Eg: irreparable Asherman syndrome,
Unicornuate uterus associated with recurrent pregnancy loss.
 Absolute or serious medical contraindication to pregnancy. Eg:
pulmonary hypertension.
 Biological inability to conceive. Eg: single male, homosexual male
couple.
 Unidentified endometrial factor. Eg: multiple unexplained previous IVF
failures despite the transfer of good-quality embryos, recurrent
miscarriages and implantation failure.

8. Counseling
For the genetic couples:
 A review of all alternative treatment options.
 The need for counseling.
 They need to find their host.
 The practical difficulty and cost of treatment.
 The medical and psychological risks of surrogacy.
 Potential psychological risk to the child.
 The chances of having multiple pregnancies.
 Possibility of child born with abnormality.
 possibility of smoking and drinking during pregnancy.
 The possibility that the host may wish to retain the child after birth.
 The importance of obtaining legal advice associated with surrogacy.

9. Cntd…
For the host:
 The full implications of undergoing treatment by IVF and surrogacy.
 The possibility of multiple pregnancies.
 Social implication associated with surrogacy practice.
 Abstinence from unsafe sex during and just before the treatment.
 The medical risks associated with pregnancy and possibility of caesarian
section.
 Psychological risks associated with surrogacy.
 The possibility of sense of bereavement while giving baby to the genetic
parents.
 The possibility that the child may be born with abnormality.

11. Process of surrogacy
 Find a surrogate and create a legal contract and have it reviewed.
 The embryo transfer could be fresh or cryopreserved.
 For a fresh surrogate transfer, medications (eg: oral contraceptive pills
or progesterone) are used to synchronize the menstrual cycles of both
the gestational surrogate and intended mother.
 The intended mother uses fertility medication to stimulate the
development of eggs.
 The gestational surrogate takes medications to prepare her uterus for
surrogacy.
 At the appropriate time, the eggs are removed from the intended
mother(or independent egg donor) and fertilized in vitro with her
partner’s sperm( or with donor sperm).

12. Cntd…
 The cultured embryos are then transferred into the uterus of
gestational surrogate.
 Once a pregnancy is confirmed, a surrogate either stays in
surrogate house or her home and obstetric care is provided.
 As the child is born, the intended parents obtain full legal custody
as outlined in the legal contract.
 The process may differ according to the type of surrogacy and
country

13. Complications
 Multiple pregnancy and obstetric complications.
 Emotional trauma to surrogate after having to relinquish the child.
 The host may wish to keep the child.
 An abnormal child may be rejected by both genetic and host parents.
 The question of whether it is ethical to pay hosts and if so how much.
 The long term effects on children born as a result of gestational
surrogacy are not known.
 The long term psychological effect on both the genetic couple and
host surrogates is not known.
 A few genetic woman have responded poorly to follicular stimulation.