Surrogacy Services

• Why Surrogacy
• Possibilities for IVF/Surrogate Parenting
• Selecting the Surrogate
• Screening the Surrogate
• Follicular Stimulation and Monitoring the Female Partner (Egg Provider)
• Synchronizing the Cycles of Surrogate and Egg Provider (Egg Donor/ Genetic Mother)
• Tests and Processes involved in Sperm Extraction- Sperm Provider (Genetic Father/ Sperm Donor)
• Building the Surrogate's Uterine Lining with Hormonal Injections
• Egg Retrieval, Fertilization and Embryo Transfer
• Management and Follow-up after the Embryo Transfer
• Towards the Bioethics of Gestational Surrogacy
• International Surrogacy- Legal Implications

 

Why Surrogacy?

 

Surrogacy is when another woman carries a baby for a couple/ individual who are unable to conceive or carry a child themselves. This Treatment is offered usually due to inability of Intended Mother/ Intended Parents to conceive, or carry a child to term, due to medical or other problems.

 

• Recurrent miscarriages despite of all possible treatments
• Repeated failures in IVF treatment
• Premature menopause, often as a result of cancer treatment
• A hysterectomy, or an absent or abnormal Uterus
• Inability to conceive in case of Single Parents
• Possibility of a Health condition which makes pregnancy and birth dangerous.

 

Possibilities for IVF/Surrogate Parenting

 

The various possibilities wherein Gestational Surrogacy can be carried out are

 

• In Cases with Donor Eggs and Sperm from Genetic Father
• In Cases with Donor Sperm and Eggs from Genetic Mother
• In cases where Sperm is from Genetic Father and Eggs from Genetic Mother

 

Surrogacy in India with using Embryo adoption is prohibited in India; hence it is mandatory that one of the Intended Parents have a Genetic Link with the child born through Surrogacy Treatments

 

Selecting the Surrogate

 

Presently in India as Bill to regulate Surrogacy is with the Government waiting to be introduced in parliament and is under consideration and hence We at KIC follow the guidelines issued by Indian Council of Medical Research (I.C.M.R.) and American Society of Reproductive Medicine (A.S.R.M.) in process of recruitment of Surrogate Mother. I.C.M.R. is the Government organization that is entrusted with the responsibility of framing of Laws for regulating various ART Treatments in INDIA.

 

These guidelines state that Facility providing Surrogacy Treatment should not be directly involved in recruitment of a Surrogate Mother.

 

Following these guidelines at our clinic, Surrogate Mothers for all our cases are recruited through a N.G.O (NON GOVERNMENTAL NON PROFIT ORGANIZATION) called Amma Women Welfare Association (AMMA) actively involved in development and providing assistance to poor and needy women and by an ADVOCATE.

 

The website for AMMA is http://ammawowsociety.org

 

Screening the Surrogate

 

Once the surrogate has been inducted, she will undergo thorough medical and psychological evaluations, including:

Psychological Interviews to determine that Surrogate Mother is mentally healthy and to ensure that she will be able to follow the protocols provided to her in due course of becoming a Surrogate Mother and during her Pregnancy period and later. Careful evaluation psychologically as well as physically is carried out to ensure that the surrogate has not been subjected to any pressure or coercion.

 

Blood tests (as appropriate) for sexually transmitted diseases and all communicable diseases are carried out. Variety of Blood-Hormone tests, such as the measurement of Plasma Prolactin, to ascertain her immunity to the development of Rubella (German measles) and Thyroid- Stimulating Hormone (TSH) are also performed.

 

A cervical culture and/or DNA test to screen for infection with Chlamydia, Urea Plasma, Gonococcus, and other infective organisms that might interfere with a successful outcome.

 

Once the Women intending to be a Surrogate Mother has undergone these tests and her Medical, Physical and Psychological Fitness is ascertained then only she is formally inducted into Program.

 

Note: the same standards of Medical, Physical & Psychological standards are used for evaluating Donors as-well. but depending upon the ethnicity of the Donors there are other tests carried out too. All donors are tested for the presence of a cystic fibrosis (CF) mutation. Donors of African, and Mediterranean descent undergo a hemoglobin electrophoresis as a screen for sickle cell trait and thalassemias. If the donor is of Jewish origin, CF mutation analysis and screening for Tay-Sachs disease, Canavan disease, familial dysautonomia, Gaucher disease, and other genetic diseases is done. Donors who are of French Canadian descent are screened for CF as well as Tay-Sachs disease.

 

 

 

Follicular Stimulation and Monitoring the Egg Provider (Egg Donor/ Genetic Mother)

 

This procedure is used to stimulate the Egg Provider (egg donor/ Female Partner of the infertile couple), here Hormonal Injections are given to the Egg Provider to stimulate her ovaries to produce multiple follicles. Progress of this is monitored through Ultra Sound guided Scans at regular intervals.

Tests and Processes involved in Sperm Extraction- Sperm Provider (Genetic Father/ Sperm Donor)

 

Blood tests (as appropriate) for sexually transmitted diseases and all communicable diseases are carried out on a Sperm Donor. His sperm is tested as per WHO Methodology for various parameters like Physical Appearance, Chemical Appearance, Motility, and Morphology.

 

In case of Oligospermia & Azoospermia Testicular Biopsy and procedures such as TESA & MESA are carried out.

 

Synchronizing the Cycles of Surrogate and Egg Provider (Egg Donor/ Genetic Mother) 

 

This is important to ensure Fresh Embryo Transfer, here Cycles of Surrogate and Egg Provider (Egg Donor/ Genetic Mother) are synchronized to prepare Surrogate Mothers Endometrium to receive Fresh Embryo’s created by using Sperm and Oocytes from Egg Provider.

 

Building the Surrogate's Uterine Lining with Hormonal Injections

 

The surrogate will receive estrogen orally, by skin patches, or by injections, and then progesterone to help prepare her uterine lining for implantation.

 

 

 

 

 

Egg Retrieval, Fertilization and Embryo Transfer

 

The egg provider (aspiring mother) undergoes trans vaginal ultrasound-guided egg retrieval during the period between day-11 to day-14 of stimulation or when follicles reach 17 mm size.

 

Egg fertilization is done on the same day of retrieval by fusing the Sperm and Egg, and embryo culture process is carried out for approximately 72-120 hours following egg retrieval.

 

Embryos are transferred to the surrogate's uterus on day-2, day-3 or day-5 (Blastocyst). Surrogate Mother then is shifted to post operative unit for rest.

 

Management and Follow-up after the Embryo Transfer

Progesterone is given to Surrogate Mother and pregnancy test is carried out on the 12th Day of Embryo Transfer and updates are provided to Intended Parents in a time interval ranging from a week to 10 days with a special emphasis for checking for chromosomal and other structural defects in the growing fetus.

 

In the due course of Pregnancy Surrogate Mothers are monitored on a daily basis by the medical team, they are monitored on a weekly basis by a Gynecologist to ensure that the safety and growth in Pregnancy and appropriate steps are taken for safety and wellbeing of the Surrogate Mother and Fetus.

 

Surrogate Mothers are also monitored by a Nutritionist on a fortnightly basis where her Diet is planned accordingly with the nutritional requirements of each Surrogate Mother based on the trimester of preganancy.

 

During the course of pregnancy we ensure that the Surrogate Mothers are provided healthy, hygienic environment and other amenities to ensure that the chances of infections, diseases are minimal.

 

Towards the Bio ethics of Surrogacy

 

The determination of ethical guidelines has not kept pace with the exploding growth and developments in ART Treatments. Globalization of these treatments has contributed to increase of avenues involving Ethical Standards which yet to be looked into. However, some centers in this field are working together, sharing experiences and advice, in an attempt to formulate a code of ethics,for this purpose we have our own ethics commitee at the clinic.

 

Organizations such as A.S.R.M. (American Society for Reproductive Medicine), E.S.H.R.E. (European Society of Human Reproduction and Embryology), I.C.M.R. (Indian Council of Medical Research) and forums such as C.O.G.I. (Controversies in Obstetrics, Gynecology and Infertility) are working towards discussions, and framing of such guidelines to standardize the processes of Surrogacy Globally.

 

In today’s scenario India has come up as one of the epicenters providing Surrogacy treatment for Intended Parents across the globe. Low Costs, Availability of Resources, World Class Quality of Treatments, Low or no Waiting Times, easy access to Medical Professionals compared to Western Countries and Europe and Less Legal Complications, evolving of Internet have contributed to this fact.

 

There have also been voices raised on issues such as exploitation of poor and needy women, commercialization etc. but for a country where in a substantial part of the population is considered to be living in Below Poverty Line Standards with daily income being less than 2$, Surrogacy has helped many women in improving the standard of lives of themselves and their family. It is not always the compensation part that forces a Women to become a Surrogate Mother, but a desire to improve the overall financial health of her family, a desire to secure future of her loved ones, a desire to grow. There are many instances wherein a woman after becoming a Surrogate Mother has used the Money she has secured to finance her child’s education, open up a business of her own for her survival, constructed her own house. The fact that compensations offered to these wonderful women are more than double the salaries of what a average Graduate in India would earn per annum illustrates that this income is substantial to improve the overall standard of living of these women.

 

Properly framed Legal Guidelines wherein the Surrogate Mother is counseled and informed beforehand that she will not be having any rights on the baby she is bearing, has fuelled the rise of International Intended Parents visiting India for this treatment. Unlike other countries like U.S.A., Canada, U.K. Surrogate Mothers have no rights over the baby they would be bearing thus reducing the chances of legal conflicts and making this journey more secure for Intended Parents.

 

In KIC we have an Independent Ethics Committee comprising of individuals from different fields such as Law, Social Service, Ex Government Employees, Doctors which scrutinizes each and every case and based on their views and approval it is decided to enroll a particular case or not.

 

International Surrogacy- Legal Implications

 

Complexity of International Surrogacy Arrangements and differing Laws in different countries has led to may Intended Parents getting stuck up in complications involving Legality of this processes.

 

For instance for US Cases the emphasis is on the parties in the Surrogacy Agreement and the names on the Birth Certificates, which should match, for countries like UK, Spain etc, Surrogate Mother needs to be single otherwise her husband is considered to be the Legal Father of the child, some states in Australia only recognize Altrustic Surrogacy Arrangements, countries like France, Netherlands,Italy etc prohibit Surrogacy in any form.

 

Keeping in view this point in KIC we have constituted a in-house legal team that evaluates every case on Legal Perspective and then decides to enroll a particular case or not, this department also looks into providing of documentation post Birth of a child for all Surrogacy Cases to ensure a smooth, safe and secure journey to all successful parents back home.