Tuesday, 29 July 2014

IVF for Surrogacy and Egg Donation

For assisted reproduction purposes, egg donation typically involves the process of in vitro fertilization as the eggs are fertilized in the laboratory; more rarely, unfertilized eggs are frozen and stored for later use by the intended parents. Egg donation is part of the process of third party reproduction as part of ART (Assisted Reproductive Technology).

After egg donation, In vitro fertilization (IVF) is performed for gestational surrogacy. In the process, eggs are removed from an egg donor or from the intended mother and fertilized with sperm in a lab to create embryos. The resulting embryos are grown in laboratory conditions for 3-5 days. In a surrogacy arrangement, these embryos are then implanted into the uterus of a gestational surrogate. In an egg donation arrangement, they are transferred into the intended mother.

For the IVF procedure, surrogates and egg donors undergo medical treatments. An egg donor will be injected medications to stimulate the production of eggs. A surrogate takes medications to prepare her body for the embryo implantation.

Intended parents need to make a variety of choices in conjunction with the medical team at your IVF clinic. These decisions directly affect not only the success of the procedure, but also the number, health, and the biological makeup of the prospective children. The quality of the resulting embryos may affect the number that is recommended to be implanted. You may also have legal agreements in place that stipulate the number of embryos that can be transferred. You will also need to determine what to do with any remaining frozen embryos following the procedure.

The egg retrieval and IVF procedures are brief. Following the embryo transfer, your surrogate will require a period of bed rest. At any point in the process, you should feel free to reach out to your IVF clinic for any medical questions or to Circle with any questions about your contract, travel, or any other related issues.

Dr Neeraj Pahlajani

How to Communicate with Your Surrogate

For fostering a good relationship with a surrogate, communication needs to be strong. It can be through emails, phone calls, even video calling, but you need to be in regular touch with the surrogate. Communication would ease the tension and also help both surrogate and intended parents to understand each other’s concerns. For establishing a good communication, you need to be direct and allow each other to open up.

Intended parents should encourage weekly exchange of emails or texts to know about each other’s well being. Regardless of how often you and your surrogate talk during the pregnancy, it is suggested that intended parents should increase communication before the birth of child. It is recommended that during the surrogate’s pregnancy, talking and exchange of ideas should be ensured. It will help to safeguard everyone’s expectations.

What Should the Intended Parents Talk?

1. Ask about surrogate’s well being

2. Ask if she needs anything

3. Ask if she is willing to pump breast milk

4. Talk about your relationship with surrogate after birth of child

Staying connected after the baby is born is also an important part of the surrogacy journey. At Pahlajani Surrogacy Care, we ensure that intended parents and their surrogates develop strong ties. The friendship between the recipient mother and surrogate even continues after she delivers your baby. 

We encourage intended parents and surrogates to discuss about the baby to eliminate confusion and the potential for disappointment. Communication helps the surrogate to keep that strength and helps intended parents to know about the journey of their child inside surrogate’s womb. A lack of effective communication can often lead to misunderstandings, in turn leading to feelings of dishonesty or distrust. 

Maintaining open and steady communication between the agency and the intended parents enables each party to feel more comfortable and at ease 
during the process.

It is important for the intended parents to identify how involved they want to be during and after the pregnancy.  With that in mind, it is essential that the needs of the intended parents be matched with those of the surrogate.  Most couples prefer an open relationship with their surrogate

Dr Neeraj Pahlajani

Monday, 28 July 2014

Tips for Surrogates to Keep themselves Healthy during Pregnancy

For many gestational surrogates, finding the time and energy to eat right and exercise throughout this exciting journey can be much easier said than done. It is suggested that surrogates should form a routine and keep themselves active. There are certain light exercises, and other simpler ways to keep surrogates healthy, few are as below -

1. Walk

Surrogates do not need to stick to rigorous workout routine to stay fit but should prefer to walk at least 30 to 60 minutes a day to keep themselves healthy. This would give you energy and also fresh.

2. Eat healthy

Eating habits would also keep the baby happy. Stick with your fitness and nutrition goals is to write everything down. Not only is this a great way to keep track of your eating and exercise during your pregnancy, it could also turn into a journal or log of your surrogacy experience.

3. Exercise

Surrogates should to avoid traditional crunches and only run with doctor’s approval, low impact cardio, using the elliptical machine or treadmill, and Pilates are great for targeting your core muscles without much discomfort.

4. Bond with Intended Mother 

She might be your email friend or even workout partner, surrogates should try to use the company of intended mothers to give her assurance that her baby is fine and how much you are carrying for it. Consider attending a weekly Pilates or yoga class, or simply going for walks and cooking a healthy a meal together.

5. Home remedies

Keep some prenatal workout videos on hand to do in the comfort of your own home. There are certain routines designed with modifications to suit pregnant mothers who need different energy levels to keep them active.

6. Drink water

Be sure to always keep water nearby and drink plenty of it. As your surrogacy progresses, your workouts will begin to feel more difficult. This is normal, so listen to what your body says and reduce the pace when it asks you to slow down.

Always be sure to your doctor regarding exercise you should be doing while pregnant. It is important for you and baby to be health. So, stay calm, workout and never allow stress to invade your life. Even the simplest daily activities can make a world of difference when it comes to keeping you active and feeling great.

Dr Neeraj Pahlajani

Surrogacy after Embryo Implantation Failure

India is acknowledged for being a global leader in IVF technology for two basic reasons - surrogates are easily available and IVF treatment is much less expensive, many couples travel to India for surrogacy treatment.

Typically, women who ask for surrogacy are older women, or women who have failed many IVF cycles. Surrogacy is the solution to their problem of repeated failed embryo implantation.

Here there is a common reason why embryo implantation fails. Some women think that it is because of their defective uterus but actually the implantation fails because of genetically abnormal embryos. Now, if the embryos are abnormal it might be the reason for an abnormal baby. While these defects are often random, they are commoner in older women. This is because the eggs of older women have more genetically abnormalities, because they have aged and have genetic defects, which cannot be screened for.

As women get older, their fertility declines. Most assume that this is because their reproductive system is aging - and for most women their reproductive system consists of their uterus. With reduction in fertility the functioning of uterus becomes poor.

Surrogacy in India has benefits considering the women being more receptive towards the entire process and the cost of surrogacy in India is affordable. Even Indian laws are flexible. With gestational surrogacy, infertile couples can pass on their genetics to children. Therefore, surrogacy after repeated embryo implantation failure should be considered after consultation with doctor.

Dr Neeraj Pahlajani

Tuesday, 22 July 2014

Becoming a Surrogate Mother – Ways to Draw Support from Your Family

For a woman to become a surrogate is a big decision. It can difficult to balance emotions with your family and it is important to have support from your family upon your decision to become a surrogate mother. It is necessary that your family, spouse and children are comfortable with your decision. It is because your family is your emotional support and therefore becoming a gestational surrogate holds same importance as it holds for you. Below are few ways you can break the ice with your family about surrogacy,

1. Discussion

Talk to your spouse openly about the idea without hiding your inhibitions and tell him the reason why you are thinking about embarking on. You should tell him that you have a strong desire to help another family. Once you are confident on your part and have valid reason to support your decisions, you are sure to convince your partner. 

You should understand that being a surrogate is going to affect their life enormously, and pregnancy means work for a spouse or partner too, with medical checkups, travel to meet with intended parents and other obligations. Your husband or partner needs to know that there are restrictions on intercourse after birth and in some cases during pregnancies as well.  

2. Use facts to deal with insecurities

Sometimes, husbands become insecure at the notion of his wife carrying “another man’s baby.” For such a situation, you need to tell him about the process of gestational surrogacy —there is no genetic tie to you or to your husband. If it takes more than one time to assure your partner, then do it. It is your duty to explain the process precisely and clear their doubts so that your family and the family for which you are carrying baby both are happy.

3. If you already have kids, thank them

It is important for your children to know about your decision. Do not make a mistake to leave them in oblivion. Pregnancy is something you cannot hide and it would be a wise decision to discuss things before your children start thinking otherwise. You should know that once you tell your children about it, they will be proud of their mother.

4. Avoid hiding things and be truthful

You should be positive about the whole idea of surrogacy and discussing things with your husband and children. Believing that things would work and everything will be fine will keep you going. Explain to children that mommies carry babies in their wombs, and that the intended mother’s womb just isn’t working — so you are simply helping another mother by carrying her baby for her until it is born.

5. Do not expect your children to accept things in first go

Give your family time to process the whole idea. Be absolutely certain your child is aware that the baby you’re carrying is not yours, is not a little brother or sister.

6. Reassure your family and remind them that they are needed

Never make your family feel ignored. Always tell them that you are doing this only because they were around you. Tell them about your ideas and your perspective. Reassure them early and often that this is not the case, and that this pregnancy is simply a wonderful and generous service you are performing for another family who cannot do it themselves.

Dr Neeraj Pahlajani

Monday, 21 July 2014

Egg Donation

Egg donation is the process in which a woman donates eggs, also called ova or oocytes for purposes of assisted reproduction. The donated eggs are used for in vitro fertilization as the eggs are fertilized in the laboratory or are frozen and stored for later use by the intended parents. 

Below is the process of egg donation -

1. Locating Egg Donors

For finding egg donors, you can contact donation agencies or fertility clinics in India.

2. Educating donors 

It is important that a donor is educated about the medical process, reproductive system, effects of donation, medical implications, legal requirements, and complications involved in the process.

3. Medical background of donor

The donors would have to undergo some specific tests before donation to ensure they are fit for the program, and will give good results as expected by parents. 

4. Signing Contract

After discussions, briefing, understanding the responsibilities, limitations, financial considerations, a contract is signed with the donor.

5. No contact with Intended parents

As per the Indian laws, the egg donation is anonymous.

6. Medical Procedure

The retrieval of egg is done through medical procedure by ensuring best medical facilities at Pahlajani Surrogacy Care.

Dr Neeraj Pahlajani

What Questions You Need to Ask Before Becoming a Surrogate?

Few questions that you need to ask before becoming a surrogate are as below-

1. What is your current health condition?

The most important consideration is good physical health. A surrogate mother in India should not have long term or life-threatening illness, should not be a smoker and or use illegal substances. Also, surrogate mother should not be obese because of health risks that would pose for both you and the baby. Other risks include diabetes and high blood pressure. Therefore, the surrogate should have normal Body Mass Index (BMI).

2. Stressed about your financial condition?

Even though you are becoming a surrogate for financial purpose but being stressed-out over money is an undesirable state at any time. Surrogates should not be worried about money. Your mental health can affect your physical well being. Therefore, the amount you receive for becoming a surrogate should never be the main or only reason for wanting to become a surrogate mother.

3. Who are your supporters?

If you chose to be a surrogate, you need to be clear about who all would be around you to assist and support you throughout the process. Although, Pahlajani Surrogacy Home gives you an environment of love and care you need to be around your family and friends who are enthusiastic and positive about her decision to help another family realize their dreams. Also, the prospective surrogate must have reliable transportation, and be able and willing to travel as necessary – for screening, meeting and matching with the intended parents, in-vitro fertilization, and routine medical testing.

4. Why you need to be comfortable about sharing your personal history?

Surrogates need to be open about their medical history and lifestyle with the intended couple as well as doctor. You need to be comfortable about sharing the history of pregnancies, abortions, and/or miscarriages; your psychological stability and any periods of depression or mental illness and your record regarding sexually transmitted disease.

Dr Neeraj Pahlajani

What Gestational Surrogate Needs to Know

Serving as gestational surrogate for an infertile couple to create a family is a something not everyone can do. It requires investment of emotions and few other complexities to deal with. 

There are certain things a gestational surrogate needs to know,
First, any woman serving as surrogate needs to that there is great range of medical information available.  

1. Eggs of surrogate are not used in gestational surrogacy

The eggs, or oocytes, come from either the intended mother or a third-party egg donor. This is why we call it “gestational surrogacy,” not “traditional surrogacy.”

2. Necessary routine tests

Gestational surrogate would need to undergo vaginal ultrasound that allows the physician to examine the uterus. There are chances the surrogate may be asked to have a hysteroscopy — in which a tiny camera painlessly examines your uterus — or other procedure to determine the general health of your uterus. Routine blood tests will be given to rule out the presence of communicable diseases such as AIDS, herpes, and hepatitis. You will be asked to provide an up-to-date pap smear, and might be requested to have a mammogram done.

3. Embryo formation

As a gestational surrogate, you will be given several medications to help prepare your uterus to receive the embryo. These medications may include standard birth control pills (at the beginning of your menstrual cycle). You will be started on estrogen at about the time the intended mother or the egg donor is being induced to ovulate if the embryo transfer cycle is a coordinated or “fresh,” one. Then, just before her eggs are harvested, you will begin on another hormone — progesterone — to further prepare for implantation. 

Normally, you will be required to continue to take hormones, usually by injection, even if the embryo transfer is what we call a “frozen” cycle, where the embryos have already been created and are frozen for future use by the intended parents. Remember, this is meant to be general guidance here, and is not meant in any way to be giving medical advice or instruction.

In this, hormones are given to the intended mother or the egg donor to induce ovulation, and her eggs are harvested via aspiration guided by vaginal ultrasound. Then, from 50,000 to one million sperm are mixed with the eggs and incubated, so that fertilization can occur. When the timing is right, the resulting embryos are transferred into your uterus, as the gestational surrogate. 

5. Embryo transfer

The embryo is carefully flushed in the liquid medium for transfer through your cervix into your uterus. Sometimes, the doctor will use ultrasound to help with placement of embryos, and afterward you may be asked to remain lying-down for a period of time.

6. Blood tests

After two weeks of embryo transfer, a simple blood test will be performed to confirm pregnancy — at which point both estrogen and progesterone medication may be continued.

Dr Neeraj Pahlajani

Wednesday, 16 July 2014

13 steps to Surrogacy

After making futile efforts to conceive, surrogacy is one unimaginable gift that a couple can have. The desire to become parents is possible with surrogacy arrangement. Below are the steps of how to go about surrogacy in India,

1. Contact surrogacy clinics in India

Visit websites, write emails and establish a personal contact with the doctor for reliability.

2. Clear your doubts and do not hesitate to ask questions –

From the qualifications of the fertility doctor to history of international clients, you should feel free to ask questions.

3. Read and re-read India laws of surrogacy

4. Calculate and review the costs of surrogacy in India

Typically, the cost of surrogacy depends on the policies and services offered by various clinics. You need to be sure about cost incur including the additional costs, which might be changed on unexpected situations like neonatal intensive care costs if the baby is born pre-mature.

5. Confirm the total cost of medication and treatment

Considering that surrogacy in India is cheaper, you may choose to do the entire IVF cycle in India, thereby spending more time in India, but spending less money.

6. Decide between traditional and gestational surrogacy –

Depending upon the priorities, you need to be clear whether you are looking at using donor eggs or using your own. Also, if you decide sending your embryos to India then you need to be sure about the assistance provided by clinic.

7. Gather all your medical records and forward it to the doctor –

This might include sperm analysis and a STD screen. If you decide to send embryos, you need to forward the reports of a STD screen.

8. Schedule a time to begin your treatment -

If you are using your own eggs, it is likely that some of your treatment can occur at home, with egg collection in India. If you are using donor eggs, then your treatment time frame will be guided by when egg collection happens for your egg donor.

9. Plan your travel to India -

First you need to apply for medical VISA. The number of days you need to spend in India depends on whether you are using donor eggs, or sending embryos from your home country. If you are using your own eggs, you will spend 5- 15 days in India and if you have sent your embryos then you will only need to spend 3- 5 day in India.

10. Meet the doctor and discuss

It is important to establish a transparent communication medium between the couple and doctor. Tell the doctor about number of embryos you want to transfer. While this can increases the odds of a successful pregnancy, it also increases the odds of a multiple pregnancy.

11. On the day of egg collection, if you are using your own eggs, you will have minor surgery. Don't plan on doing much else that day - it is a relatively short procedure that does not require an overnight hospital stay. If you are using donor eggs, you may be required to supply a fresh sperm sample.

12. Going home with your baby -

By the time this has happened, you should be aware of what the requirements are for your particular country and embassy to get citizenship and a passport for your baby. For most countries this requires a DNA test to confirm the genetic link to one parent by a DNA service approved by your Embassy. Irrespective of whether you use your own genetic material or donor eggs, both parents’ names will be on the birth certificate. 

Dr Neeraj Pahlajani

Friday, 11 July 2014

Answers to Top Concerns Intended Parents Have about Surrogacy

To participate in surrogacy arrangement is similar as stepping into new avenues for both surrogate mother and intended parents. While a surrogate mother has her own reasonable inhibitions, the intended couples are concerned about their relationship with future baby.

Sometimes, certain number of lingering concerns surrounds the surrogate parents we realize that even after committing to using a surrogate to help build their family. To call it abnormal would be unjust because surrogacy is an experience for both the intended parents and their surrogate carrier. 

However, it is only natural that an arrangement for an individual to bring another couple’s child into the world would give rise to some concern.
While undergoing Surrogacy in India, it is ensured that the top concerns of the surrogate mother and intended parents are answered to wash out their inhibitions and make the process comfortable. There are few concerns of intended parents,  

1.  Uncertainty about emotional connect with the child
Before starting a family, couples traditionally want to have a child genetically connected to them. And with surrogacy it is possible. However, the idea of another woman helping the couple to carry the baby is sometimes uncomfortable with the couples, who are otherwise left with no option than to opt for surrogacy. The reason is simple, they feel lost when they think about the relationship with the child. The fact that the standard procedure of conception, pregnancy, and childbirth is not performed by the intended mother confuses the couple.

But the couples need to understand that surrogacy is the arrangement that allows the use of intended father’s sperms and intended mother’s eggs to form an embryo in a laboratory and transfer it in the surrogate’s womb to carry. This means, the surrogate is just the carrier, who nourishes the embryo to give birth to a child genetically connected to intended parents.  
Some prospective parents, women in particular, worry that because they are not carrying the baby themselves that when the baby is born he or she won’t feel like “theirs”. This is a common misconception, and from our experience, it is far from the truth. When the child is born, prospective parents become parents. The child is theirs in every way, and they have the time needed to bond with their new baby.

2. Contact and relationship between surrogate and intended parents

Before signing the surrogacy agreement, a resistance free channel of communication is established between the surrogate carrier and prospective parents.  

It depends on the comfort of both surrogate and intended parents to decide about the type of communication. Generally, the surrogates and prospective parents choose to communicate fairly often, and even form strong friendships during the course of the pregnancy and after the birth of the child.

3.  How are surrogates screened and prepared for their role?

After establishing that the applicant woman is capable of becoming surrogate for the couple, surrogate mothers are screened before their first surrogacy cycle. 

Surrogate screening involves the following tests: medical, a mock cycle, psychological, and a partner screening in which the surrogate’s partner may be asked to undergo a blood test.

The intended parents should trust the doctors and surrogates as women who are approved to become surrogate mothers are very well prepared for their role. They understand the situation of intended parents and make efforts to address their concerns to ensure minimum inhibitions.

Dr Neeraj Pahlajani