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.

4. In Vitro Fertilization, or IVF

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

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

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

Surrogacy - Types, Facts and Benefits

When a woman fails to conceive a baby due to some reasons, she requires the help of another woman, who carries her baby in her uterus through the process called surrogacy. The carrier woman is known as a surrogate and she has to undergo In Vitro Fertilisation (IVF) in order to place the fertilized egg into the surrogate's uterus. Before opting for surrogacy in India, infertile couples should know the facts about two primary types of surrogacy,

Traditional Surrogacy

In traditional surrogacy, the surrogate donates her own eggs and is impregnated through the process of artificial insemination known as intrauterine insemination, or IUI with the intended father's sperm. Therefore, the traditional surrogate acts as both the egg donor and as the actual surrogate for the embryo.

Facts about Traditional Surrogacy

1. Sometimes, the intended mother fail to produce mature eggs, that is, ovaries do not produce normal follicles due to ovulatory dysfunction. In such situations, the IUI procedure is followed on surrogate mother. In this procedure, the infertility specialist will transfer sperm that is taken from the biological father and will subsequently transfer that sperm into the surrogate's uterus so that fertilization may take place naturally.

2. A traditional surrogate will undergo insemination at the time of her natural ovulation, occasionally necessitating medication prescribed by her doctor to make sure that she does ovulate.

3. The child will have a genetic link to his father, since the father's sperm was used in creating the baby. There is no genetic link to the intended mother; which is a primary difference between traditional and gestational surrogacy.

4. Therefore, with traditional surrogacy, the surrogate is also the biological mother of the child. This type of surrogacy is typically only used if the biological mother's egg and/or the biological father's sperm are unable to be used.

5. Generally, people over the age of 50 or women who are unable to use their own eggs use traditional surrogacy since the option frees the intended parents from age-related limitations.

Benefits

It removes the age bar to get pregnant and even allows one of both the parents to be the genetic parent.

Gestational Surrogacy

In gestational surrogacy, the egg and sperm of the intended parents are used to form an embryo through a process called in vitro fertilization and later it is transferred in surrogate’s uterus to carry it for pregnancy. In most of the cases, it will take between three and five days for the embryos to develop in the laboratory prior to transferring them to the surrogate. Then, once the embryo has successfully been placed into the surrogate's uterus, the surrogate will carry the embryo through the pregnancy term until its birth.

Facts about Gestational Surrogacy

1. With gestational surrogacy, the surrogate's eggs are not used at all. Therefore, the child will not be related to the surrogate biologically.

2. It allows a couple to have a biologically related child by using a surrogate as the carrier for the couple's embryo.

3. The aid of a gestational surrogate is needed when a woman is unable to conceive naturally or through fertility treatments.

4. This option is explored after fertility drugs or in-vitro fertilization have proven unsuccessful, or if either party has irregularities in their reproductive organs that complicate conception.

5. The rate of success when using in vitro fertilization will depend upon several factors such as the age and health of the biological mother who is providing the eggs.

6. The process of gestational surrogacy can take several years including the amount of time to find an adequate surrogate, extraction of viable eggs and sperm can take several weeks from intended parents, preparation of surrogate for pregnancy with a hormone regimen that can take several months, implanting the embryos and additional nine months for the gestational surrogate to carry the baby.

Benefits

The gestational surrogacy allows the infertile couple to have their biological child, which otherwise is not possible through any other process. The intended parents will have their names in birth certificate and have legal rights on the child. Surrogate would have no legal right on the child and surrogacy cost would be almost same for both the options.

Dr Neeraj Pahlajani

Surrogacy In India: A Guide for Intended Parents

Below is the nine step guide for intended parents, 

Step 1:

After consulting the doctor, intended mother would be asked about her medical, personal, menstrual and obstetric history with details of her previous surgeries if any before under surrogacy treatment.

Step 2:

The reports would be studied in detail and later intended mother would be counseled at Pahlajani Surrogacy Care about the treatment and various packages of surrogacy, so as to optimize her chances for successful surrogacy treatment. Later, intended mother would be asked to register with the Pahlajani Surrogacy Care.

Step 3:

After the formalities of registration, the intended parents are matched with the surrogate database with our clinic help the couple choose appropriate surrogate mother.

Step 4:

After the selection of a surrogate, intended mother’s menstrual cycle would be matched with that of the surrogate, which is called synchronization of cycles by putting both surrogate and intended mother on birth control pills. Sometimes synchronization may require use of injections- a class of medications called GnRH Analogues, for example - Lupride, Suprefact, etc. Surrogacy treatment starts from Day 1 of intended mother menstrual cycle.

Step 5:

Once the cycles are synchronized, intended mother will be injected with Gonadotrophins to grow and ripen the eggs, which is called “Controlled Ovarian Stimulation”. It lasts for 9 to 12 days to record the response of intended mother ovaries about number of eggs maturing each day. The doctors would the above process using periodic transvaginal ultrasonographies or even blood tests to ensure optimized ovarian response and reduce the chances of excessive response.

Step 6:

Meanwhile, the surrogate, who is cycled to match intended mother periods, will be treated from Day 1 of her period by giving them Oestrogens and Progesteron medications to ripen the inner lining of her uterus-called Endometrium, to become receptive for acceptance and implantation of embryos to be transferred. The doctors records the response of her uterine lining is periodically assessed using trans-vaginal ultrasound scans at our clinic.

Step 7:

Egg (Oocyte) Retrieval:

Once the developing eggs reach optimum size, the genetic mother or egg donor undergoes procedure of oocyte retrieval, under short General Anesthesia to obtain eggs. IVF/ICSI/IMSI is performed to impregnate these eggs.

Step 8:

Between Day 2 and Day 5 of embryo formation, the embryo transfer is performed into the uterus of surrogate. Meanwhile, surrogate would be on certain recommended medications for implantation of transferred embryos called luteal phase supports.

Step 9:

Pregnancy Test:

Nearly 14 days after embryo transfer, the Serum Beta HCG test is performed on surrogate’s blood. If the test is positive, the same test is repeated every 4th day till the beta HCG levels cross 20,000 iu.

Dr Neeraj Pahlajani

Finding a Surrogate in India

Surrogacy in India is sometimes calculated by misplaced ideas and misconceptions. However, surrogacy is a wonderful experience for surrogates, but there are certain ground rules defined for both intended parents and surrogates to abide before venturing into the journey of surrogacy. Surrogates, who might below to varied strata of society, act as wish fulfillers for infertile couples.

How do you know if you need a surrogate?

There are certain reasons you might need a surrogate to carry your baby. Few common reasons are listed below,

1. Missing or Abnormal Uterus (might be because of hysterectomy that requires removal of uterus)

2. Multiple Pregnancy Loss

3. Several Failed IVF Transfers

4. Potential Life-Threatening Health Risks from Pregnancy (Example – Heart disease)

5. Unexplained Infertility

What to consider before finding a surrogate?

1. Evaluate the surrogate's motivation

2. Her support system

3. Her past and present health and social history

4. Her physical ability to successfully achieve a pregnancy

5. Her psychological and emotional outlook and stability

How to find a surrogate?

Pahlajani Surrogacy Clinic helps you find surrogates, who are motivated to assist infertile couples in building their families.

1. Ask friends or family. 

Given the high cost of surrogacy and the complex legal issues it raises about parental rights, and therefore a family relationship can be simpler to manage.

2. Through a surrogacy agency. 

Most people turn to a surrogate agency to arrange a gestational surrogate. An agency helps would-be parents find a suitable surrogate, makes arrangements, and collects any fees passed between parents and the surrogate, such as reimbursement for her medical expenses.

Legal Considerations before finding a surrogate in India

Before opting for surrogate parenthood in India, the ART Clinics, intended parents and surrogates need to abide certain regulations of the Indian Government,

1. The surrogates must be between 21 to 35 years of age.

2. No surrogate should undergo implantation cycles more than three times for a couple.

3. If married, the surrogate must obtain the consent of her spouse.

4. Only a Citizen of India can be considered for surrogacy.

5. Surrogate mother must renounce all parental rights over child.

6. Parents must accept the child born of the surrogacy.

7. IVF will be separated from surrogacy requirements, which will be outsourced to specialized agents.

Dr Neeraj Pahlajani