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The Gestational Surrogacy Program at San Diego Fertility Center
The physicians of San Diego Fertility Center have years of shared experience helping patients become parents through gestational surrogacy. We will help you evaluate the benefits of gestational surrogacy and provide you with information about cost, legal issues, and treatment protocols.
In traditional surrogacy, the surrogate is pregnant with her own biological child, but this child will be raised by others. In gestational surrogacy, the surrogate becomes pregnant via embryo transfer with a child that is not biologically her own. The gestational surrogate may be called the gestational carrier.
Once a suitable surrogate has been identified, and the screening process is complete, the cycle can begin. Timing depends on the surrogate's menstrual cycle and any scheduling conflicts among the surrogate, intended parents, or professional staff.
Surrogacy Cycle Process Overview
Once a suitable surrogate has been chosen from the surrogacy agency of your choice and the screening process and legal contracts are complete, the cycle can be initiated. The timing of initiating the cycle depends on the menstrual cycle of the surrogate and any scheduling conflicts among the surrogate, intended parents, or professional staff.
Prior to treatment, it is important to understand the health of the patient. In the US, because these tissues will most probably go into another person, the FDA (Food and Drug Administration) regulates certain types of testing and the timing of these tests to protect everyone involved.
Egg Retrieval and Sperm Donation
Your physician will want the sperm to be available at the clinic prior to the egg retrieval. The sperm can be donated several ways: at our San Diego clinic, at our New York office, or with one of our international partnered clinics. For our international intended parents, they do have the option to donate their sperm at one of the worldwide clinics that we collaborate with and then have it shipped to our San Diego clinic.
In regards to the eggs, the intended mother/egg donor will begin taking FSH to stimulate egg production. These treatments are monitored with vaginal ultrasound and blood estrogen levels until the eggs are ready to be retrieved. Usually, these treatments will take approximately two to three weeks and will require a few office visits for ultrasounds and blood tests for monitoring.
During monitoring, the ultrasound results of the ovaries and uterus will determine when the eggs are mature and ready to be retrieved. On the day of the egg retrieval, the intended mother/ egg donor undergoes a vaginal, ultrasound-guided procedure under light anaesthetic at SDFC. When the egg filled follicle is seen with the ultrasound, a needle will be directed through the vagina into the follicle and then the follicular fluid and eggs are aspirated into a test tube. An embryologist works with the physician in the operating room to examine the fluid under a microscope and find the eggs. On the same day as the egg retrieval, the sperm provided will be thawed.
The embryologist will then use a method called ICSI (intracytoplasmic sperm injection), which is an in vitro fertilization procedure in which a single sperm cell is injected directly into the cytoplasm of an egg. The following morning, the embryologist team will determine how many of the eggs have successfully fertilized into embryos.
Embryo Growth & Genetic Testing
The embryos are allowed to grow in the lab for several days to make sure they are healthy and dividing properly. Nature tells us that not all human embryos are perfect and by allowing them to grow in the laboratory incubator, we can see which embryos are the healthiest and most likely to result in a successful pregnancy. We usually allow the embryos to grow in the laboratory for seven days and then select a few of the best embryos to be frozen.
Before the embryos are frozen, Intended Parents will have the option to conduct additional testing (PGT-A) on any of the embryos and to decide whether to discard any genetic abnormal ones.
Once a suitable surrogate has been chosen (either independently or through a surrogacy agency of your choice) and the screening process and legal contracts are complete, the cycle can be initiated. The timing of initiating the cycle depends on the menstrual cycle of the surrogate and any scheduling conflicts among the surrogate, intended parents, or professional staff.
The surrogate will begin hormonal therapies to prepare for a successful pregnancy. The surrogate will begin taking estrogen to stimulate endometrial (uterine lining) growth. This treatment is monitored with vaginal ultrasounds and blood tests to verify that the uterus is ready to accept an embryo. Usually, these treatments will take approximately two to three weeks and require a few office visits for ultrasounds and blood tests.
The number of embryos placed in the uterus can greatly influence the success of the cycle, but it can also increase the chance of multiple births. The determination of how many embryos to transfer is made carefully; this can only be decided after the physician has reviewed all the available information about embryo quality, quantity and testing. Typically, we will recommend transferring one or two embryos into the uterus depending on how many babies the intended parents wish to have.
The actual embryo transfer procedure is a gentle, painless process. A soft tube (outer catheter) is inserted by the physician to a pre-determined position in the uterus. A smaller tube (inner catheter) is then loaded with the embryos and guided into the uterus through the outer catheter. The embryos are then injected into the uterine cavity and the catheter set is removed. The embryologist will inspect the catheters for any potential remaining embryos once the procedure is completed. The surrogate will be instructed to go home and rest, and to continue her estrogen and progesterone treatments. A pregnancy test 14 days after the embryo transfer will determine if the cycle is successful.
In successful cycles, the hormonal supplements are continued through the first trimester (12 weeks) of the pregnancy. Once the first trimester is completed and the placenta has matured to the point where it can provide for all the hormonal needs of the pregnancy, no further supplements are required. We will monitor blood levels of estrogen and progesterone at the end of the first trimester and taper off the hormone supplements gradually. Once the hormone supplements are stopped, the rest of the pregnancy is indistinguishable from any other pregnancy! SDFC will then transfer the surrogate’s care and pregnancy monitoring to her chosen OB/GYN physician