The surrogate mother is probably the most important part in the surrogacy process. Therefore, understanding more about surrogate mothers will help you go through the process more easily and calmly. Surrogates can be classified into two types: traditional and gestational.
In traditional surrogacy, the surrogate is inseminated with the sperm of the intended father or donor sperm, making the resulting child genetically related to the surrogate. On the other hand, in gestational surrogacy, an embryo is created using the intended parents' or donors' genetic material which is then transferred to the surrogate's uterus. The surrogate does not contribute her own egg to create the embryo in gestational surrogacy, so the child is not genetically connected to the surrogate. Nowadays, traditional surrogacy, where the mother is an egg donor and a gestational carrier as well, is less commonly used in assisted reproductive technology. Instead, the second type — gestational surrogacy — is usually preferred.
Finding A Surrogate
Surrogacy programs establish various criteria for accepting women as surrogates, all of which include minimum standards. Prospective surrogates typically need to be within a specified age range (e.g., twenty-five to thirty-five years old), in good health, and proven to be fertile (having had at least one child). They must undergo extensive screening for inheritable diseases and sexually transmitted infections. Additionally, a psychological assessment is required to evaluate a woman's emotional stability and readiness to undertake the role of a surrogate. During counseling, various scenarios are explored, such as potential miscarriage, developing an emotional attachment to the unborn child, or feelings of regret about relinquishing the child.
Traditional Surrogacy
In traditional surrogacy, the surrogate serves as both the biological mother and the carrier of the pregnancy, as we mentioned above. This means the surrogate uses her own eggs for conception. The intended father provides the sperm, or donor sperm may be used, and the insemination is typically performed using procedures like intrauterine insemination (IUI) or intracervical insemination (ICI) at a fertility center. It's essential that the sperm provider undergoes screening for infections.
One significant risk of traditional surrogacy is that the surrogate, being the biological mother, has full parental rights over the child, regardless of any prior agreements. To mitigate this risk, many couples opt for gestational surrogacy instead. Another concern is the potential for the surrogate to develop a strong emotional attachment to the fetus, as it is genetically related to her. When surrogacy was a newly emerging field in America and people lacked a full understanding of the process, several cases arose where surrogates sought to retain custody of the child after birth, despite having agreed beforehand to relinquish parental rights. The surrogate’s genetic connection to the child made these legal cases difficult to resolve.
Gestational Surrogacy
Gestational surrogacy is preferred because the surrogate is not genetically related to the child. This reduces the surrogate's legal rights as a biological mother and typically results in a less intense emotional bond with the fetus as well. This makes the process comparatively easier for intended parents as well as for surrogates themselves.
As mentioned earlier, gestational surrogates are women who carry a pregnancy using eggs donated by the intended mother or an egg donor and sperm donated by the intended father or a sperm donor. When a gestational carrier has been found, the next step is to create an embryo and implant it in the carrier’s uterus. During this procedure, the intended mother or the egg donor has her eggs harvested for the IVF procedure. A woman usually produces one or two eggs in a natural, non-stimulated cycle. However, the egg donor usually undergoes ovarian stimulation to make it possible to retrieve multiple eggs from the ovaries. The woman undergoes ultrasound monitoring to track the development of her eggs. Once the eggs reach a specific size, she receives a final hormone injection to aid in ovulation. The eggs are then retrieved via laparoscopy.
Natural, non-stimulated cycles are more cost-effective than stimulated cycles and avoid certain risks associated with hormone stimulation, such as ovarian hyperstimulation syndrome.
After retrieval, the eggs are fertilized with sperm from the intended father or a donor in an IVF procedure. The resulting embryo is transferred into the surrogate, who has undergone hormone therapy beforehand to prepare her uterus to receive the embryo. During this phase, the surrogate takes additional hormones to support the lining of the uterus and enhance the chances of successful implantation.
The surrogate agrees to abstain from sexual intercourse for a specified period, typically two weeks before and after the embryo transfer. Two weeks after the embryo transfer, a test is usually done to confirm the pregnancy.
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