Steps of surrogacy procedure

Firstly, couple chooses a woman who in future will become a surrogate mother; her participation in this program is compulsory voluntary. All legal clinics with positive reputation have database of surrogate mothers where you can choose woman who in future will bear your child.

Initial requirements for surrogate mother are quite simple:

  • age from 20 to 35 years;
  • presence of own healthy child;
  • mental health;
  • absence of serious chronic diseases. 

On the role of surrogate mother couple can choose examined relative or completely outside person - this choice is always individual and depends on the wishes and preferences of the family.

After future surrogate mother and genetic parents come to accommodation with each other woman who will carry a child, goes for tests and pass the following medical examinations: 

  • blood type and Rh factor;
  • blood test for syphilis, HIV, hepatitis B and C (valid for 3 months);
  • test for venereal infections (clamidiosis, genital herpes, ureaplasmosis, mycoplasmosis,  cytomegalovirus, rubella, etc. (valid for 6 months);
  • urine analysis (valid for 1 month);
  • complete blood analysis + coagulability (valid for 1 month);
  • blood chemistry test: GPT, ACT, total bilirubin, sugar, BUN, etc. (valid for 1 month);
  • fluorography (valid for 1 year);
  • smears on flora from urethra and cervical canal; level of vaginal cleanness (valid for 1 month);
  • cytological examination of smears from cervix;
  • examination by therapeutic and his report on the health’s state and absence of contraindications for pregnancy (valid for 1 year);
  • examination and report of psychiatrist (once).  

If all tests and analyses have shown that the woman who agrees to carry a child is healthy, doctor starts the next stage - synchronization of the menstrual cycles of genetic and surrogate mothers.

The main task of this phase is to achieve the necessary maturity degree of the endometrium (the inner layer of uterus) of surrogate mother for embryo’s implantation (reattachment) till the time of embryos’ derivation and transfer. During these preparations, according to a certain scheme, surrogate mother is delivered hormonal agents that cause endometrial maturation, or synchronization is performed in natural cycle. During this phase, doctors carry out verification of hormone level in the blood and ultrasound monitoring of endometrial and ootheca. Of course, during this period, surrogate mother may use only barrier methods of contraception, but not hormonal ones.

Further, when synchronization of cycles has been reached, standard IVF procedure can be started. During this phase, embryos taken from genetic parents are transferred to the uterine cavity of surrogate mother.

IVF procedure, for all its participants, consists of several stages.

Medical examination of genetic parents. It is conducted by the following parameters.

For women:

  • general and special gynecological examination;
  • ultrasound examination of the pelvic organs;
  • identification of blood type and Rh factor;
  • CBC, including coagulation time (valid for 1 month);
  • blood test for syphilis, HIV, hepatitis B and C (valid for 3 months);
  • smears on flora from urethra and cervical canal; level of vaginal cleanness;
  • examination by therapeutic and his report on the health’s state and ability for carrying of a pregnancy. 

According to indications, genetic mother goes through the following examinations:

  • examination of uterus and fallopian tubes (hysterosalpingography or hysterosalpingoscopy and abdominoscopy);
  • biopsy of endometrium;
  • bacteriological testing of material from urethra and cervical canal;
  • cytological examination of smears of cervix uteri;  
  • blood tests for hormones;
  • examination for presence of antisperm and antiphospholipid antibodies (antibodies against sperm);
  • examination for infections (clamidiosis, ureo-and mycoplasmosis, cyto-megalo virus, toxoplasmosis, etc.);
  • conclusion decision of other specialists on examination’s results.

For men:

  • blood test for syphilis, HIV, hepatitis B and C (valid for 3 months);
  • spermogram;
  • identification of blood type and Rh factor;
  • consultation of andrologist;
  • examination for infections (clamidiosis, ureo-and mycoplasmosis, virus of herpes simplex, cytomegala virus, etc.).

In addition, married couple aged over 35 years old has to carry out medical genetic consultation.

Induction of superovulation

This stage begins after the examination of the genetic mother. Superovulation is a process of maturation of several ovums in one ootheca (normally, during each menstrual cycle, only one ovum is maturated in ootheca). Stimulation of women’s superovulation, who wishes to have a child, is conducted to increase the chance of pregnancy. To reach it, women is injected a special hormones that cause maturation of several follicles (bubbles in which ovums grow). Their development is controlled by examination of hormone level in blood and daily ultrasound examination starting from the 4th-5th day of stimulation till follicles reach a certain size.

Methods of control:

  • Ultrasound monitoring is the main method of control over the process of follicles and endometrium development during superovulation induction. During ultrasound monitoring, the number of follicles and sizing of their average diameter and endometrium thickness is fixed. 
  • Hormonal monitoring is a dynamic identification of the concentration of ootheca hormones in blood and supplements data of ultrasound examination on follicles maturity.

Indicators that induction of superovulation was successfully completed are:  the follicle’s diameter is more than 17 mm and thickness of the endometrium - 8 mm and more. To complete the ovum’s maturation, doctor injects intramuscularly human chorial gonadotropip hormone that stimulates the process when ovum leaves ootheca. In 35-36 hours ovulation must start - follicles leave ootheca.

Centesis
Further is procedure of follicles centesis – getting of ovums by means of follicles’ paracentesis with a special needle introduced through vagina into the pelvic cavity and ootheca, and pumping out of ovums. This procedure is held in 32-40 hours after introduction of chorion gonadotrophic hormone. Procedure is performed under ultrasound control with the help of special puncture needle. In the case of inability to fulfill a puncture through the vagina, ovums can be obtained by laparoscopic method, i.e. by puncturing the abdominal wall under control of a special camera, introduced into the alvus.

Usually, genetic mother is recommended, before puncture, to stop eating and drinking 8 hours before the puncture and to make local vagina sanitation (vaginal infiltration of candles or disinfecting fluid) a few days before the puncture to reduce the risk of infection at the time of puncture. During several days after puncture, women can feel certain soreness in the pelvic area, but usually there are no unpleasant consequences.

Fertilization
Ovums of genetic mother have been taken and transferred to embryologists. What's the next step? Further, the most important thing happens - "insemination of ovums and embryos’ culture in vitro», i.e. fertilization of taken ovums by husband's sperm (genetic father) in vitro.

Before follicular’ puncture to genetic mother genetic father donates sperm. Before this procedure man is recommended to sexual continence during 3-5 days. Needed sperm is taken through masturbation.

Then ovums, received from wife, are fertilized by the sperm of her husband. This process happens in the following way: follicular fluid obtained due to follicular puncture is placed in Petri dish, estimation of quality of received ovums is conducted, after which they are transferred to a special incubator with sperm. Fact of ovums’ fertilization can be seen in 12-18 hours. If procedure went successfully and fertilization happened, they are placed in a special environment, where initial development of embryos takes place.

Repeated estimation of fertilization is conducted in 24-26 hours. Control of ovums’ fertilization is held during examination of dishes with cultured cells under microscope. However, it is not enough their presence to make a decision to transfer embryos into the uterus of surrogate mother: firstly you must ensure the normal development of embryos. It can be seen only from quantity and quality of the dividing cells of embryo, and not earlier than one day after fertilization, when the first signs of splitting cells can be seen.

If fertilization was not happen, the whole procedure is repeated once again during another menstrual cycle.

Embryo transfer
If fertilization has taken place, next stage can be started - embryos transfer into the uterus of surrogate mother, who was prepared for this procedure with the help of preliminary hormonal therapy.

Transfer procedure is carried out on the gynecological chair: doctor carefully introduces a special catheter into uterus, embryologist brings a special syringe filled with a liquid, which contains embryo, and they are gradually introduced through the catheter into the uterine cavity through the cervical canal. This is a completely painless procedure. If it is not possible, for some reason, embryo transfer can be made through the wall of the uterus (transmyometrial). In this case, needle can be inserted into the pelvic cavity through the vagina or the abdominal wall. Generally, no more than three embryos are transferred, though more number is also possible - if lower implantation’s probability is expected.

After procedure of embryo transfer, surrogate mother received the so-called hormone support with the help of progesterone medication - it improves condition of the inner lining of the uterus - the endometrium, and in such way increases chances for successful attachment of embryos.

Surrogate mother must abstain from sexual contacts during 2 weeks after embryo transfer, and hard physical work and physical activity. When will result be known?

Embryos are transferred on the 17th day of the menstrual cycle (days are counted from the first day of menstruation), pregnancy diagnostics on the content of beta-CG in blood or urine is conducted in 12-14 days after the embryo transfer, and since the 15th day special hormonal drugs are put on, and in the result of positive test for pregnancy this treatment is continued till 12-14 weeks of pregnancy.

Ultrasound confirmation of pregnancy can be conducted since 21 days after embryo transfer.

After the pregnancy beginning, surrogate mother is under the monitoring of doctors.