- The first pregnancy following gestational-surrogacy was described by utian et al and since then surrogacy has become a viable option for many infertile couples to have a biologically releted child,especially in whom it is impossible or undesirable on medical grounds for the intended mother to carry the child herself.
- In traditional surrogacy,the surrogate mother provides the oocyte as well as the uterus to foster pregnancy.
- However,in In Vitro Fertilization (IVF) surrogacy (otherwise known as’gestational surrogacy’or’full surrogacy’),the surrogacy mother gestates the genetically unrelated embryos produced by the gametes of the commissioning couple.
Indication For Gestational Surrogacy
- After hysterectomy
- Congenital absence of uterus
- Recurrent abortions
- Repeated failure of IVF Treatment
- Severe medical conditions incompatible with life
Recruitment of Gestational Carriers
According to ICMR (Indian council of medical research) the following guidelines has been laid down for the selection of surrogacy mothers which were strictly adhered to while recruiting these surrogates.
- Surrogate mother should not be more then 45 years of age. Before accepting a woman as a possible surrogate, it must be fully ensured that the woman satisfies all the testable criteria to go through a successful full term pregnancy.
- A relative, a known person, as well as an unknown person can act as a surrogate for the couple. In the case of relative acting as a surrogate, the relative should belong to the same generation as the woman desiring surrogate.
- A prospective surrogate mother must be tested for HIV and shown to be seronegative for the virus just before the embryo transfer.
- No woman may act as a surrogate more than thrice in her lifetime.
Following selection, the potential surrogate undergoes a complete work-up which includes screening for sexually transmitted disease, basic endocrinological test and ultrasound pelvis.
- The commissioning couple and gestational carrier along with their spouse then undergo psychological and legal counselling with appropriate legal contracts.
Cycle Synchronization and Treatment Protocol
- Both the commissioning mother and the surrogate mother are put on oral contraceptive pills in the previous cycle in order to synchronise there cycles.
- A long protocol for pituitary desensitization in used for the commissioning mothers Ovarian stimulation is done using gonadotropins starting on cycle day-2.
- The dose is adjusted according to ovarian response which is monitored by doing transvaginal sonographies and serum estradiol levels.
- HCG is administered when two of more leading follicles reached=18mm
- oocyte reteieval is done under general anaesthesia after 34-36 hours.
- The gestational carriers undergo pituitary desensitization by a long acting GnRh analogue administered in the luteal phase of the previous cycle.
- All these then receive exogenous estrogen (esradiol valerate) therapy for endometrial preparation before the embryo transfer.
- Micronised progesterone is added on the day of ovum pickup of the commissioning mother. Day 3 or day 5 embryo transfers are done.
- Post transfer luteal support is given to all the recipients in the form of estradiol valerate 6mg/day and micronized progesterone 600mg/day.
- B-hcg is done on day 14 post transfer to confirm pregnancy. If pregnancy was confirmed, luteal support is continued till 12 weeks of gestation.
- A similar protocol for preparation of gestational carrier is used in case of frozen embryo transfer cycles.
- Micronized progesterone is started once the endometrial thickness and endometrial blood flow is adequate on sonography.
- Embryo transfer is subsequently done on day-3/day-5 of strating of progesterone.