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The Surrogacy Contract

The surrogacy agreement is both the foundation of the surrogacy process and is vital to ensuring expectations are met and that both intended parents and surrogates are protected from potential risks and liabilities. Every surrogacy agreement is tailored to meet the needs and expectations of both the surrogate and intended parents. It is vital that all parties involved understand both the provisions and exclusions contained within the surrogacy agreement to prevent potential disagreements, complications and disputes throughout the surrogacy journey. With a comprehensive agreement that outlines both the rights of the surrogate and the intended parents as well as the risks and responsibilities of all parties involved, potential disputes and miscommunications are limited; This helps to protect everyone in the surrogacy process.

There are certain topics that are necessary to discuss and are essential in any surrogacy contract:

Medical

A contract should identify medical providers as well as your IVF clinic, reproductive physician and obstetrician. The surrogate has the right to choose the obstetrician that she is comfortable with and this should be clearly identified within the surrogacy agreement, a provision that the intended parents will have the opportunity to approve of the chosen physician is often included but the final decision resides with the surrogate.

Legal

Each state has laws dictating the surrogacy process; A contract should include what the laws of the state are, what procedures need to be followed as well as the legal responsibilities for all parties involved. This section could include anything from legal proceedings that enable validation of the surrogacy process to who is required to attend the court proceeding for the pre-birth order to ensure legal parentage to the intended parents on the birth certificate.

General Provisions

Each state has laws dictating the surrogacy process; A contract should include what the laws of the state are, what procedures need to be followed as well as the legal responsibilities for all parties involved. This section could include anything from legal proceedings that enable validation of the surrogacy process to who is required to attend the court proceeding for the pre-birth order to ensure legal parentage to the intended parents on the birth certificate.

The surrogacy agreement will also outline the number of embryos the surrogate is willing to transfer per cycle, this is usually limited to two or three, but can be more or less based on the physician’s advice that is based on both the quality of the embryo as well as the age of the embryos. Healthier embryos tend to be transferred one at a time unless an attempt for multiple birth is both desired and agreed upon.

Invasive Procedures

Surrogacy agreements also outline issues that may arise with regards to invasive procedures such as termination, selective reduction and other difficult decisions that parties may have to address and attend to throughout the surrogacy process. This is an essential part of every contract to ensure that all parties are in agreeance and comfortable with the possible decisions that may need to be made.

Compensation

It is important that compensation be addressed through the surrogacy contract to ensure that the cost and responsibility for pregnancy falls on the intended parents and that the surrogate is fairly compensated for her time and commitment to the surrogacy process as well as compensated in a timely and fair schedule.

Risks and Liabilities

As with any pregnancy there are potential risks and complications, the surrogacy agreement should address these risks and complications and outline what if any decisions may need to be made and who is responsible for making them. A proper contract will also include extra compensation amounts the surrogate may receive in the case of invasive procedures, carrying multiples, bedrest, or potential loss that could occur.

Responsibilities

The contract will outline the surrogate’s responsibilities throughout the pregnancy as well as the intended parents’ responsibilities that they are required to meet throughout the process.

Drafting and Negotiating the Surrogacy Contract

The surrogacy contract is a collaborative effort between the attorneys, surrogate and intended parents. In most cases the initial draft is created and presented by the intended parents and their attorney for review by the surrogate and her attorney. It is important that the surrogate ensures that her requests and interests are heard and considered so the necessary changes are made to the agreement. The contract can go through many revisions before all parties are in agreement and willing to sign, this is normal and should not be seen as discouraging. Don’t be afraid to have your concerns and desires heard and represented in the contract.

It is vital that both the surrogate and the intended parents have their own attorneys when negotiating the contract; This helps to ensure a fair and balanced contract, reduce stress from both parties that could potentially damage the relationship between the surrogate and intended parents and also helps to ensure that the contract is in the legal language that is required through the court process.

The contract needs to be negotiated, signed and completed prior to medical procedures being done; This is a requirement with many fertility clinics to ensure that all parties are protected.

The Dangers of Independent Contracts

It is never advisable to attempt such a contract without the help of attorneys, while there are many templates available online that some feel would suffice. These templates often miss some of the vital points that should be contained within the surrogacy agreement and do not cover all the possible outcomes, variables, circumstances, and needs that could affect the parties involved. It is never advisable to enter into such a contract without proper legal counsel on both sides of the agreement; doing so could lead to extreme legal consequences and disputes between the parties involved. Without a proper contract, there really is no legal protection in place for the surrogate, the intended parents, or the child to be.

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How to Qualify as a Surrogate

Becoming a surrogate is an incredible decision that warrants both respect and gratitude. While it may seem like a long and daunting task to apply and be approved as a surrogate, this is truly not the case. That is to say, that while you may not be able to snap your fingers and be approved the process is relatively simple if you meet the criteria.
Out side of the laws of the State in which you reside, as many states have different laws and regulatory statues that govern surrogacy, there is a set of criteria that the majority of agencies require of their surrogates.

If you are considering becoming a surrogate you need to meet the following certain criteria.

Lives in a surrogacy friendly state

In order to qualify as a surrogate, you have to reside within a surrogacy friendly state. While the majority of states now allow for compensated surrogacy agreements, there are a few states that still do not permit such agreements.

Between 21-42 years old

The age range is set based on statistics that show that women between 21-42 years of age tend to respond better to IVF treatment and deliver healthy babies. While this should not be seen as a guarantee of success when considering being a surrogate, there is a higher percentage of success within this age range.

Has a BMI (body mass index) between 18-35

This is a requirement based on success and response of IVF treatment. IVF treatments tend to work better with women that have a BMI below 35 and these women tend to have less complications during pregnancy.

Has delivered at least one child

There are a few reasons for this requirement, the main being that no surrogate misses out on having the chance at having her own family because she chooses to do a selfless act and carry a child for another family. As with any pregnancy complications can arise, though not often with IVF treatment in some cases it can happen and ensuring the surrogate has one child in her history prevents the surrogate from being unable to carry her own children. The other reason for this requirement is that it helps the chances of successfully carry a pregnancy to term as past birth history can often be a good indicator.

Be a U.S. Citizen

Within the U.S. to legally become a surrogate you must either be a U.S. Citizen or have been a permanent resident for a minimum of 3 years. While the U.S. is open to working with international intended parents, this is not the case when it comes to surrogates.

Has had no more than 3 c-sections

Any woman wishing to become a surrogate cannot have had more than 3 c-sections in their previous birth history.

Non-Smoker

A woman who is looking to become a surrogate must be a non-smoker for a minimum of one year prior to beginning the surrogacy process. Research indicates that smoking can have negative effects on both the pregnancy and the fetus.

Drug Free/Alcohol Free

Drug use is an absolute no when it comes to surrogacy, as it can both harm the surrogate and compromise the surrogate’s response to IVF treatments and hormone injections as well as harm the fetus that the surrogate is carrying.

The Process

If those requirements are met, then you are well on your way to getting started. You will be asked to complete an application that tells the agency about you, your history and your plans and needs throughout the surrogacy process. This allows for the development of a list of potential intended parents that meet your desires and needs.
Once you have completed that step its on to the background check, medical and psychological screening (check our blog for information on both of these screenings) and choosing the couple you want help. While this may seem like a lot most of it can be done from the comfort of your home in your free time, and you are not required to plan or make appointments the agency will do that for you that work around your schedule.

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Foundations of Gestational Surrogacy for Surrogates

When considering an agency for gestational surrogacy it is important that you work with an agency that is comprised of caring staff that both understand the surrogacy process and have experience working within the legal frameworks of your state.

The Right Agency

There are protections and rights in place for women who become gestational surrogates and an agency that cares for you and ensures that you know your rights and is able to give you advice and information on them is paramount. The right agency will help to ensure that you have the right lawyer, help you with contracts to ensure that they have built in protections for you as well as uphold your rights to medical treatment and decision-making capabilities. Your support team will walk with you through the process and ensure that your questions are answered and your concerns are addressed.

At Gestacy, we ensure that our surrogates are put first, treated with both respect and dignity as well as supported and cared for throughout the process by a team of experts and experienced surrogates who can help guide you through the process.

Know your choices

The ultimate goal of surrogacy is to help create a family for an individual or couple who are unable to conceive and create a family without a little help. Who doesn’t need a little help sometime?

As surrogates you have the right and power to choose. Among the many choices you get to make are:

Who to carry for?

Surrogacy is a long and beautiful process, one that can lead to amazing bonds with the intended parents. For this reason, it is important that the surrogate chooses an individual or couple that she is comfortable with and feels supported by. At Gestacy you will be given the opportunity to see profiles and choose the couple or individual that you want to carry for, this choice is yours to make.

Legal Counsel?

You have the right to choose your own legal counsel, this is not a decision that is made or should be made for you. It is important that you feel you have a lawyer that is working in your best interest and protecting your rights. At Gestacy we will make recommendations and give you options on lawyers that have a proven track record within the field of surrogacy and working with surrogates; But the final decision is yours to make.

Medical Treatment

As a surrogate you have the right to make decisions about your medical care, who your doctors are, and which hospital you want to work with as well as which treatments and procedures you are willing to undergo. While it important to work with the intended parents to ensure that all parties are on the same page and comfortable with the decisions made, the final decision resides with the surrogate.

Your responsibilities

Being a surrogate does come with some responsibilities, as any legal and medical process will. Knowing your responsibilities and being willing to meet them is important to the surrogacy process.

Paperwork

Surrogates are responsible for ensuring all their paperwork is completed. This paperwork includes your application, medical and pregnancy records, medical insurance policies as well as completing your psychological and medical evaluations. These records are essential to completing the surrogacy process and the sooner they are all completed the quicker you can begin the process with your intended parents.

Invasive Procedures

It is important to consider your views on potential invasive procedures you may be asked to undergo throughout your journey. The list provided is examples or potential procedures you should understand and decide if you are comfortable with or not: termination, selective reduction, amniocentesis, multiple births. At Gestacy we do our best to match you with intended parents who match your views on these to ensure that our surrogates feel no pressure to change what they are comfortable with or undergo any medical procedure.

Pregnancy Care

Being pregnant and taking care of yourself is essential in any pregnancy, and this does not change through the surrogacy process. You are responsible for ensuring proper medical treatment is being sought, avoiding foods and substances that could potentially harm the baby as well as risky activities that could pose danger or cause unnecessary complications during pregnancy.

Legal

You are responsible for ensuring that you cooperate with the legal proceedings and submitting the necessary legal paperwork to ensure that the intended parents are named as the legal parents to the baby you are carrying. This both removes any potential responsibility on the part of the surrogate after the baby is born as well as provides peace of mind to all parties involved.

Respect

Surrogacy can be a stressful and complicated process. Mutual respect is a cornerstone of surrogacy, as surrogates you are deserving of both respect and appreciation. It is important to also understand that this is a very scary and nervous time for your intended parents as well. Mutual respect goes a long way in making this not only a successful journey but a rewarding and fulfilling one as well. As surrogates you are responsible for ensuring that you both involve your intended parents on the level you all discussed and keep them up to date on the pregnancy as well as all the medical processes you are going through.

The Gestational Carrier Agreement

After considering your options and choosing which family you want to carry a child for, the gestational carrier agreement becomes your framework for your individual surrogacy journey. This agreement is the basis of protection for all parties involved, insuring that you are legal covered, your rights are upheld and your decisions are respected throughout the process.

Supports

Gestational surrogacy can be both emotional and difficult at times throughout the journey, it is important that the right supports are in place to ensure that you have someone to talk to, hold your hand and support you throughout the process. Gestacy ensures that you have support from within the agency, from other surrogates who have both completed or are going through the process, as well as the clinic you are working with. It is also important to have support at home; family, spouses, children and friends can all help you through any difficult moments that can arise. Please see our blogs on talking to children and family about surrogacy if you need help putting these supports in place.

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Why Choose IVF?

It is a big decision to try IVF, or in vitro fertilisation. It is expensive, and it can be difficult. Not to mention that there is no guarantee of success; Although some clinics do offer a success guarantee now, this is contingent on you having enough embryos to go through the process more than once as well as being able to afford going through more than one round of IVF treatment.

IVF (in vitro fertilization) provides a solution to many individuals and couples helping to resolve their conception issues. Deciding on IVF is a big decision, it is expensive and it can be a difficult path. IVF is often a last resort for individuals and couples who have either tried tirelessly to conceive or are unable to bear a child. The process is both time consuming and costly but for most is the only viable option to create a family in which their child is genetically linked to them. While there is no guarantee that IVF will work, with all the advancements in the last decade the success rates for IVF are high.

So why choose IVF?

Infertility

Infertility affects a large percentage of the population. It is estimated that 1 in 8 Americans suffer from infertility. Because of these numbers it is not surprising that we see a rise in the usage of fertility clinics as well as a push towards financial coverage for fertility treatments.

IVF can be used to treat infertility in patients who encounter the following problems:

  • Individuals with genetic disorders who require egg/sperm donation or wish to have their embryos genetically tested
  • Women who have had their fallopian tubes removed
  • Women with ovulation disorders or who have experienced premature ovarian failure
  • Women who have uterine fibroids
  • Men who suffer from low sperm count or low sperm mobility
  • Women who have blocked or damaged fallopian tubes
  • Men and Women who experience unexplained infertility

 

In most cases IVF treatment is sought after many failed attempts at getting pregnant or following the failure of other fertility treatments.

This is not always the case, as sometimes IVF is the first treatment sought or even the only one looked at which may be the case if:

  • A surrogate is needed
  • An egg donor is being used
  • If a woman’s fallopian tubes are blocked
  • In extreme cases of male infertility
  • If previously created or donated embryos are being used

 

The benefits of IVF go beyond just the conception of a child. With IVF healthy eggs or sperm can be frozen for use in future IVF treatments. For example, people who have cancer sometimes arrange to have their healthy eggs and sperm frozen as chemotherapy and radiology can harm fertility. This can allow them to create a family later on that is genetically linked to them.

In other cases, IVF can be a preventative measure where people or couples choose to use donor sperm or eggs to prevent passing on a genetic disorder to their children.

Always HOPE

It can be overwhelming when looking at the schedule of blood work, ultrasounds and medication, if you couple that with the cost it can be a troublesome and worrying experience, but with the right set of supports in place and a goal for your future IVF can be a wonderful experience that helps you create your family.

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What Does the Psychological Evaluation Encompass?

Are you thinking about becoming a surrogate? Want to know more about the approval process?

Towards the end of your approval process you will have to undergo psychological screening, this process is intended to ensure that the surrogacy process will not be a depleting or devastating experience for the surrogate.

 

Most agencies will cover this, in the case that you are not working with an agency you will want to ensure that you work with a psychologist who understands the emotional impact of surrogacy so they are better able to assess your mental state surrounding surrogacy to ensure that surrogacy is a safe option for you and will result in a positive outcome in your life.

Understand that it is normal to feel nervous about the screening test, and that this test is not intended to judge you as a person but rather to ensure that you as the surrogate will not be negatively impacted by the surrogacy process. Remember that there is no right or wrong answer, answer as honestly as you can and try not to think about the end result, just remember this step is in your best interest to protect you.

 

The questions you will be asked are meant to make sure that you have both the personality and the emotional maturity to know and understand what will be asked of you as a surrogate, the possible decisions you will be asked to make, and the emotions that you may experience throughout the surrogacy journey.

 

The screening is done by a psychologist or social worker specializing in third-party reproduction. They will want to know if you have had any psychological challenges and how you were able to overcome them and resolve them. You will talk about what you should consider before becoming a surrogate in order to help you think and reflect to ensure that being a surrogate is a healthy and positive decision for you.

 

When the screening takes place is depended on the clinic and agency you are working with, but it is a requirement in any surrogacy journey. It can be done in conjunction with the medical screening or separate. But once both the psychological and medical screening are complete the process tends to move at the speed in which you are comfortable with.

Evaluation

Personality Assessment Inventory (PAI)

In some cases, you will undergo a personality assessment in conjunction with your psychological evaluation, this depends on both the agency and the clinic you are working with.

The PAI is a 344-item personality test that assesses the surrogate’s personality and psychopathology, this test takes roughly an hour to complete. It’s divided into 22 scales, including anxiety-related disorders, alcohol and drug problems, aggression, dominance, warmth, inconsistency, and negative/positive impressions.

Personality Assessment Inventory (PAI)

The psychological screening is a mandatory requirement. This meeting can be scheduled in person or conducted via facetime/Skype.

During this interview the surrogate will be asked a series of questions regarding:

  • How she sees the surrogacy journey, and what she is comfortable and not comfortable with
  • What the surrogate’s support system looks like
  • Who she would like to carry a baby for
  • Questions regarding invasive procedures, her thoughts and feelings on such things as selective reduction and pregnancy termination

In the case of a surrogate who is in a relationship the examiner will also request to speak to your spouse or significant other in order to ensure that both you and your partner are on the same page throughout surrogacy journey. Effective evaluation, clear expectations and communication between all involved parties help to ensure the possibility that the IPS and Surrogate can have a healthy, happy and safe surrogacy journey.

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What does the Medical Screening Look for?

So, things are moving along for you. You have done all the paperwork and you have met the perfect family you want to take this journey with. Your application is completed and your ready to move forward. Your appointment with the fertility clinic is set for your medical screening.

Its normal to have questions, and its also normal to be nervous.

So, lets discuss what you can expect at the IVF Clinic, what kinds of tests will they be running and what are they testing for, as well as what makes you a good surrogate from a medical standpoint.

Like with any other doctor, your Intended Parent’s (IP’s) IVF doctor will first want to see your previous pregnancy records. Prior to your appointment you will be asked to communicate with your regular doctor to release these records to the clinic. Having these records prior to your appointment can move the process along faster. The Reproductive Endocrinologist (R.E.), which is the IVF doctor will want to go through your records to check for healthy past pregnancies to ensure surrogacy is a medically safe procedure for you. The R.E. will be looking for medical complications in your past such as placenta previa, premature delivery, gestational diabetes, low amniotic fluid, placenta bleeding, leaking fluid etc. While not a certainty, any of these complications are considered red flags which make for a less ideal surrogate candidate with a higher percentage of not being accepted by the doctor even if you have previously been accepted by the agency.

Your initial screening appointment will usually include a series of blood tests, a hysteroscopy, uterine measurements, cervical cultures and a toxicology screening. Some of these tests may not be required depending on both the clinic and the extent of your medical history records.

What exactly are these tests?

Blood tests

These blood tests are performed to test for disease, wellness and health. Each fertility clinic has their own set of things they are examining in the blood screenings, here are some examples (but not limited to):

  • HIV
  • Rubella
  • Varicella
  • Blood Type
  • Ab Screening
  • CBC (complete blood count)
  • Metabolic Panel
  • Hepatitis B
  • Hepatitis C
  • Thyroid Function
  • Prolactin
  • Vitamin D
  • Syphilis
  • Chlamydia
  • Gonorrhea
  • HTLV-1
  • RH Factor

Miscellaneous Screening: You will also be given a series of tests to check for alcohol, drugs and nicotine. Positive results for drugs or nicotine are an immediate disqualification. If you have elevated levels of alcohol in your system which could indicate alcohol abuse this is also a disqualifier for surrogacy.

Hysteroscopy: This procedure is similar to a pap smear, in this test the R.E. uses a hysteroscope which is a thin lighted tube to look at the health of the cervix, uterus and uterine lining. During this procedure the R.E. is looking for abnormalities, tears and general health of these organs. You may be given a sedative to help you relax if you feel you need one.

Uterine Measurement: The R.E. will measure your uterus to make sure that it falls within the normal size and shape for pre-pregnancy and that there are no major abnormalities that could prevent pregnancy or make transfer difficult.
Spouse: In the case that you have a significant other or are married, your spouse/significant other will also be required to be tested for contagious diseases, alcohol, drugs and nicotine. Because your spouse is a part of both your journey and your support network they will need to pass both in order for you to be considered a healthy candidate for surrogacy.

Pelvic Exam: In most cases the R.E. will require you to do a pelvic exam. This is a familiar exam for most woman who have been pregnant. This exam is done using a transvaginal ultrasound wand to check the position of your uterus, ovaries and to rule out any intrauterine irregularities that may make it difficult to become pregnant through IVF such as fibroids and adhesions.

Overall,

All the tests are put in place in order to protect you as the surrogate during pregnancy as well as to protect the baby from potential risks factors that can be easily prevented.

The medical exam is put in place to ensure that surrogacy is a safe option for a surrogate. Surrogates are amazing women who give of themselves, share their lives and give hope to individuals and couples who are unable to create their families without them. It is important that the surrogate is safe, supported and medically capable of becoming a surrogate without adverse or damaging effects on their lives that could prevent them from moving forward in their own lives with a sense of satisfaction, peace and health.

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What are the Rights of Surrogate Mothers?

Throughout history surrogacy has always been a complicated legal process; With the rise of surrogacy as a viable option to help individuals and couples complete their dreams of becoming a family, it has become a necessity for the laws to expand to ensure the rights of the surrogate are protected and respected just as much as the rights of the intended parents. Because a surrogate is giving both her time and energy to what can be a very physically demanding process in order to help others it is important that their rights are specifically outlined in the surrogacy agreement.

During the surrogacy process documents protecting the right of all parties are signed well before pregnancy, these documents outline the rights of the surrogate and the intended parents, the expectations of both parties and all financial expectations and benefits. It also outlines who is responsible for decisions in the event of unforeseen circumstances and complications.

So, what are the Surrogate’s rights?

During the surrogacy process documents protecting the right of all parties are signed well before pregnancy, these documents outline the rights of the surrogate and the intended parents, the expectations of both parties and all financial expectations and benefits. It also outlines who is responsible for decisions in the event of unforeseen circumstances and complications.

Because surrogacy includes both the intake of medicine to facilitate the process as well as many complicated and serious medical procedures there are unquestionable rights for the surrogate that are protected and upheld throughout the process by way of the surrogacy contract.

  • The surrogate has the absolute right to make decisions regarding herself as well as the pregnancy, more specifically the surrogate has the right to terminate the pregnancy at anytime should she choose to do so, and the same works in reverse where the intended parents wish to end the pregnancy; the surrogate is free to choose the alternative and continue the pregnancy.

To avoid any potential complications in this area it is important that the surrogate and intended parents work together to ensure that all parties are in agreeance and on the same page regarding what would happen in the event of complications and unforeseeable circumstances should they arise.

  • The surrogate has the absolute right to be informed about all medical procedures that she has to forgo and the medicine that she will have to take, both what the medicine is for as well as any possible side effects that could be a result.
  • The surrogate has the right to health insurance, at no cost to her. Should the surrogate have surrogate compatible health insurance she has the right to be compensated for the use of that insurance.
  • The surrogate has the right to be medically examined at no cost to her, as well as to seek free medical support should she experience any side effects as a result of the medication or procedures. The surrogate also has the right to visit the doctor regularly throughout the process with no cost to her.
  • The surrogate has the right to seek psychological help during pregnancy as needed without bearing the cost on herself.
  • The surrogate has the right to receive the monetary compensation as set out in her contract, and in the timeline agreed to by both parties.
  • In the case that a surrogate agrees to carry a child for a couple that has HIV or Aids she is entitled to consult an infectious disease doctor to be fully informed about the possible risks to her health.
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How to prepare for embryo transfer

When it comes to the embryo transfer it is the cornerstone of any fertility treatment. It is the final step of the IVF process, and after weeks of being monitored and taking medication to help the process this is the moment when all your work and effort come to and end; the transfer will either take resulting in pregnancy or the transfer will be unsuccessful requiring another round of IVF treatment. This is the point where it becomes a waiting game with fingers crossed hoping for implantation.

What is embryo implantation?

Implantation is what occurs when the embryo attaches to the wall of the uterus into the endometrial lining. With IVF this usually occurs one to five days after the embryo transfer. During an IVF cycle a woman takes medication to make her endometrial lining as thick as possible to help increase her chances of successful implantation.

What are the chances of success with implantation?

There are two major factors that affect the chance of successful implantation, the first is the quality of the embryo and the second is the receptiveness of the uterus.

Embryo Quality

Embryos are at their healthiest state when the eggs used are young, which is why we see a decrease in the number of successful transfers as the eggs used come from older women. Poor egg quality results in embryos that are often not healthy enough to complete implantation resulting in a non-successful pregnancy. In many cases a woman whose eggs are not healthy enough for the IVF process can use an egg donor to help increase their chances.

Uterus Receptiveness

The human body is a complex organism and so many factors contribute to how receptive the uterus is to implantation. Which is often the case when it comes to women who have spent years attempting to become pregnant to no avail. Among the many factors that contribute are hormones, autoimmune disorders, thyroid function, trouble with building a uterine lining as well as the shape and position of the uterus. In some cases, these issues can be solved with medication to help increase, decrease or stabilize the issues, in other cases this is where a surrogate becomes a necessity to complete a successful IVF cycle.
The clinic will run a series of diagnostic tests and images to help determine the problem in order to attempt to solve it. Unfortunately, once following the doctor’s recommendations on medication and health there is little a woman can do to ensure implantation, the process is out of the woman’s control and all she can do is wait and see, stressing too much can cause more problems, it is best to relax and wait and give the process a chance to work.

Before Transfer

Embryos are transferred three to seven days after being monitored in the lab. Blastocysts are embryos that have been monitored for at least 5 days which allows for more testing of the health of the embryo which allows for transfer of the healthies and most viable embryos which is known to increase the rate of successful implantation.

Preimplantation Genetic Screening (PGS)

This is a technique that is used to ensure that the embryos have the right number of chromosomes. It is where the embryologist screens for genetic mutations that could cause implantation failure.

Preimplantation Genetic Diagnosis (PGD)

PGD is a screening test used to screen for single-gene disorders where parts of chromosomes are rearranged. This test is used primarily when a patient is concerned about specific disorders or genetic abnormalities such as Cystic Fibrosis, Tay Sachs or other severe genetic disorders.

Both tests are done in a lab and pose very little risk to the embryos.

Other Techniques

In the case where genetic testing is not performed there are other techniques that can offer insight into both the health and development of the embryo.

Assisted Hatching

Embryos in the early stage of development are surrounded by a thin membrane that is known as the zona pellicuda. In order for an embryo to complete successful implantation the embryo must ‘hatch’ from this membrane. In the technique known as assisted hatching the embryologist uses a microscope to create a tiny hole in the membrane which can help to improve the chance of implantation.

Time Lapse Photography

With this technique the embryo is placed in an incubator called the EmbryoScope which takes photos of the embryo every few minutes and then creates a time lapse video that the embryologist can watch to determine how the cells are dividing and developing. These patterns in development can help the embryologist to determine the health of the embryo and ensure that the best embryos are chosen for transfer.

Medication

In most IVF cycles medication is used to manage and control your hormones both before and after transfer to help prepare your endometrial lining to ensure that most ideal uterine environment for implantation and embryo development.

Transfer

Your doctor will discuss the best treatment plan as well as the number of embryos to transfer.

Elective Single Embryo Transfer (eSET)

With eSET the healthiest embryo is chosen for transfer, with other viable embryos frozen for future use with cryopreservation, this procedure is often used when the embryos are at the healthiest state or when there may be more risks involved with carrying multiples.

Multiple Embryo Transfer

When more than one embryo is transferred it is most often for one of two reasons; the health of the embryos is not ideal so transferring multiple embryos will increase the chance of at least one embryo implanting or when the parent(s) are hoping to increase their chance of multiple birth.

On the day of transfer

You will be given the opportunity to both confirm your identity and the number of embryos to transfer. You may be asked to arrive at the clinic with your bladder half full which can help to improve visibility of the abdominal ultrasound when it comes to transfer.

The embryos transfer will feel much like a Pap Smear. The entire process is a quick procedure that will only take about 15 minutes, with the transfer itself being under a minute. During this procedure a speculum is placed in the vagina and your cervix is washed and cleansed to prevent infection. The embryos are placed into a catheter and passed into the uterus. You will be able to watch the transfer take place on the ultrasound screen.

In most cases the woman is asked to relax with her legs slightly elevated for about 15 to 30 minutes following transfer, this is not always the case but it is good practice to relax and allow your body to do the work.

Is there anything you can do to ensure implantation?

Not really, our bodies are largely out of our control. However, there are some ways to help the health of your uterus.

Try massage, gently massaging your abdomen can help with digestion and to remove toxins from your body. You may also want to try fertility yoga which can help to relieve stress.

Try to avoid being cold, cold hands and feet can mean poor circulation and at this point you really want to ensure blood is circulating to your uterus.

Get your rest, now is not the time to exhaust your body, your body needs its rest to ensure that is has the energy to do what you need it to do in the upcoming weeks.

Try not to stress, stress always has negative impacts on your body and can cause unnecessary problems. If your struggling watch a movie that will make you laugh or even try some laughing exercise. Laughter is always the best medicine for stress.

After Transfer

After transfer there is no set way to ensure implantation. It is recommended that you take it easy and relax. Bed rest can be beneficial in the days that follow and maintaining a low stress environment can be vital, which can be hard in the dreaded two weeks wait following transfer before taking that official pregnancy test to determine whether the transfer was a success or not. It is important not to overwork yourself with vigorous exercise which can lead to uterine contractions which is not something you will want to risk at this point.

 

When it comes to your diet, it is important to eat healthy, there are no superfoods to ensure implantation success, but it is important to eat as though you are already pregnant to ensure that should the transfer result in successful pregnancy that the baby is getting the proper nutrition right from the start. The clinic will most likely have you taking folic acid and prenatal vitamins when transfer takes place.

 

Act as if you are pregnant so the same rules would apply as though you were 5 or 6 months pregnant, you will want to avoid things like hot tubs and saunas as these are not healthy for your body during pregnancy.

 

In the weeks following transfer you will want to avoid things that could cause infection, transfer entails a procedure that can leave your lady parts sore and sensitive, but also susceptible to infection so it is important to avoid submerging yourself in water for a few weeks to allow yourself a little time to heal and prevent infection.

 

Waiting can be hard but remember good things are worth the wait

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An Overview of the IVF Process

Beginning IVF (in vitro fertilization) can often seem overwhelming and the process filled with uncertainty. Remembering your goal of a healthy baby can help you to understand that though complicated the process does have purpose.
It is important for both parents and surrogates to have a clear understanding of how the IVF process works before entering into it. We have given a basic overview of both the process and the risks involved to help you along your way.

What is IVF?

The term IVF stands for in vitro fertilization which is actually Latin meaning ‘in glass’; IVF is an assisted reproductive technology (ART) that is done through the process of extracting eggs, retrieving sperm and them combining both in a laboratory dish to create an embryo which is then transferred to the Uterus. IVF is often the last hope for individuals and couples who are not able to conceive through conventional ways or are unable to carry a child. It has given new hope to the birth of families over the last few decades.

Once combined the egg and sperm are then monitored through the fertilization process where successfully fertilized eggs will become embryos. These embryos are then examined, tested and often frozen to prepare for transfer.

An IVF ‘cycle’ is how we describe one round of IVF treatment, which begins on the first day of your menstrual cycle and lasts on an average of 6-8 weeks. It is important to remember that IVF is not a treatment but a series of procedures that the woman must go through both before and after transfer.

The Cycle Before Transfer

In some case during the cycle before transfer the woman may be put on birth control pills, this has been shown to help improve the odds of success and it may help decrease the risk of such things as ovarian cysts. Birth control is just one of many options available, a woman may also be asked to track her ovulation through such things as ovulation kits and basal body temperature charting; In this situation the fertility clinic will want to be notified once ovulation is detected and the woman may be put on a GNHR antagonist or agonist depending on the specific case. These are usually in the form of an injectable substance, but other forms may be given such as nasal spray or implant. The purpose of these medications is to allow the doctor control over the woman’s ovulation in order to increase the IVF success rate.

Step ONE

The first day of your IVF cycle is the first day of your menstrual cycle. Woman going through IVF will be on medication before the beginning of their cycle so this can be confusing.

Step TWO (if you are doing egg retrieval)

If egg retrieval is being done then fertility medications are prescribed to help stimulate egg production. A transvaginal ultrasound will be given to look at your ovaries along with blood tests to check hormone levels. Ovaries typically only produce one egg; the medication is given to help boost the natural levels of hormones in your body to encourage the follicles in your ovaries to produce more eggs. In most cases the medications used is either follicle-stimulating hormone (FSH) or luteinizing hormone (LH) but other medication may be given more specific to your body and treatment plan.

Step FOUR (The Sperm)

Eggs are retrieved through a surgical procedure where a needle is guided by ultrasound through the cervic to remove the eggs. Medication is often given to help with the discomfort, and you may be put to sleep. The procedure takes about 20 minutes, resulting in an average of 8-15 eggs. Some cramping and spotting are common following the procedure.

Step FOUR (The Sperm)

In this step the male is asked to produce a sample of his sperm which is them prepared for combining with the eggs.

Step FIVE: Fertilization

In this process the eggs and sperm are mixed together in a laboratory dish to help encourage fertilization. In cases where there is a less likely chance of natural fertilization a procedure called intracytoplasmic sperm injection (ISCI) may be used where a single sperm is injected directly into the egg in order to increase the chance of fertilization. Once mixed the eggs are monitored to confirm fertilization and once fertilized they become embryos.

Step SIX: Embryo Development

Once fertilized the embryos are put into an incubator where the conditions for growth and development are perfect. The embryos are then monitored over the course of the next 3-5 days to look at cell development.
A healthy embryo has a two- to four-cell embryo on day 2 and a six- to eight-cell embryo on day 3. Unfortunately, not all fertilized eggs will reach the ideal stage for transfer, some may not mature and in other cases the sperm may not be strong enough.

Step SEVEN: Embryo Transfer

Embryos are usually transferred to the woman’s uterus three to five days following egg retrieval and fertilization, however in some cases the embryo may be frozen to wait for the woman’s body to be in the optimal position for transfer which is usually the case when the embryos are PGS/PGD tested to check the health of the embryos.

In the transfer procedure a small catheter is inserted into the uterus to transfer the embryo(s). this procedure is painless for most women although it may be followed by some minor cramping. Successful transfer results in implantation.

Step EIGHT: Blood Testing

Around two weeks after your embryo transfer you will have a blood test to check your HCG levels in the hopes of confirming pregnancy. The clinic will let you know when this needs to be done.

After the Pregnancy Test

If you find yourself pregnant after the pregnancy test, depending on the clinic you may be monitored by the clinic itself or be transferred to a doctor closer to home for monitoring. Many clinics will monitor you through the first trimester to ensure success.

If the IVF cycle was unsuccessful the clinic will work with you to make a schedule to begin a new cycle.

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Is Paid Surrogacy Legal?

The first surrogacy contract was written in 1980, it was a traditional surrogacy case and the first case in which the courts favored the intended parents and upheld the surrogacy contract. It was five years after that we saw the birth of gestational surrogacy.

Surrogacy is the practice by which a woman becomes pregnant with the intention of the baby being given to ‘intended parents’. There are most specifically two types of surrogates, the first traditional surrogacy is where the surrogate has her own egg fertilized and therefore does carry a genetic link to the baby and the second is Gestational surrogacy where the surrogate, through means of Invitro fertilization is implanted with an embryo that carries no genetic link to her.

While Surrogacy is an evolving practice, the question of surrogacy’s legality is not a simple one to answer. While surrogacy in some form is legal through all US states, the status of which surrogacy is legal varies quite vastly from state to state, as most American legislation does.

In many US states surrogacy is permitted, some with more favorable surrogacy laws then others. As surrogacy becomes more widely accepted the number of states that develop the legal framework to embrace the surrogacy process begins to expand, after Washington and New Jersey’s recent legislations allowing surrogacy as an accepted practice that only leaves Michigan, and New York where paid surrogacy is not permitted in any form and can be subject to criminal sanctions should surrogacy be practiced.

Pre and Post Birth Orders

These documents are an essential part of every surrogacy arrangement in the United States, they set out the legal parents of the child as well as relieve the surrogate of any obligations for the baby. These orders are, in simple terms, a document that sets out the parentage of the baby. Different states require different orders depending on both laws and the venue under which they are accessing the system. These orders are not effective until after the birth of the baby but can often give peace of mind to the intended parents. The main difference between the two orders is when you can apply for them, with pre-birth orders you can start them in the 4th month of pregnancy, whereas, with post birth orders they cannot be applied for until day 3 or 5 after the baby is born.

The Golden States: California, Connecticut, Delaware, Nevada, New Hampshire & Rhode Island

Referred to as the Golden States because they have the most permissive and progressive legal framework for surrogacy.  The legislation in these states protect both the intended parents and the surrogate. They allow for intended parents to hire a woman as their surrogate, establish the intended parent’s parentage before birth which in turn allows the surrogate to be released from any parental obligations upon birth of the child. These states also have the framework in place for the intended parent’s names to be on the birth certificate as well. Because of this legal framework these states attract intended parents from all over the world who are seeking the help of a surrogate to help complete their family.

Extended States: Texas, Utah, Virginia, Wisconsin, Washington DC, Illinois, Maine, Florida, Arkansas, Iowa, New Jersey, Tennessee, North Dakota, Massachusetts, New Mexico, Pennsylvania, Maryland, Wyoming & west Virginia

Those wishing to access surrogacy do not have to go to the golden states to be able to use a surrogate to help create their family. Many states allow surrogacy but may pose limitations on who can use a surrogate based on such things as the genetic link to the baby, sexual orientation and in some states marital status. However, with an attorney who is familiar with the law and able to navigate the system prospective parents can find hope in these states and have successful surrogacy journeys leading to the creation of their family.

In Pennsylvania, Maryland, New Mexico, Wyoming and West Virginia, surrogacy is accepted and permitted, however the process will vary based on conditions and the legal venues under which you are accessing the system, but the courts are favorable in these states as long as you meet the conditions of the state.

The Vacuum States: Georgia, Colorado, Kentucky, Alaska, Alabama, Hawaii, Idaho, Kansas, Louisiana, Minnesota, Mississippi, Missouri, Montana, North Carolina, Ohio, Oklahoma, Oregon, South Carolina, South Dakota and Vermont

There are also states in the country which allow surrogacy by default, merely because there is no legal framework or case laws to rely on. Within these states, while surrogacy is legal it is important to have a 3rd party reproductive attorney to navigate these systems to ensure a seamless journey from start to finish. Most states fall under this vacuum. Georgia, Colorado and Kentucky pose the least amount of restrictions, whereas the rest will award parentage or post-birth parentage restrictions based on one or more of the following: genetic link to the baby, marital status and sexual orientation. In these states it is vitally important to understand the laws of the state you are working under and have the right attorney who knows how to navigate them to ensure you meet the legal requirements of the state.

Unsanctioned States: Arizona, Indiana & Nebraska

In these states, while surrogacy is not illegal the courts and legal framework does not always uphold surrogacy contracts which could lead to the right of parentage for the intended parents in a state of flux with their parentage in question. Surrogacy contracts are often not upheld in these states.