SURROGACY: PROS AND CONS

Surrogacy

Surrogate motherhood – many people talk about it: psychologists, TV shows, the church … “Infertility” is like a sentence for a young married couple, and this diagnosis has already become not uncommon. No one can lose the sonorous laughter of children and meet old age alone, and glory to the scientific progress in medicine, thanks to which such an opportunity as surrogate motherhood has appeared!

The desire to be a happy, complete family takes precedence over the feeling of bitterness and helplessness. It makes you look for a way out of such a difficult, seemingly impasse.

If traditional treatment methods were powerless, then modern medicine offers assisted reproductive technologies, such as surrogacy with the possibility of IVF.

An important condition for such a procedure is functioning ovaries. Doctors use the sperm and eggs of a couple who have tried repeatedly and unsuccessfully to conceive. The resulting embryo is transferred into the uterine cavity of a healthy woman, who will be the surrogate mother for the baby under the IVF program. This procedure ensures the formation of an embryo that is genetically related to the couple. Already, thousands of babies have been born in this way.

How does the surrogacy procedure work?

Adopting a child, one or two, three – perhaps there are such cases, but many couples want their child, which does not work. Women often try to carry a child, reaching a critical situation that is dangerous for the child and the woman. This concerns, first of all, the question of life. In such cases, a program with the participation of a surrogate mother comes to the rescue, who will bear a child for an infertile couple and possibly for a single parent. This method of overcoming infertility has become the most popular worldwide. Who can be a surrogate mother:

• relatives;
• familiar;
• women who are not related by kinship (outside women who want to receive a reward).

Since there are certain requirements for outsiders, then special agencies that already have selected candidates are usually engaged in selecting a surrogate mother.

The main requirements for a surrogate mother are as follows:

• the age category should be from 20 to 35 years (exceptions are possible for close relatives);
• having a healthy child of their own;
• a woman must be healthy physically and psychologically;
• no history of chronic, hereditary diseases;
• lack of operations on the reproductive organs, ectopic pregnancies, cesarean sections;
• notarized consent of the spouse, if the candidate is legally married
• the absence of bad habits is a prerequisite for all applicants;
• social well-being: status, the well-being of the family, professional activity, ecology in the place of residence.

To prepare for the process of surrogate motherhood, a woman must undergo a thorough examination: a gynecological examination and ultrasound of the pelvic organs, as well as psychological testing. If there are no pathologies of the reproductive organs, then the woman is sent to the next stage of examinations, these are instrumental diagnostics and laboratory tests:

• Analysis of urine;
• blood chemistry;
• A clinical blood test with a coagulogram, i.e., this is a comprehensive analysis that allows you to assess blood clotting;
• blood test for HIV infection, syphilis, hepatitis C, and B viruses;
• Ultrasound of the pelvic organs;
• fluorography;
• swabs for urogenital infections (chlamydia, mycoplasma, ureaplasma);
• smears on the microflora of the vagina, urethra, and cervical canal;
• oncocytological studies of scraping from the cervix;
• tests for infections such as rubella, hepatitis, and cytomegalovirus;
• psychiatric consultation;
• Conclusion of the therapist about the absence of contraindications for pregnancy and childbirth.

For future fathers, it is also necessary to pass the necessary tests:

• blood for HIV infection, hepatitis C, B, and syphilis;
• blood testing for IqG, M to cytomegalovirus, and herpes simplex virus type I and II;
• spermogram indicators: volume, viscosity, the color of ejaculate (sperm), morphology, and activity of spermatozoa;
• smear on the flora from the urethra.

If early hidden pathologies were revealed during the preparation, the list of examinations and analyzes could be increased.

An obligatory stage of surrogate motherhood is the procedure of in vitro fertilization, during which genetic material is provided to the biological mother.

For the endometrium of the uterus of the surrogate mother to be able to accept the implanted embryo, the menstrual cycles of the biological and surrogate mothers are synchronized.

Suppose it is impossible to combine the phases. In that case, implantation is delayed until the moment when the uterine mucosa and the hormonal background of the candidate correspond to the luteal phase, that is, the time interval between ovulation and the onset of menstrual bleeding. Embryos for this period are subjected to cryopreservation; this freezing method prevents the formation of ice crystals that can damage the embryo’s cells. And to get a large number of eggs, a woman is prescribed special hormone therapy at this time. Control of the growth and maturation of eggs is carried out under the supervision of ultrasound.

The next step will be ovarian puncture, which is performed on the biological mother 35-36 hours after the introduction of the human chorionic hormone (hCG). The hCG hormone appears on the 6-8th day after fertilization; it shows the presence of a successful pregnancy. The puncture is performed under sterile conditions, under general anesthesia, in a transvaginal way. The follicular fluid with eggs is sucked off from mature follicles with a special aspiration needle, which is then placed in an incubator. This procedure is carried out by puncturing the posterior fornix of the vagina and the ovarian parenchyma – the main tissue of the ovaries, in the layer of which there are follicles.

Sex cells can also be removed by laparoscopy (surgery through external punctures) if there are large adhesions in the pelvic area or if the ovaries are located abnormally when the transvaginal method cannot be used.

Then semen is obtained from the biological father. If there is obstruction of the vas deferens, then puncture the epididymis. The procedure is performed on the same day as the ovarian puncture of the biological mother.

The final step will be fertilization. Standard in vitro fertilization occurs with good sperm counts and sufficient availability of eggs. At this stage, selected healthy male and female cells are placed in a special nutrient medium, where the sperm chooses the egg itself and attaches to its surface. With the help of special enzymes, the surface layer of the egg is dissolved, and the sperm penetrates inside. As with natural selection, the egg is fertilized by the most active and complete sperm.

After fertilization, the zygote (fertilized egg) is in a nutrient medium for 3-5 days, where it further divides. Then the grown embryo is transferred to the inner epithelial layer of the uterus, which has already been prepared with the help of hormonal therapy.

IVF and surrogacy

The in vitro fertilization program is a miracle for a childless family. Possibility to give birth to a child without long-term infertility treatment. Many will even consider whether it is worth doing this, waiting and believing for so long, when faith becomes smaller over time.

A test-tube baby grows and develops in the mother’s womb in natural conditions. After birth, the baby is no different from ordinary children; only specialist doctors who fertilize the egg outside the female body and then transfer the embryo into the uterine cavity later know this. In the future, the course of pregnancy and childbirth will proceed as in normal pregnancy in an ordinary woman. Sometimes this method is the only possible one for many pathologies, namely:

• the presence of hormonal disorders, the absence of fallopian tubes;
• when the circumstances of infertility are not defined;
• blockade of the genadotropic function of the pituitary gland before stimulation by superovulation.

To do this, procedures such as:

• hormonal stimulation of the ovaries;
• ovarian puncture under ultrasound control;
• embryological stage, i.e., fertilization of the obtained eggs with sperm;
• transfer of the embryo into the uterine cavity;
• hormonal support of the female body after the transfer of embryos into the uterine cavity.

Usually, the blockade of the genadotropic function of the pituitary gland begins on the 21st day of the menstrual cycle; a woman is given a special drug. Perhaps the body will react with dizziness or headache, irritability, and mood changes may appear after discontinuation of the drug, and the normal state returns.

The next step will be the growth and maturation of follicles with eggs.

With natural ovulation, one egg is released from the ovaries and may remain unfertilized; with IVF, it is possible to receive several eggs. Ovulation is carried out with special drugs that contain follicle-stimulating hormone (FSH), which is responsible for the maturation of follicles and the egg.

Starting from the 2nd-5th day of the menstrual cycle, FGS preparations are administered for 8-12 days. During this time, many follicles mature, inside which the eggs are located. With the help of ultrasound, you can monitor the condition of the ovaries, the mucous membrane of the uterus, and the development of follicles.

Upon reaching the follicle of a certain maturity, an ovulatory dose of the drug chorionic gonadotropin (CG) is prescribed, which prepares the eggs for release from the follicle. This procedure is performed under short-term anesthesia and ultrasound guidance. It must be borne in mind that during the examination, it is necessary to come on an empty stomach, as there will be intravenous anesthesia. And there will be one more requirement of anesthesiologists – not to paint lips and fingernails. It is necessary to refrain from sexual activity for 3-5 days.

For a man, it will be necessary to donate sperm, which will be processed accordingly and used in the future for fertilization.

The eggs obtained by puncture are transferred to embryologists, and the next stage in the IVF program begins – embryological.

The bowl of a nutrient solution containing the eggs is placed in an incubator, where the egg is kept under conditions similar to those of a woman’s natural body. After 5-6 hours, the eggs are fertilized with same-day sperm. Before such a manipulation, spermatozoa are also prepared – they are separated from the seminal fluid, washed, and placed in a nutrient medium.

When the eggs and sperm are mixed, they are returned to the incubator. The sperm cannot fertilize the egg due to a decrease in the quality of germ cells. Then the specialists help the sperm penetrate the egg and fertilize it.

If a man is infertile due to any disorders, then the spermatozoon is taken from the epididymis or isolated from the testicular tissue.

To predict genetic diseases, pre-implantation diagnosis is usually used even before embryo transfer into the uterine cavity.

It is possible that after fertilization, many high-quality embryos are in the test tube, then they are subjected to conservation in liquid nitrogen.

And if a woman does not get pregnant, there is a chance to use the saved embryos.

Indications for the surrogacy program

For the procedure of surrogate motherhood to be approved by doctors, several indications are required, which include:

• congenital or acquired absence of the uterus or its underdevelopment;
• Obstruction of the cervical canal – an anatomical disorder expressed in partial or complete fusion of the canal. This congenital anomaly, like synechia, may be acquired due to any situation. The formation of a new cervical canal is possible, but this does not guarantee the bearing of a child;
• Untreated synechia or Asherman’s syndrome are adhesions (partial or complete) in the uterus. These may be the consequences of difficult childbirth, curettage, missed pregnancy, the use of intrauterine devices, the removal of fibroids;
• more than three miscarriages;
• more than three failed embryo transfer attempts;
• The presence of chronic genetic diseases, such as Rokitansky-Kustner-Mayer syndrome. With this syndrome, the uterus is either absent or has an irregular structure; the vagina may be short or absent altogether. Often, surgery does not solve the problem.
• Repeated, unsuccessful IVF attempts, when a couple repeatedly resorts to reproductive methods, but each time certain problems occur – the impossibility of implantation for unexplained reasons in the presence of a healthy embryo or missed pregnancy, multiple miscarriages, exhaustion of the woman’s body as a result of repeated attempts to bear a child;
• Pregnancy complications are rare, but it is a sad case since a woman does not have the opportunity for this for medical reasons. However, everything is in order with reproductive functions; these include severe heart defects, epilepsy, systemic lupus erythematosus, liver cirrhosis, oncological diseases, and diseases of the kidneys, which can lead to chronic renal failure. This is a serious physiological and psychological problem. In case of a strong desire to have your child, you should not wait, but it is better to contact the specialists of the surrogate motherhood clinic; as a rule, these are IVF clinics. This is the best option since the clinic conducts the so-called IVF protocol and guarantees the surrogate mother’s health.

Conclusion

For the first time, they learned about surrogacy in the United States in 1986, when a woman was implanted with someone else’s embryo, and she endured, safely gave birth to a healthy baby with genetic material alien to her.

Do not confuse the surrogate motherhood program with artificial insemination, which involves the introduction of male sperm into the woman’s genitals, in which case the baby born by the surrogate mother will be her own.

An important point in the method of surrogate motherhood can be considered the procedure for mandatory testing of the embryo for genetic diseases, such as:

• Down syndrome;
• Turner syndrome;
• muscular dystrophy;
• Blood diseases.

Cell transplantation to a surrogate mother is allowed within two embryos; the woman’s written consent is required for the third.

 Recall that all subsequent stages of pregnancy in a woman pass as in a normal pregnancy.