Discuss Times report, The Surrogate
[Carrie Pratt | Times]
A seven-part series running this week chronicles the exhaustive efforts of a career surrogate mother from Bradenton as she tries to get pregnant one last time.
Are you curious about how it all works or do you have questions about the series? Join a live discussion with a Tampa fertility doctor and reporter Leonora LaPeter Anton from 10 - 11 a.m. Thursday.
Post your questions or comments now.
This is Dr. David Keefe, from USF IVF. I'd be happy to address any questions you have about this story.
I agree adoption is a wonderful option. However, it's not for everyone. Some couples are considered by adoption agencies as too old to adopt. In many cases it's not any less expensive either. Adoptions frequently require tens of thousands of dollars in legal and administrative fees. For many couples the genetics are less important than the fact that the baby will grow in the uterus of a woman, the surrogate, who will take the same precautions in terms of eating healthy, avoiding smoking, alcohol and drugs as the intended mother herself would take if she were medically able to carry the baby. At USF IVF we discuss all options, provide the pros and cons of each, and help couples decide what works best for them. For some couples surrogacy is the best option.
Screening the surrogate is a very important part of the process, not only to ensure the treatment works out for the intended parents and the resulting baby, but also that it is the right choice for the surrogate herself. The surrogate meets with a therapist who is highly experienced and knowledgeable about surrogacy specifically and infertility in general. In addition, before training in Ob/Gyn and Infertility at Yale, I trained in Psychiatry at Harvard. The goals of this evaluation are to ensure the prospective surrogate understands the implications of carrying a baby for another couple. Does she live a healthy lifestyle? What will it be like for her to give up the baby to the intended parents at birth? Have the intended parents and the surrogate decided what relationship the surrogate will have with them and the baby after birth? We discuss boundries. We like to understand what makes the surrogate tick, to make sure serving as a surrogate is the right choice for her. Next, I obtain an extensive medical history, especially about her prior pregnancies. How did her prior pregnancies and deliveries go? Did she need a cesarian section? Did she develop any medical problems during pregnancy? We help her understand how each pregnancy can be a little different. We perform an extensive battery of blood tests to make sure her body is ready for pregnancy, and we ensure her uterus is healthy enough to carrry the baby. We perform a drug screen. And we do a back ground check to make sure the story fits and that there is not history of criminal behavior.
Selfish is not word I would use to describe the couples I have known who pursued surrogacy. My experience is the opposite- they want to give all their love to a baby. Many for one reason or another cannot adopt. Others want to create a baby with their husbands. Many of us take for granted the ability to have a child.
The number of embryos to transfer to a surrogate is one of the most important discussions we have during the process. Bottom line- the more embryos we transfer to the surrogate, the better the chances for the attempt will lead to a pregnancy, but also the greater the chance of twins or more. At USF, we rarely transfer more than two fresh embryos, because we fear the complications of a triplet or quadruplet pregnancy. Triplet and quadruplet pregnancies can create major and sometimes lifelong complications for the baby (e.g. cerebral palsy, lung and eye damage, etc) because they almost always deliver prematurely. Complications to the surrogate also arise from these higher order multiple pregnancies, so we try to transfer one or two embryos. The key is to have an efficient program to freeze and save the extra embryos. We use a new method of freezing which gives almost the same success rate to frozen thawed embryos as to fresh embryos. This puts less pressure on everyone to transfer multiple embryos during the fresh cycle.
The success rate of the surrogacy cycle dpends largely on the age of the woman (typically the intended parent) providing the eggs, because the effects of reproductive aging are felt first by the eggs. The uterus doesn't age very rapidly. Many 50 year olds remain physically fit and emotionally ready to care for a baby, but unfortunately their eggs rarely hold up. There are exceptions- my own sister was conceived when my mother was 47. Many women in their mid forties onward use an egg donor.
Success rates with fresh embryos are higher than with frozen thawed embryos. The age of the woman providing the eggs is the single, biggest determinant of the success rate of frozen thawed cycles, as it is with fresh embryo transfer cycles. The technique and skill of the IVF laboratory freezing the embryos, however, also plays a big role. The best technique to freeze embryos is vitrification. Vitrification avoids formation of ice within the embryo. Embryo have lots of water inside them, and therefore will crack from ice expanding once they are cooled. Vitrification adds a kind of natural antifreeze to make sure no ice crystals form in the embryo. The embrylologist doing the freezing has to have deft hands, advanced training and great focus to perform vitrification properly. At USF IVF, vitrification of embryos from young women produces embryos which deliver a 40% pregnancy rate once the embryos are thawed and transferred.
Egg donors ideally are younger than 35, healthy, drug, alcohol and tobacco free, with no major medical problems, reliable, and not over- nor underweight. They also need to understand all that is involved in donating eggs to another woman. They need to feel comfortable that their genes will contribute to a baby who will be raised by someone else. We also like to find a donor who looks something like the recipient, so the baby will feel like he/she fits in. We need to know that the donor is stable emotionally, and motivated to go through the entire process, because dropping out can be devastating to the recipients and discouraging to the donor herself. She undergoes a psychological evaluation and physical, genetic and laboratory exams. There does not seem to be any major difference in success rate from the egg donation cycle if the donor has made a pregnancy previously. Finally, boundries for the relationship between donor and recipients have to be discussed and agreed upon before the cycle.