The first pregnancy following gestational-surrogacy was described by Utianet al1 and since then surrogacy has become a viable option for many infertile couples to have a biologically related child, especially in whom it is impossible or undesirable on medical grounds for the intended mother to carry the child herself.
We have two type of surrogacy either it can be Traditional or Gestational surrogacy. In Traditional surrogacy, the surrogate mother provides the oocyte as well as the uterus to foster pregnancy. Well in gestational surrogacy which can also called as full surrogacy or IVF Surrogacy over here the surrogate 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 abortion
- Repeated failure of IVF treatment
- Sever 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 surrogate mothers which were strictly adhered to while recruiting these surrogates.
- Surrogate mother should not be more than 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 a relative acting as a surrogate, the relative should belong to the same generation as the women 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. We as a routine perform hysteroscopy in a previous cycle for all women to evaluate the uterine cavity. The commissioning couple and the gestational carrier along with their spouses then undergo psychological and legal counseling 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 is 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 transvaginalsonographies and serum estradiol levels. HCG is administered when two or more leading follicles reached ≥ 18mm and oocyte retrieval is done under general anaesthesia after 34–36 hours.
The gestational carriers undergo pituitary desensitization by a long acting GnRhanalogue administered in the luteal phase of the previous cycle. All these then receive exogenous estrogen (estradiolvalerate) 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 estradiolvalerate 6mg/day and micronised progesterone 600mg/day. ß–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 starting of progesterone.