STEP 1 To whom surrogacy is advised?

There are several groups of patients that natural and IVF surrogacy may be advised to. IVF surrogacy Women whose ovaries are producing eggs but they do not have uterus this could be because they have had a hysterectomy performed due to cancer, severe haemorrhage or ruptured womb, or they were born without a uterus. This is by far the most common indication for IVF surrogacy. A woman, whose uterus is malformed or damaged and is incapable of carrying a pregnancy to term, may be recommended IVF surrogacy. Women who suffer from medical problems such as diabetes, heart and kidney diseases and in whom a pregnancy would be life threatening. However, their long term prospect for health is good. Repeated miscarriages where the causes of miscarriage have been fully investigated, may also suggest IVF surrogacy treatment. Traditional surrogacy Women who have no functioning ovaries due to premature menopause A woman, who is at risk of passing on a genetic disease to her offspring, may opt for traditional surrogacy. Women who suffer from medical problems such as diabetes, heart and kidney diseases and in whom a pregnancy would be life threatening may select traditional surrogacy if their long term prospect for health is good. Surrogacy for social reasons such as the inconvenience of carrying a child, fear of pregnancy or interrupting a career is not accepted.

STEP 2 Consultation & Assessment

Consultation with a medical doctor to assess whether the couple is medically suitable for treatment. Assessment of genetic couples
For IVF surrogacy in the ages of commissioning genetic couple should be under 35 years for women and under 55 years for men. In natural surrogacy, no restrictions are placed on the mans age.

An in depth review of the medical history from both partners and a physical examination is normally performed.

Assessment of the host - the carrier The ideal surrogate should be married or in a stable relationship. Should be between the ages of 21-35. It is also preferable if the surrogate has at least one previous live birth without complications.

Potential surrogates should not have habits of smoking, alcohol, illicit drug use, or a history of medical disorders that could jeopardize the health of the fetes.

In order to ensure the above criteria are met, the patients medical history is reviewed, physical and internal examinations are performed, and the surrogates uterus is evaluated by ultrasound scan or hysteroscopy. Furthermore, a psychological evaluation is usually carried out.

STEP 3 Independent counselling

Many psychological, ethical and legal issues surround surrogacy and hence the independent counselling of both genetic and host couples is strongly recommended. Counsellor shall ensure that all implications of the procedure have been carefully explored and help all parties concerned to come to an understanding of the tremendous impact that surrogacy will have on their life, on the child born as a result of treatment and other children the couple have as well as the difficulties that lies ahead. The counsellor may also address issues of confidentiality, the payment of expenses to the host, and the adoption of the baby by the genetic couple. The counsellor will address antenatal screening and what should be done if the baby is found to have congenital abnormalities. In addition the counsellor may discuss the risk of multiple pregnancy and what the parents will tell the child when they grow up. The distress generated when surrogacy arrangements breaks down can be catastrophic and great care should be taken to provide adequate counselling before embarking on this treatment.

STEP 4 Ethics committee

If the couple seeking surrogacy are found to be suitable, then their case will be put before the ethics committee. This is an independent body of professionals. The ethics committee will evaluate the case and come to a conclusion on whether surrogacy is viable and recommended. In addition, the committee will evaluate the welfare of the child born as a result of the treatment. Selecting surrogate Only few of the many surrogate mothers that are screened are selected, who are in best of health, having good reproductive history, free of any sexually transmitted diseases, and most importantly who have the fervour to support someone to make their family complete. Before presenting any surrogate mother, it is ensured that following steps are followed Detailed interview (verbal and written) Psychological analysis. Reliable support system from family and friends. Detailed medical records reviewed Background investigation

Step 5 Signing the contract of surrogacy

The contract of surrogacy shall be explained in detail, acknowledged and signed for mutual benefit. Legal assistance shall also be provided on signing the contract.

Step 6 Screening before surrogacy treatment

Once the surrogate mother has been matched with her intended parents she will undergo a full medical examination. She will have blood drawn to evaluate her hormone levels and to see if she might have any infectious diseases. She will also undergo a sonohysterogram, which allows the doctor to evaluate the capability of her uterus to carry a pregnancy to term. If the doctor finds cysts, fibroids or endometriosis in her uterus, the process with the particular surrogate shall be delayed or cancelled.

Step 7 IVF surrogacy procedure

The intended mother and the surrogate will receive medications-some oral, some injected that will synchronize her menstrual cycles, stimulate the intended mothers eggs and prepare the surrogates uterine lining to receive the embryos. The eggs are conveyed from the intended mother in a procedure called- egg retrieval. She is usually sedated for about an hour while the eggs are harvested. The eggs are then taken to an embryologist embryos are then transferred into the surrogates uterus. The surrogate is awake for this procedure, which isnt painful. Medications that the surrogate has taken will cause the lining of her uterus to thicken, in order to accept the transferred embryos. The surrogate shall be advised to rest for approximately 24-72 hours following the embryo transfer, in order to ensure the best opportunity for the embryos to implant in her uterine lining.

Because multiple pregnancies impose increased risk to both the mother and the babies, the number of embryos to be transferred will be restricted to two.

Traditional surrogacy procedure.

The surrogate is inseminated with the male partners sperm. The insemination may be either intracervical insemination (ICI) using neat sperm or intrauterine insemination (IUI) using washed and prepared sperm.

STEP 8 Pregnancy testing

Ten days later the surrogate will have a blood test to determine whether pregnancy has been achieved. If the tests are positive, the surrogate will be advised about what further medication or hormone support she will need, if any. Once the fertility doctor considers the pregnancy stable-usually after 12 weeks-the surrogate will be referred to her obstetrician for the remainder of the pregnancy and the birth. Until the baby is delivered, the surrogates pregnancy will be monitored. She will undergo regular hormone monitoring and ultrasounds to check on the status of her pregnancy.

STEP 9 Baby Pickup

The process of bringing a baby born to your home country takes two to three weeks. You need to get a birth certificate, then citizenship for your baby in your native country, and finally an exit visa. * *not applicable for the residents of India Our program is designed for all intended parents regardless of country; however, there are several countries in which surrogacy is illegal. For international clients, the first part of the research process should be determining whether or not their country has laws regarding not only surrogacy, but the legal and citizenship status of a baby born through surrogacy in another country.

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Glossary
Hysterectomy the surgical removal of the uterus Hysteroscopy the inspection of the uterine cavity by endoscopy Antenatal screening any diagnostic procedures performed before the birth of a baby. Congenital abnormalities defects in or damage to a developing fetus. Fibroids A benign tumour of muscular and fibrous tissues, typically developing in the wall of the uterus. Endometriosis A condition resulting from the appearance of endometrial tissue outside the uterus and causing pelvic pain. Uterine lining the inner membrane of the uterus. Obstetrician A physician or surgeon qualified to practice in medicine and surgery concerned with childbirth and the care of women giving birth. Endocrinologist physician who specializes in the diagnosis and treatment of conditions affecting to or the denoting glands that secrete hormones or other products directly into the blood. Andrologist -doctors who look after the sexual health of an individual. Embryologist a physician who specializes in study concerned with the study of embryos and their development.