Surrogacy in Mumbai
We at Ankoor Fertility Clinic are willing to help, you just have to help us by participating. We are here to bridge the gap. Being childless is extremely traumatic for the couple, particularly for the women. Times are changing now with newer technology and almost everyone can be a mother now. Today the society has become more accepting of surrogacy as an option for childbearing. Let us give you insights into helping you bust your myths about surrogacy in Mumbai.
What is Surrogacy?
Surrogacy is when a woman carries a baby for a couple who are unable to conceive or carry a child themselves for medical or physical reasons.
The intended parent(s) are person or persons who become the legal parent(s) of a child born through surrogacy.
Types of Surrogacy:
- Traditional Surrogacy: This is a pregnancy where a surrogate mother is artificially inseminated, either by the intended father or an anonymous donor and carries the baby to term. The child is thereby genetically related to both the surrogate mother, who provides the egg and the intended father or anonymous donor. This type of surrogacy is PROHIBITED according to Indian government guidelines.
- Gestational Surrogacy: This is a pregnancy where IVF is used, either with the eggs of the intended mother, or donor and sperms of the intended father or donor. The surrogate mother, therefore, does not use her own eggs and is genetically unrelated to the baby.
There are three stages to ‘host’ surrogacy:
- Egg donation-
The female intended parent, or an egg donor, undergo special procedures to extract a number of eggs.
The eggs are fertilised with sperms of the intended father or donor in the laboratory, resulting in embryos.
- Embryo Transfer-
The embryo is transferred into the womb of the surrogate mother. The embryos can be transferred into the surrogate either ‘fresh’ or after having been thawed from the stock (frozen embryo transfer- FET). For a fresh embryo transfer, the cycles of the surrogate and the egg donor must be synchronised, and this is done using hormone medications and injections. In cases, where embryos have been frozen already and the thawed embryos are being transferred, the surrogate mother is provided with hormone medications for preparing her endometrial lining, in a planned cycle.
For Intended Parents:
A couple who will raise the child once it is handed over to them by the surrogate is known as a commissioning couple or intended parent. The commissioning couple may both be the genetic parents, or just one or neither of them may be genetically related to the child.
- Indications for surrogacy-
Below are a few listed medical conditions wherein it may be difficult or sometimes impossible to bear a child in your own womb:
- The absence of her uterus since birth is a congenital abnormality. Such women will never have menses/periods.
- Conditions like cancer, severe bleeding in the previous childbearing which could not be controlled or Rupture (tear) uterus leading to obstetric hysterectomy (removal of the uterus) in order to save the mother’s life.
- Damaged or thin uterine lining especially in INDIA:
- Tuberculosis (these women may not have cough or fever but may experience very less bleeding during menses) OR
- Women who have repeated miscarriages (Recurrent miscarriage is defined as two or more spontaneous pregnancy losses)
- Women who have repeated failed IVF cycles (Recurrent implantation failure (RIF) refers to cases in which women have had three failed in vitro fertilization (IVF) attempts with good quality embryos)
- Any medical condition that would endanger the life of the mother.
- A severe case of Rh isoimmunisation.
- Repeated cleaning of the uterus (D&C) – The inner lining of the uterus is damaged because of which the embryo would not be able to implant in it.
- Success rates of Surrogacy-
The success rate of surrogacy centres in Mumbai, like here at Ankoor Fertility Clinic is very good with an implantation rate of around 80% and a carry home baby rate of around 60%.
An eligibility certificate for intending couple is issued separately by the appropriate authority
- Age of intending couple – 23 to 50 years (female) & 26 to 55 years (male) on the day of certification
- Married for at least 5 years & Indian citizens
- Have not had any surviving child biologically /adoption / through surrogacy earlier
- Provided a child who is mentally / physically challenged/suffers from life-threatening disorder / fatal illness with no permanent cure and approved by the appropriate authority with a due medical certificate from a District Medical Board
A surrogate mother is in possession of an eligibility certificate issued by the appropriate authority
- Ever married woman having a child of her own
- 25 to 35 years on the day of implantation
- Not donating her egg or oocyte or otherwise;
- No woman shall act as a surrogate mother by providing her own gametes
- A certificate of medical & psychological fitness from RMP
Prohibition of conducting surrogacy
- No person including a relative or husband of a surrogate mother or intending couple shall seek or encourage to conduct any surrogacy or surrogacy procedures on her except for the purpose specified
Written informed consent of the surrogate mother
- No person shall seek or conduct surrogacy procedures unless he has—
- explained all known side effects & after-effects of such procedures to the surrogate mother concerned;
- Obtained in the prescribed form, written informed consent of surrogate mother to undergo such procedures in the language she understands.
- The surrogate mother shall have an option to withdraw her consent for surrogacy before implantation of the human embryo in her womb.
Prohibition to abandon child born through surrogacy
- Intending couple shall not abandon the child, born out of a surrogacy procedure, for any reason whatsoever, including genetic defect, birth defect, medical condition, defects developing subsequently, sex of child or conception of more than one baby
- A child born out of surrogacy shall be deemed to be a biological child of intending couple & be entitled to all the rights & privileges
- Breastfeeding and other mother care after surrogacy-
It is very much possible that the intending parent can feed her baby in spite of not carrying her in your womb.
The different ways of breastfeeding-
Just because the baby is born through surrogacy does not mean he or she cannot receive breast milk and the many health benefits it provides.
The commissioning/intending mother can give her own breast milk to the baby, in spite of not carrying the baby in her womb. This can be done by ‘induced lactation.
Induced lactation has been embraced by the nursing community as a welcome method to enhance the bonding relationship between a new mother and baby born through surrogacy. We at Ankoor Fertility Clinic start preparing the intending mother for this induced lactation from the 6th month of gestation itself. This has given us very good results.
For Surrogate Mother:
A woman who carries the child in her womb, for a couple who are unable to conceive due to specific reasons is a surrogate mother. As a surrogate, you have the chance to make parenthood possible for someone who otherwise would not have the opportunity.
Criteria for Surrogate Mother-
Surrogates are selected only in the early reproductive years (up to 35 years) of her life and she should have already proven her fertility by giving birth to her own child.
The surrogate and her partner are screened for the following. A detailed history of the surrogate and her husband is taken.
DETAILED CASE HISTORY OF SURROGATE:
- 21 – 35 years of age – Shall be eligible to act as a surrogate mother
- Should have her own children.
- ART bank – may advertise to seek surrogacy
- No details relating to caste, ethnic identity or descent of any of the parties
- No ART clinic shall advertise to seek surrogacy for its clients.
- No surrogate mother shall undergo embryo transfer more than three times for same couple.
- The birth certificate of a baby born through surrogacy shall bear the name(s) of individual / individuals who commissioned surrogacy
- All information about the surrogate shall be kept confidential. Except by an order of a court of competent jurisdiction.
- Surrogate shall not act as an oocyte donor for the couple seeking surrogacy
- Consent of her spouse shall be required before she may act as such surrogate
- In the case of a relative acting as a surrogate, she should belong to the same generation as women desiring a surrogate.
- Not have the service of more than one surrogate at any given time.
- Not have a simultaneous transfer of embryos in woman & surrogate.
- Menstrual & Obstetric history (how many pregnancies she has had, when was the last pregnancy, any history of recurrent abortions, etc. to determine fertility potential)
- Family history (history of any genetic/congenital abnormalities in any family member)
- Personal history(habits like using tobacco, smoking, drinking, what is the contraceptive being used)
- Any history of blood transfusion
- A drug intravenously administered into her through a shared syringe
- Last coital date
- The couples extramarital relationship status in the last six months
- Psychological counselling is done to inform the surrogate, her husband and her family members about all the procedure, diet, follow up, financial and legal aspects
We at Ankoor Fertility Clinic Mumbai, also carry out blood tests and screen for any hormonal abnormality in the surrogate, any major blood disorder, and infections that can be transmitted to the baby. Detailed pelvic sonography is done to ensure maximum chances of success. We also do blood tests of the surrogate’s husband to screen for any infectious diseases that may be transmitted to the baby.
PRACTICAL ASPECTS IN SURROGACY TREATMENT
What is Gestational surrogacy?
- A woman carries a pregnancy created by the egg and sperm of the genetic couple
- The egg of the wife is fertilized in vitro by the husband’s sperms by IVF/ICSI procedure
- Embryo formed is the genetic child of the infertile couple
- Transferred into the surrogate’s uterus
- Surrogate carries the pregnancy for nine months and delivers the baby
- The child is not genetically linked to the surrogate.
Indications for surrogacy
- Congenital absence of uterus (Mullerian agenesis)
- Hysterectomy – Cancer, Hemorrhage in prev Cesarean section /Rupture uterus.
- Uterine malformations – Unicornuate uterus, Bicornuate uterus with rudimentary horn
- TB endometrium – severe adhesions, Asherman’s Syndrome
- High risk of rupture – Previous uterine surgeries for rupture uterus or fibroids
- Repeated miscarriages / failed IVF cycles – Unexplained factors
- Medical problems – Diabetes, heart or kidney diseases like chronic nephritis
- Woman with Rh incompatibility
Different combinations of IVF with surrogacy
- Wife’s egg + Husband’s semen = Embryo transferred in the surrogate
- Wife’s egg + Donor’s semen = Embryo transferred in the surrogate
- Donor’s egg + Husband’s semen = Embryo transferred in the surrogate
- Donor’s egg + Donor’s semen = Donor Embryo transferred in the surrogate
What is the surrogacy procedure?
- Matching of cycles of genetic mother & surrogate – OCP
- GnRh analogue (lupride depot 3.75mg IM) Luteal phase day 21-22
- Surrogate is put on estrogen tablets to prime uterus
- OI protocol used for genetic mother – Agonist / antagonist
What is the surrogacy procedure?
- When the follicle reaches an 17-18 mm size hCG trigger is given
- TVOR is done 34-36 hours later
- Surrogate is started on progesterone – Day of hCG injection / oocyte retireval
- On the same day, the genetic father gives semen sample
- Eggs of genetic mother are fertilized with sperms
- Embryo – transferred into womb of surrogate under ultrasound guidance
- Surrogate is then put on luteal support using progesterone tablets/injections
- Pregnancy is confirmed using a simple blood test done 2weeks later