- When should I stop IVF and start considering surrogacy?
- What are the legal aspects of surrogacy in the USA?
- Is surrogacy the only option for Asherman’s syndrome? And what is it?
- Is surrogacy my best option if all my failed IVF attempts were caused by my uterus?
- How can we check that the cause is the uterus? What tests are available?
Is surrogacy for me if I had many IVF failures?
Watch the webinar with Gad Lavy, M.D., F.A.C.O.G, a medical director and founder of New England Fertility (NEF), who is talking about surrogacy for patients after multiple failed IVF attempts. Dr Lavy has presented some case studies of his own patients.
Questions and Answers from the event
How long before the embryo transfer should the surrogate mother take her prenatal vitamins? Which organic prenatal is the best in your view with folate rather than folic acid?
As part of the preparation of the surrogate, we review her medical history, her health history, her diet, so and of course, we recommend prenatal vitamins. As as soon as we introduce ourselves to the surrogate, we make sure that she goes on the prenatal vitamins. The reality is that actually if the woman is healthy, she doesn’t have any medical issues, and has a balanced diet, the need for supplements is questionable, but we always do it.
Once you get pregnant, you have to take prenatal vitamins because your body requirements increase. This is an ongoing debate about whether organics are better, I personally don’t think that makes much of a difference. I think you just have to get whatever vitamins you get, you have to get from a reliable manufacturer, there’s really no difference in my opinion between folate and folic acid, and again, mostly because folic acid is a water-soluble vitamin and it doesn’t stay much in your system, you want to make sure that the person their diet is good, it’s balanced and that they take a prenatal that usually has enough folic acid. I like to add a little bit extra folic acid to what’s already in the prenatal vitamins just basically for good measure and just because it does help prevent certain defense.
What sort of tests are done during the pregnancy, and how long should they be on prenatal vitamins? What should they not be taking in terms of vitamins or medications?
I think the most important is that they have a well-balanced diet. I think taking prenatal vitamins especially, with the newer preparations that have DHEA, is enough. I think sometimes people tend to overdo it with their vitamins and we discourage that. One of the prenatal vitamins, I mean, we usually use ones that are a prescription, and I think that’s very complete for a healthy person, and you don’t need anything else. Most of these vitamins, as I said, don’t get stored long term in your body, and they need to be taken regularly, which also means that it doesn’t take very long for even people who are deficient to get to normal levels.
What if some unexpected medical complications happen when the surrogate is pregnant? Is there any guarantee?
The pregnancy is a pregnancy, it’s not a disease, but it’s something that carries risk, so again one of the reasons to pick women who have children is to try to mitigate, to reduce that risk as much as possible. So somebody who’s had normal uncomplicated pregnancies, normal deliveries, their chance of having any complications is much, much less than someone who conceives for the first time, so that’s sort of just going into the process and picking the surrogate. Now, on the embryo side, as I said doing PGS, for me, it is a big advantage because it allows you to select the more viable embryos, has a better chance of being successful.
For example, the risk of having a pregnancy loss, a miscarriage is much reduced by picking PGS normal embryos, but of course, things can happen, there are certain defects, the developmental defects that the baby can have that are not genetic, that we cannot test for, things that develop during the pregnancy and then there are things that can happen to the surrogate. She can develop hypertension and diabetes and pre-eclampsia and all those other things that can happen in pregnancy. Again much less likely for someone who has a good history, so the answer to the question is that there’s no way to be 100% sure that everything will go well. All we can do is prepare, and we do our best to make sure we’ve covered all the different aspects and lower the risk as much as possible.
As far as a guarantee, I mean it’s a difficult thing to do because you can’t guarantee for sure that the pregnancy will be okay, but there are ways, if you’re going through this process, there are ways that you can plan or sign up for what we call a baby guarantee, in other words, you continue trying with a surrogate until there’s a baby, it’s more like an insurance policy, it can be done, it’s more expensive, we e offer that package and certainly we can talk to you about that.
Is surrogacy possible with an embryo donation? Or either own egg or own sperm must be involved?
No, certainly not in the U.S., so certain countries require that you have some genetic connection to the baby, but in the U.S., it’s not necessary, it’s not required, so it depends on the laws in your own country. We often do surrogacy with donor eggs, or with donor sperm, and we sometimes do surrogacy with both. If there’s someone, f.e. a woman who is a little bit older who doesn’t have eggs or doesn’t have good eggs and needs an egg donor, she doesn’t have a partner, that person can use an egg donor, a sperm donor, and a surrogate. Again, the process in the U.S. is very transparent, very legal, that way, and you just have to check in your country if that’s something that is allowed.
Why do you think surrogacy is still illegal in some countries? Do you think it might change in the nearest future?
I don’t have a simple answer for that because you can see f. e. in Europe, there are some countries where surrogacy is legal, Eastern Europe like Russia, Georgia, Ukraine, but it’s only legal for heterosexual, married couples. Then there are other countries where it’s illegal, and those countries are very different. I mean, you can look at Scandinavia where it’s illegal, and you can say well this is a very progressive country maybe there the reasons are more that have to do with fear of exploiting women, and I think that’s probably, what is the motivation behind it. Then there are countries like Spain, Italy, and France, where it’s probably more, has to do with either cultural or religious or other reasons, so I think it’s different in different countries. Even in the U.S., surrogacy is legal in only some states and not legal in others, some of it is religious, some of it is political, so I think in every case, it’s different.
Unfortunately, the trend, in my experience as I was working in India and in Thailand, Nepal, Georgia, and Ukraine actually, strange things are actually going the wrong way in most places because f. e. people used to travel to India for surrogacy because it was easy and not very expensive, and that closed down, and then the same thing happened in Thailand, and then the same thing happened in Nepal, which was sort of big surrogacy destination. I don’t know how to answer that, is it going to change soon? I hope so, I think mostly in the U.S., it’s changed because of grassroots movements and pressure, but I don’t know.
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