What makes a good surrogate?

The magic question that is asked all the time, but it is difficult to answer.  The reason that it is so challenging to answer is because the right answer is different for each intended parent.  What makes a good surrogate for A does not automatically make a good surrogate for B.  Obviously there are traits and characteristics that are important for each potential surrogate to possess, but the finer differences of each person are just as important to factor into the big picture.

So there are a few items that are automatically needed to be considered...

1. ‣You must be between 21 and 40 years old
2. ‣You must have given birth previously (no more then 3 previous C-sections)
3. ‣You must have no prior pregnancy complications or early deliveries (prior to 36 weeks, with the exception of multiples)
4. ‣You must not abuse alcohol or drugs, including certain prescription medications
5. ‣You must be a non-smoker and reside in a smoke free home
6. ‣You must not be on public assistance, including medical benefits
7. ‣You must have reliable transportation and childcare
8. ‣You must have access to all your previous medical records (including labor and delivery)
9. ‣You will have to undergo medical and psychological screening (if you are married, your spouse will need to undergo screening as well)
10. ‣You will have to pass a criminal background check
    ‣Have medical health insurance that covers pregnancy and delivery costs and that does not have a surrogacy exclusion (you will have to provide a copy of your policy and exclusions)

      So outside of these requirements there are traits that I look for...a love of pregnancy, a sense of compassion, a maturity about life and a realistic outlook about surrogacy and the commitment it requires.  Any experienced surrogate will testify that surrogacy is a serious commitment of time and effort.  The commitment is not only required of the surrogate, but of her spouse and family.  The responsibility is not one to be taken lightly.  IPs invest so much in their surrogate, financially and emotionally.  I can not forget to mention that an open mind and a sense of humor are undoubtedly a necessity!

Contract Time

One of the least favorite but most important part of any surrogacy is contracts.  It is generally a stressful time for all parties involved.  Even though most IPs and Surrogates want to get through contracts as quickly as possible, it is important to make sure everyone is protected and on the same page.  I have found success in the contract phase of surrogacy by making sure all key issues and financials are agreed upon prior to engaging the attorneys.  It is never a pleasant experience to have to negotiate through lawyers and it can be damaging to a very new and delicate relationship.

It is critical to go into the contract knowing that everyone is in agreement on major issues like selective reduction, termination, number of embryos to be transferred, financials, etc.  It is also very important to work with an attorney that you like and are comfortable with.

I have worked with surrogacy attorneys all over the country and have learned a great deal from each and every one of them.  It is reassuring to have a diverse network of experienced, educated resources available.  Signing and executing a surrogacy agreement is truly an occasion to celebrate.  It gives a sense of security and a reality of everything being official.  The next step after signing on the dotted line is always a favorite.....cycling!

Day 3 vs Day 5 Embryo Transfer

One of the most exciting moments of any surrogacy journey is the embryo transfer.  It is so amazing to be able to see your little embryos when they are only a few days old.  All clinics grade the embryos on a scale (this scale varies from clinic to clinic and often is a combination of letters and numbers).  Most clinics will share your embryos grades with you and explain why they are graded that way.  This analysis helps the RE chose the best embryo(s) to transfer.

Clinics choose to transfer on Day 3 vs Day 5 (some clinics Day 6) for many different reasons.  It is considered the most ideal to transfer on Day 5.  The philosophy is that the longer the embryos are grown in culture, the better the odds of choosing the strongest one(s) to transfer.  Some of the factors in the decision of transfer timing is the number of embryos, the quality of those embryos and the availability of all the parties involved.  I thought it would interesting to share a few pictures of some of Pink & Blue's embryos (those of our IPs).

The above photo is of two Day 3 Morulas.  They are graded fair, you can see the cells are even and there is no major sign of fragmentation.

The above photo is also two Day 3 Morulas.  One is graded very good and the other is fair.  You can see there are more cells in the lower embryo and it looks more even.

The above is a Day 6 Blastocyst.  It was graded excellent.  You can see it is just starting to hatch prior to transfer (unassisted hatching).  The embryo is expanded and even with a clear inner cell mass and a good trophectoderm.

The above are two Day 6 blastocysts.  One is graded excellent and starting to hatch (the right).  The second is starting to collapse prior to transfer.

The above is a Day 5 Blastocyst graded excellent.  You can see the same traits as above.  Expanded, clear inner cell mass and trophectoderm and no fragmentation.

The above is a Day 5 Morula.  It was graded fair.  There is some fragmentation, and it is obviously delayed in development.

The above is a Day 5 Blastocyst that was graded very good.  The inner cell mass was good, there was some irregularity in the trophectoderm.  

It is important not to put too much stock in the grading of your embryos.  I have seen picture perfect, amazing embryos that did not result in a pregnancy.  I have also seen less then ideal, poor grade embryos make the most beautiful babies.  Embryo grading is a tool used to help boost the odds, but it is limited and by no means a guarantee.  

POAS!

Answer Brand HPT

I know many of the POASaholics out there (myself included) are thinking to yourself...Finally!

Walgreen's Brand HPT (the dreaded blue dye)

For those of you who are not familiar with the lingo, POAS means Pee On A Stick (A.K.A. a home pregnancy test). Many women are addicted to this process and love to analyze every test.

Equate Brand HPT

Is there a faint second line?  What if I tilt it under the light?  Oooh, maybe I should scan it and invert the colors or tweek the colors.

Answer Brand HPT

Intended parents generally have different feelings on if they want to know about the HPT results or wait the dreaded 2 weeks for the beta test.  It is really personal preference, and most surrogates are very supportive and sensitive to their IPs wishes.

The beta test actually tells the amount of HCG in the bloodstream instead of just confirming the presence of the hormone.  Betas are usually run in a series (each test is spaced by 2 to 3 days).  The amount of the hormone is one component to the test, but the second is the growth of this number.  The general rule of thumb is that the number should double every 48 to 72 hours.

One of the many perks of my job is getting pics of HPTs, I have as much fun analyzing other people's tests as my own.

FRER Brand HPT

I thought it would be fun to share some of the pics that I have been sent for your viewing pleasure.  If anyone has any they would like to share, please feel free.

FRER

Internet Cheapies

Equate

The King of HPTs, the digital!

Note:  All of the above tests are positive and were confirmed by positive betas.

Let's talk about hormones

Let's talk about the good, bad and the ugly of Hormones.  Many Intended Parents, especially the Intended Fathers, have a lot of questions about the medications involved in surrogacy.  I thought it would be a good time to go over these (especially since I am seeing the light at the end of the Lupron tunnel).  The most frequent question is "Why does our Surrogate need hormonal supplement if she has a great pregnancy history?"
This is actually a very easy question to answer, because it is always the same answer.  To best explain, a biology lesson is needed.  Each month, when a woman ovulates, the follicle where the egg is expelled creates a small cyst.  This cyst secretes the hormone progesterone to support the pregnancy (if it occurs) until the placenta is large enough to take over around 7 to 8 weeks.  In surrogacy, we suppress the Surrogate's natural cycle and she does not ovulate.  Since she does not ovulate, there is no cyst to produce progesterone.  That is why the supplement is needed to sustain the pregnancy until it is far enough along for the placenta to safely support it.  Most clinics supplement until 10 to 12 weeks of pregnancy to be on the safe side.  Every clinic has a different protocol, they all use different medications, different doses and different calendars.  That being said, they all have the same goal.  Most protocols involve birth control pills, Lupron, estrogen and progesterone.  There are different ways to administer most of the hormones and it is important to work with the clinic to find the best option for each situation.

Intended Parents always ask why the hormones are needed, but the Surrogates always ask how they are administered.  The reason behind this question is because most women dislike needles.  It is almost impossible to do a medicated cycle without utilizing injections at some point, but there are ways to minimize how many are needed. Progesterone in oil is the biggest of the needles, it is a large intramuscular injection given once or twice a day in the hip/butt.  There are alternative to using PIO, there are vaginal suppositories and gels.  There is no needle involved with these options, but they tend to be messy.  Lupron is a daily injection giving with a small subcutaneous needle.  The injection is not very painful or intimidating.

The last important thing to note about hormones, is how they will make your surrogate feel.  It goes with out explanation that the medications will alter her mood.  She may feel sad, weepy, tired, hungry, moody, and angry.  Some women have very little side effects from the therapy and a few have severe side effects, but most fall somewhere in the middle.  The good news is that the effects are short lived (until the pregnancy hormones take over) and for a good cause.  It is important to be aware that your surrogate may be more emotional during cycling.  Acknowledgement of her feelings is very comforting during this stage of the process.