Let's talk about eggs!

It all starts with an egg!  There are so many things to consider when starting a surrogacy journey, it is easy to overlook such a tiny thing.  Tiny, but amazing, and a very critical detail in the process.  For some couples or individuals, the egg source is a non-issue.  They are able to use their own or have a close friend or family member willing to donate.  Many intended parents do not have the luxury of their own healthy supply of eggs and need to rely on yet another amazing woman, who is generous enough to donate a handful of her eggs.

Choosing an egg donor can be a relatively simple or very complex process.  Everyone has different traits or characteristics that are important to them.  The more restricted the search becomes, the harder it can be to locate an ideal donor.  The first major decision is to match with an anonymous or directed (known) egg donor.  There are pros and cons to both options, but it is important to know how you feel about the choice before moving further.  I have worked with both types of donations and seen, first hand, how they both work amazingly.

It is generally faster and more cost effective to use a clinic based anonymous donor program.  This choice is good for many intended parents.  The main drawback is the lack of information about your donor.  You will know the stats and family history, but not a sense of personality.  You often are only allowed to view childhood pictures of the donors.  For some IPs, this is not enough information to make a choice.  For those, directed or known donation may be a better fit.  More recently, semi-open donations have become more popular.  This way IPs are able to see more photos, possibly speak to or meet with the donor.  They still may not know her last name or her identifying information, but they get to have a better sense of who she is.  The problem is that it is much harder to find women willing to donate under this arrangement.

No matter what route is chosen, it is important to be realistic with your expectations and during the search.  Once your egg donor is chosen, it is time to celebrate!  

Congrats and on to the next step.

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.