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Surrogacy and Preeclampsia

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Preeclampsia is a medical condition that appears only during pregnancy. It’s characteristics may be quite distinct. However, if the condition is mild, it is important to be familiar with all common symptoms and contact the doctor in a timely manner. There is also a connection between surrogacy and preeclampsia. Further we will additionally discuss what can intended parents do to make their parenthood journey less complicated.

 

What is preeclampsia?

Preeclampsia is a complication that may appear only during pregnancy. It will usually start after 20 weeks of gestation. It is important to diagnose preeclampsia and treat it on time. Otherwise, the condition can lead to fatal consequences for baby and a mother.

The most common symptoms of preeclampsia are high blood pressure (more than 140/90 mmHg) and protein in the urine (proteinuria).

High blood pressure solely does not necessarily indicate preeclampsia. For example, gestational hypertension is a condition of having high blood pressure during pregnancy, but without extra protein in urine  or problems with  any other organs. However, there are cases when gestational hypertension ultimately develops to preeclampsia.

When the condition is more severe, symptoms can be accompanied with:

 

  • severe headaches
  • abdominal pains
  • blurred vision or sensitivity to light
  • shortness of breath
  • seldom urination

 

Swollen hands and legs can sometimes characterize preeclampsia.

Fatigue, dizziness and nausea may also be signs of preeclampsia and in order not to confuse them with the symptoms of pregnancy, it is essential that pregnant females attend prenatal checkups regularly.

On the appointment, doctor will check blood pressure, make urine and blood tests. Usually doctors will check kidneys, because preeclampsia can affect them too.  Ultrasound may be needed to make sure that baby is growing as supposed.

We already know that during pregnancy, baby gets oxygen and food through placenta. Preeclampsia can prevent placenta from getting enough blood. Insufficient blood flow to placenta means that baby will get less nutrients and oxygen finally resulting in premature birth. Preeclampsia can also be the reason of placental abruption(placenta separating from the uterus) finally resulting in a stillbirth. Preterm labour is also a common occurrence when having preeclampsia.

 

Risk factors

There are no known causes of preeclampsia. However, several factors have been identified to be potentially risky:

  • Having experienced preeclampsia during previous pregnancies
  • Chronic hypertension (high blood pressure)
  • Being pregnant with multiple babies (ex: twins, triplets…)
  • Being pregnant for the first time
  • Babies from different partner on second or further pregnancies
  • Having body mass index (BMI) 30 or higher, referred to as obesity
  • History of chronic high blood pressure, kidney diseases , blood clotting before pregnancy.
  • Age (younger than 20 or older than 40)
  • Genetic factors (sister or mother had preeclampsia)

 

Complications

Preeclampsia is not only a threat to a baby. In future moms, it can cause complications including :

  • stroke
  • seizure
  • fluid in the lungs
  • heart failure of cardiovascular disease
  • problems in kidneys, liver or even eyes. If severe, preeclampsia can seriously affect other organs.

 

Complications may also include:

Hemolysis (HELLP) which is a more complicated and severe form of preeclampsia and can cause fatal consequences for mother and a baby. HELLP causes the disruption of red blood cells, erythrocytes. Hemolysis is a threat for other organ systems.

If preeclampsia is accompanied by seizure, then the condition develops to eclampsia. Because of its severnes, independant from the stage of pregnancy, the delivery becomes unavoidable.

 

Treatment and consequences

If the symptoms are mild and the baby is not yet developed sufficiently, doctor may advise  a bed rest, consumption of plenty of water as well as  food rich in proteins. Medicines to lower  blood pressure may be prescribed. Regular prenatal checkups are required to control the course of pregnancy. With the help of ultrasounds, doctor will have to check the heartbeat of a baby. Steroid injections are sometimes used to accelerate the development of baby’s lungs.

Actually, the only cure to preeclampsia is the delivery. Doctor may have to induce the labour, even if mother is not close to term. When preeclampsia is severe and fetus is on the early stage of development, parents and doctor might have to discuss fatal consequences that could be caused by keeping the fetus.

Of course, it is better to be as close to due date as possible. For example after 37 weeks of gestation, when the baby is usually developed enough, delivery is the only option to keep preeclampsia from getting worse. In this case, usually both, mother and baby do just fine.

 

Surrogacy and Preeclampsia

Professional surrogacy agencies control the health of a surrogate mother regularly. Basically one of the main things intended parents should ensure is that their agency is going to screen the surrogate frequently. It is important that parents are always updated with the information about health of a surrogate and their baby.

Experienced agencies and clinics are already familiar and have experienced patients with most of the pregnancy complications. While some of the conditions are easier to control and manipulate than preeclampsia, the agency will not hesitate to explain their approach to this health condition and share best practices from their experience.

Remember, that the desired results are not always achieved on the first try. In fact, a lot of good things come after times of struggle and failure. There is certainly quite a high possibility to make everything work out just fine, however, it’s important to have a solid, stable and well thought backup plan(s). Same applies for surrogacy agencies and at some point, this is what intended parents should care about in the beginning too.

 

Best Gay Parenting Movies and Books

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A certain part of the society still doubts the ability of same-sex couples  to be successful parents. To prove the prejudices wrong, a lot of great movies and books have been created to depict the reality.  Some of them are a hilarious representation of different situations, another part, on the other hand, gives information and suggestions based on real experiences and surveys.

 

Movies

Movies we have chosen describe stories in a very interesting way. Very entertaining and enchanting to watch, while questioning the beliefs present in the part of the society.

 

Modern family (Mitch and Cam)

Modern family is a popular American TV series. While picturing the family life in a very delightful way, one can not ignore how honestly the episodes capture the reality and struggles every family faces at some moment. Heroes Mitch and Cam are two gay males living in a committed relationship. Gradually, they decide to experience the joy of parenthood and give their love and affection to the baby.

Mitch and Cam indeed become very caring and attentive parents.

You can watch the moments with Cam and Mitch here.

 

The new normal

Movie tells a story of Bryan and David, a loving gay couple deciding they are ready for parenthood. Accompanied with humour, the story describes their journey to finding a surrogate mother and emotional expectations of a positive pregnancy test.

You can watch the movie trailer here.

 

Breakfast with Scot

When Tom and Ben first realize that they have to become parents to Scot, it comes out as an unexpected surprise. Not yet being sure whether the couple wants to raise a kid, they gradually find themselves very involved and responsible for a 6 year old kid.

You can watch the movie trailer here.

 

Patrik, age 1.5

Finally a Swedish, same-sex couple has the opportunity to adopt a child. However, because of a mistake, instead of 1.5 year old little Patrick, they happen to adopt a 15 year old boy. The situation gets strained when Patrick, who is not a child at all, happens to be a delinquent teenager, with homophobic views. On their tough journey on cohabitation, all three heroes manage to learn a lot from each other.

You can watch the movie trailer here.

 

Books

 

Love Makes a Family: Portraits of Lesbian, Gay, Bisexual, and Transgendered Parents and Their Families

The book consists of interviews and photographs of LGBT parents who share own and their children’s stories. They speak about the struggles with society’s pressure (concerning their orientation or ethnicity background)  and their observations of what actually matters to have a family full of respect and love.

You can read more details & buy the book here.

 

Gay Dads: A Celebration of Fatherhood

The book tells about 25 different gay parents who describe their hard way to successful parenthood. “Gay dads” is a proof that a huge number of children are raised in loving families, where they are either born or adopted by gay parents.

You can read more details & buy the book here.

 

Lesbian and Gay Parents and Their Children: Research on the Family Life Cycle

Parenthood recommendations and research-based profound overview of same-sex couples: their relationships, ways they settle down as families and obstacles they face as couples during parenting. The results of the research are represented both : quantitatively and qualitatively.

You can read more details & buy the book here.

 

Tuberculosis and Pregnancy

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Back in the previous centuries, tuberculosis was one of the leading infections responsible for death of thousands and thousands of people. Nowadays, recovery can take a long time and the infection is usually cured with the help of antibiotics. It is possible to get infected during pregnancy and pregnant females who have discovered they have tuberculosis, should consider getting treatment as soon as possible. Further we will discuss the relationship between tuberculosis and pregnancy, symptoms, consequences and action plan in different situations.

 

About Tuberculosis

Tuberculosis (TB) is a contagious infection that is caused by the bacteria called “mycobacterium tuberculosis”. Mostly, TB  attacks lungs, but can also affect other parts of the body, for example : bones, brain, spine and kidneys.

Infected person may have tuberculosis in two forms, active or latent.

Latent tuberculosis means that the immune system is able to block the germs(microbes) from spreading. Latent TB is not infectious and does not cause any symptoms. However, the bacteria is present and the infection may once get activated. Medicines can diminish the probability of activation.

Active tuberculosis, on the other hand, is contagious. The microbes are multiplying, spreading and causing symptoms.

As latent TB doesn’t cause symptoms, it is only possible to identify the infection through medical tests. Active TB , however, has somewhat distinctive symptoms including :

 

  • A long-lasting cough (21 days or more)
  • Cough that brings up phlegm, sometimes bloody.
  • Pains in the chest
  • Loss of appetite and weight
  • Constant fatigue
  • Fever and night sweats
  • Nausea

 

Tuberculosis can be transmitted like flu or cold. Microbes can be spread when an infected person speaks, sneezes, coughs, laughs and so on. However, the infection is not easy to catch. A healthy immune system has the ability to fight and even kill the bacteria. It’s also not likely to get infected after having a brief contact with the infected person. The microbes grow relatively slowly and a frequent/long contact is required to catch the TB.

Smoking is proved to greatly increase the risk of getting Tuberculosis.

 

Tuberculosis and Pregnancy

After introduction to common symptoms of tuberculosis, it is not hard to notice a coincidence with the ones of pregnancy(change in appetite, nausea, fatigue). For that reason , sometimes the only noticeable symptom of TB during pregnancy can be coughing accompanied by the phlegm.

After noticing any of the symptoms, doctors will usually advice to do the phlegm, blood or skin tests. Chest x-ray may also be needed. Mendel-mantoux test, also known as tuberculin sensitivity test is another way to screen for the TB bacteria. A small injection in the skin followed by a swelling in the area is a sign of existence of TB bacteria. The swelling may appear throughout 2-3 days after the injection and it’s presence, doesn’t necessarily indicate the active form of tuberculosis.

Parents should not fear of the tests, as if not identified on time, tuberculosis has the potential to be very harmful for a baby. The consequences may include:

 

  • Miscarriage
  • Premature birth
  • Preterm labour
  • Baby getting infected with TB (If TB is active and mother has not started treatment yet, there is a chance that baby gets infected during labor. Doctors will make the test after the baby is born.)

 

The treatment includes antibiotics and can kill the infection if are taken regularly, according to doctor’s prescription. Majority of medicines are safe for both, mother and baby. The treatment may last up to 9 months, until the bacteria is finally killed. However, unfortunately, there are cases when tuberculosis is resistant to medicines(drug-resistant TB) and treating it can be more difficult.

Pregnant females should combine doctor’s treatment with the lifestyle that will make their immune system stronger. Eating healthy food and getting as much fresh air as possible, play an important role in the recovery.

 

Tuberculosis and Surrogacy

Of course the surrogacy agency and clinic will screen a surrogate mother on tuberculosis. However, it is possible that surrogate mother catches the infection during pregnancy – just like any other pregnant female. It is important that the surrogacy agency is not only monitoring the pregnancy, but has the ability to act operatively in similar situations. If surrogate gets infected, the agency should act accordingly and promptly to perform the steps that are needed to eliminate the issue. Surrogate mother should receive immediate treatment, get checked regularly and be controlled to lead the lifestyle that will increase the chance of a successful pregnancy to maximum.

Intended parents may want to get informed about surrogacy agency’s action plan in similar situations before the beginning of the program.

Parents have to stay positive. Despite the fact that tuberculosis is not a desired condition, especially while expecting a baby, it is better to be aware of it  and receive  treatment in a timely manner. There is always a way to make the situation better, especially with the disease that is proven to be treatable.

 

Rubella and Surrogacy

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Rubella is a viral infection usually identified by a red rash.  Everyone is familiar with rubella and it is a common practice to vaccinate children to prevent it.  While some people have merely any symptoms, the infection may appear more severe for others. Rubella is not common during pregnancy, but if identified,  is likely to be a threat for a baby.

Future parents also have to act attentively when they need to use a surrogate mother. Normally surrogacy agency will collect all of the medical data from clinic that is essential to proceed with the program. However, intended parents should still have the information – the more they know, the better.

 

What is rubella?

Rubella is also known as German measles. Mostly the infection is recognized by its characteristic red rash. The virus is infectious and is passed from a person to person by sneezing or coughing. Rubella may also be passed on during a direct contact with an infected person.

As already mentioned, in most countries it is a common practice to vaccinate children in order to prevent rubella. For that reason, the infection is nearly eliminated in some regions. However, people still  get infected and sometimes transmit the disease without even knowing they have it. This happens because the symptoms are usually revealed after 2 or maybe even 3 weeks after the exposure to the infection. After the symptoms have disappeared, the person may still be contagious for about 2 weeks.

Signs are usually so mild that they stay unnoticeable. If noticed, the symptoms are likely to disappear in 2 to 3 days. The infection is sometimes referred to as three day measles.

If present, the symptoms include :

  • Fever
  • Inflamed or red eyes
  • Swollen lymph nodes around head and neck, also behind the ears
  • Pink-red rash that consists of small spots. The rash starts on the face and spreads down to the body.
  • Cold like symptoms – headache, running nose, cough
  • Aching joints – especially in adults
  • Muscle pain

 

Rubella and surrogacy

 

Congenital rubella syndrome

If a female gets infected by rubella during pregnancy, the virus may be transmitted to the baby through the bloodstream. The infection is especially dangerous for the fetus throughout the first trimester of pregnancy. However, it may cause  difficulties on the later stages of gestation as well. Congenital rubella syndrome is when the virus is passed on to the fetus and is considered to be a threat for a baby. Congenital rubella syndrome may cause :

  • Miscarriage
  • Stillbirth

 

Or health issues in a baby :

 

  • Deafness
  • Heart problems
  • Poorly functioning organs
  • Growth or mental retardation

 

What to do?

Good news is that once having a rubella virus is usually a guarantee that a person is immune to it. If surrogate has experienced german measles, it’s already a reasonable purpose for intended parents not to be worried. However, everything should be double checked.

Usually, when females plan pregnancy, they should test their immunity to rubella in advance and vaccinate at least a month before conceiving. Of course same applies to surrogate mothers. Intended parents should make sure that their surrogate has done the tests that confirm her immunity. Surrogacy agency and clinic will normally inform their patients about medical condition of a surrogate mother.

 

Herpes and Egg Donation

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Not surprisingly, every future parent wants their egg donor to be as healthy as possible. The are a lot of cases in egg donation, when donor’s health condition is satisfactory for the procedure but doctors suddenly cancel them from the program. One of the reasons could be the discovery of a health condition, which may or not be connected with donation. Herpes is in the list of viruses that sometimes cause uncertainty and may be the reason behind egg donors not being able to enroll in the program.

What is actually the connection between herpes and egg donation?

 

What is herpes?

Everyone has heard of herpes. The medical name for the infection is herpes simplex virus (HSV). Virus itself, exists in two types : HSV-1, so-called oral herpes and HSV-2, responsible for genital herpes. Genitals and mouth area are the most common parts of the body, where herpes may appear.  HSV-1 stays in the base of the neck area causing outbreaks and cold sores on mouth or face. On the other hand, HSV-2 stays around the spinal cord in the lower back and outbreaks in the genital area.

 

Herpes is contagious, which means that it is transmitted from one person to another. While HSV-1 is transmitted via kissing, HSV-2 infection is spread during sexual intercourse.  Herpes is a very commonly spread virus. According to studies, majority of people are not aware of their infection because their symptoms are very mild or not present at all. When we talk about egg donation, genital herpes (HSV-2 virus) is relevant.

 

Herpes virus stays dormant in the ganglia. Ganglia is a cluster of nerve cells that come from different parts of the body.  Herpes virus doesn’t change it’s location – it stays in the nerve ganglia and doesn’t spread through the body.

 

What we know : Herpes simplex is virus that lives in the nerve ganglia and doesn’t spread in the other parts of the body. Based on its type and accordingly location(neck or lower back), virus may cause outbreaks on mouth or genital area. Outbreaks normally occur when the immune system of a person is weakened.

 

The truth about  the infection and egg donation is the following :

  • Herpes Simplex is a virus living latently in the nerve cells and it is not transmitted on eggs.
  • Doctor will need to make sure is that the egg donor does not have any flare-ups during the procedure.

 

The clinic may have special restrictions and may not be willing to confirm donors with herpes. However, this only makes sense when the donor is experiencing regular outbreaks that are present during the retrieval procedure too. This could also mean that egg donor’s immune system is somewhat weakened and cancelling her from the program could seem reasonable at some point.

Parents do not need to be worried if their egg donor has HSV and is not experiencing recurrence. If she is meeting all of the medical requirements as well as parents’ expectations, there is no need to worry and lose a potentially successful outcome.

 

Surrogacy in Kenya for Gay Parents

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Kenya is one of the most popular and cost effective options for LGBT, heterosexual, married and single parents.  Legislation in neither promoting, nor banning surrogacy, meaning that it is not regulated by the law. However,  a number of professional clinics and agencies are offering effective treatments and  gay parents are wholeheartedly welcome.  If you are considering Kenya as a surrogacy destination, you can inform yourself about legislation, service and other details here.

 

Lately there has been a discussion about how much gay friendly Kenyan society actually is. A lot of sources reinforce the idea that same-sex couples, in general, are strictly discriminated and prejudiced in Kenya. They also suggest to keep sexual orientation discrete not only from the society, but from the fertility clinics as well. The advice is mostly based upon the fact that a lot of religious leaders are quite skeptical about same-sex relationships, not to tell anything about their parenthood rights.

 

Hiding sexual orientation, not being honest with health care provider on such an important journey is definitely not something gay parents will choose. Why is Kenya such a popular destination then? Why are gay parents having successful results? Why do patients have positive experiences with their clinics? – Just because the spread information and belief is misleading.

 

Reality

Nairobi , the capital city of Kenya,  is developed and modern – even closer to European cities than some cities in Southeast Asia. Travelling there is safe and a pleasant experience. Parents can even combine their visit with unforgettable safari holidays. Tourism is an important sector for Kenya’s economy . Society and doctors too, are usually very welcoming towards tourists, including LGBT couples.  It would not be professional if doctors discriminated their patients based on their private lives. What about branches of international and professional surrogacy agencies? Would they send patients to clinics where they will not get treated or will be prejudiced? It simply can not be in their interest.

 

All around the globe, we encounter members of the society that are accepting, fighting or feeling neutral about every single subject. Attitude towards gay parents, like everything else, is disputable too. Stopping random people, asking for their opinion and  inspecting the actual reality are two different things. One should make reasonable assumptions based on experiences and outcomes of others. A good surrogacy agency will not refuse to clarify the issue parents are concerned about – may it be past experiences, statistics or concretely the attitude towards gay parents.

 

Surrogacy Destinations where Gay Parents are most Welcome

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Surrogacy legislation is the matter of constant change. For intended parents, there are a lot of attractive destinations. However, when it comes to choosing one, the process doesn’t seem as simple anymore. Unfortunately, surrogacy destinations are more limited for LGBT parents. We would like to present places, where gay parents are most welcome to complete their journey to parenthood.

 

The United States

Surrogacy in the United States varies from state to state. In one country, there are places where surrogacy either is banned, not regulated or accepted. Additionally in some states surrogacy is accepted for heterosexual or/and married couples only. However, luckily, there are states where gay parents are wholeheartedly welcome too. Currently, the most surrogacy, as well as same-sex friendly state is sunny California.

Unfortunately, surrogacy costs in the USA may fall in between the price range of 100 000 – 200 000 USD. For that reason, it is not an affordable option for many parents.

 

Mexico

Similar to the United States, Mexico consists of several states and each has it’s own legislation. A number agencies in Mexico are leading surrogacy programs successfully and  are happy to treat patients independent from their sexual orientation. Mostly, they are operating in Cancun and Mexico City. Surrogacy there, is not regulated by the law and is neither legal, nor illegal.

Cancun is definitely a dreamy destination for vacation and for investors accordingly. Due to the increasing number of clinics and foreign investments, compared to the  past 3 years the success rate of In Vitro Clinics has grown significantly. Surrogacy prices in Mexico are significantly lower than in the USA.

 

Asia

Gay parents have been friendly welcomed in southeast asian countries. Not a long ago, surrogacy was banned in most popular destinations – Cambodia and Thailand. However, southeast Asia is not losing the status of cost effective and same-sex friendly surrogacy destination.  Lately, Laos has emerged as a popular surrogacy destination and is likely to substitute Cambodia and Thailand.  A lot of professional doctors have already moved to Laos from neighbouring countries and continue their successful fertility treatments there. 

 

 

IVF Success Rates

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Nowadays, intended parents have an access to a number of information. This is logical, because future parents in need of an in vitro fertilization (IVF) treatment, have to be familiar with every single aspect of this process. The primary subject to interest is of course the probability of a successful outcome – healthy pregnancy. Surrogacy agencies and clinics tend to make claims about their high IVF success rates. While success rates are an important indicator of clinic’s performance, numbers do not always depict the reality.

 

Meaning and Calculation

IVF success rates represent the ratio between pregnancies and IVF procedures. One could think of it as – “how many IVF procedures resulted in a pregnancy?”. Many clinics and agencies offer two types of rates to their future patients – clinical pregnancy and live birth success rates.

Clinical pregnancy rates will tell how many IVF procedures resulted in a clinical pregnancy.

Clinical pregnancy rate = number of total pregnancies / total number of IVF procedures.

Unfortunately, pregnancy is not yet a guarantee of a healthy gestation and delivery of a baby. For that reason, the rate intended parents are more interested in, is the one of live births.

Live birth rate represents how many IVF procedures resulted not only in a clinical pregnancy, but also in a delivery. Just because pregnancy lasts about 9 months, clinics and agencies may not have such regularly updated live birth success rates.

Live birth rate = number of total live births / total number of IVF procedures.

 

What do IVF success rates really tell us?

The higher the success rate of a clinic is, more attractive it seems to patients. However, each patient is much more than a part of a chart. Intended parents have very different problems and needs, they belong to different age groups and come from various medical backgrounds. All of the factors play an important role in the field of fertility. Majority of pregnancies are successful after only several IVF procedures. Even an average young and fertile couple has only  a  20% chance of conceiving naturally  within a month.

Having a 80% IVF success rate could hypothetically be true, however not for all patients, but rather for certain age groups.

 

Success Factors

To underline how individual IVF results are, parents should consider factors that play a significant role in successful outcome.

 

  • Age

Age of the mother is one of the main factors in successful IVF. The quality and the amount of eggs become lower when females are over 35. For that reason, it is obvious that women below a certain age are going to have a higher IVF success rate. When intended mother is older than 35, it may be advised to use eggs from a younger donor.

  • Pregnancy history

IVF success factors depend on previous pregnancy(ies) of an intended mother. For example, if female has experienced recurrent implantation failure, miscarriages or stillbirths, she will probably have a lower IVF success rate.

  • Various fertility problems

Fertility issues are caused by various medical conditions an disbalances. Endometriosis, polycystic ovary syndrome, high levels of FSH and LH hormones just to name few. Accordingly, IVF success rate depends on stages and progression of various health issues.

  • Lifestyle

Female smokers tend to need more IVF attempts than non-smokers. Maintaining a healthy body mass index is also a crucial factor in fertility. Over and underweight females, as well as smokers have a lower IVF success rate than ones who lead healthy lifestyles.

 

Experience, training, dedication and professionalism of the IVF staff is also of a huge importance. IVF success rate is in fact connected with clinic’s general performance and proficiency.  However it is not a direct indicator of individual parent’s probability of success.

 

The keypoint is not to accuse the clinic claiming to have an incredibly high success rate in data manipulation and misinterpretation. Neither is the point to ignore the 80% IVF success rate of a clinic and go for the one that has humbly published the number below 30%.  Intended parents only have to know that high IVF success rate of a clinic ONLY is not yet an objective guarantee of desired outcomes and should not play the major role in formation of future plans.

 

The best way to relate personal situation with IVF success rates data, is to make assumptions based on doctor’s consultation. Based on medical testing procedures, the healthcare provider will be able to make reasonable assumption whether patient is falling in the list of “average” ones.

Surrogacy in the USA

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Surrogacy legislation in the United States varies from state to state and is a subject to regular change. While searching for surrogacy options across the country,  it is likely to encounter states where it is permitted, banned or not mentioned at all.

 

There is also a variation between states that do not prohibit surrogacy in terms of accepting commercial surrogacy, unmarried couples, naming intended parents in documents and etc. To save time and narrow down the list of options significantly , we have chosen surrogacy friendly destinations based on best experiences and following criterias :

 

  • Surrogacy is permitted (for heterosexual couples, same-sex couples and single parents)
  • Parents are named on birth certificate and have legal assurances

 

Surrogacy friendly states
  • California
  • Connecticut
  • Delaware
  • Maine
  • Oregon
  • Rhode Island

 

If intended parents come across a successfully operating surrogacy agency in any other state, it may be still worth a try. Going through surrogacy legislation by state, it is common to find regions where court is generally very favorable despite of not having a corresponding law.

 

States that intended parents should NOT consider due to the explicit ban currently include : New York, New Jersey, Indiana and Michigan.

 

It is not simple to talk about surrogacy in the USA due to constant alterations. When reaching out to the surrogacy agency , commissioning parents should clarify all kinds of information about:

 

  • Current surrogacy legislation in the state, recent and possible future changes
  • Post and pre-birth orders, who will be mentioned in the birth certificate?
  • Requirements for parents (heterosexual, married or in committed relationship, single, same sex and etc)

 

California, for example, meets expectations for intended parents independant from marital status and sexual orientation – everything accompanied by a guarantee of parenthood rights based on legal documents.

 

Pricing

Taking into account the scales and level of development we are talking about, it is not a problem to find a well equipped clinic in the United States. However, intended parents should know in advance that the average cost for gestational surrogacy in the USA is between $100-140 000. This is not an affordable option for many parents. Fortunately, there is a number of cost effective options for heterosexual and LGBT parents worldwide.

 

Embryo Quality and Grading

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Can we estimate results  of In Vitro Fertilization? What are the chances of a successful embryo transfer? What do embryo quality and grading mean? Do they tell anything about possible outcomes? These are the questions intended parents worry about the most. While embryo grading is a complex medical process, parents need and should be informed about every important step on their fertility journey.

 

What do Embryo Quality and Grading Mean?

 

Embryologists use embryo grading system in order to make predictions about embryo transfer results. These predictions do not depict the reality accurately. A lot of embryos with low or middle grading lead to successful pregnancies. Moreover, not all high quality graded embryos result in gestation. This happens mainly because grading does not give an information about embryo’s genetics.

Embryo grading system is still a powerful tool that gives a good impression about which embryos are appropriate for transferring / freezing. Estimating embryo’s quality and potential is an important step. It helps intended parents to save time, finances, protects from unexpected misfortune and may facilitate their parenthood journey.

There is no universal grading system. In some clinics grade 1 is better than 4, while in others 4 may indicate the best quality. The most common practice is to observe an embryo after 3 or 5 days of fertilization. However, embryos are not on the same development stage on these days. Embryologists use different grading systems for day 3 and day 5.

 

Grading on day 3

 

On the day 3, embryos are on their “cleavage stage”. This means that cells in the embryo (blastomeres) are dividing. Observation happens under a high power microscope. On the day 3 after retrieval, embryo itself is not growing in size – only the cells are being replicated.

Accordingly, grading criteria number one is the number of cells in the embryo. The desired number of cells on the day 3 is 6-10. Based on experience, embryos containing 6 to 10 blastomeres on day 3, are more likely to result in successful pregnancy.

Criteria number 2 is the presence of fragmentation. Fragmentation/Blebbing is the process when the inside of the cells break off and form fragments. These blebs do not contain nucleus. Nucleus is the cell storing cell’s genetic material, DNA. As fragments/blebs are separated from the nucleated part of the cell, they are not referred to as cells. It is preferable to have little or no fragmentation at all. On the other hand, embryologists may capture multinucleation (presence of more than one nucleus per cell). Multinucleation is very hard to identify but may unfortunately indicate chromosomal abnormality of the embryo.

Embryo quality and grading includes one more important criteria – cell regularity. It is desired that blastomeres are of the same or close to the same size.

After the observation on the day 3,  embryos having no fragmentations and including equally sized 6-10 cells will be considered of high quality and will be assigned the highest grade. Laboratory will assign further grades according to their own system. The higher the quality grades are, so is the likelihood of successful implantation.

 

Grading on day 5

 

On the 5th day after fertilization,embryo contains increased number of cells and a fluid cavity. As the cells are growing, they start to form in different types. We encounter two cell types on the day 5. First type forms the Inner Cell Mass (ICM) and the second one is called Trophectoderm Epithelium (TE). Day 5 embryo is referred to as Blastocyst and has reached the development stage when it is getting ready to attach itself to the uterine lining (Implantation).

ICM will grow into fetus and TE will form pregnancy essential tissues.  Due to their importance for gestation, day 5 grading system evaluates both cell types separately. ICM and TE will be both observed for their amount and density (how tightly are they packed). For example a lot of tightly packed cells indicate higher quality than loosely packed fewer ones.

Blastocyst should implant soon. Above mentioned cell types divide and fluid cavity has to enlarge and hatch out of its shell.  Fluid cavity’s volume in the embryo is one more criteria of 5th day grading.  It should begin to outgrow the space inside of the shell (zona pellucida) and then the blastocyst will be ready for the implantation.

Day 5 embryo will be assigned the higher quality grade, when fluid cavity has reached the appropriate volume, ICM is tightly packed, is sufficient in amount and TE is also forming a cohesive layer with sufficient quantity of cells.

As already mentioned, clinics may use different grading systems and utilize numbers or symbols to assign grades. However, most of the laboratories use exactly above mentioned criterias to evaluate the potential of an embryo.

While talking about the chances of successful gestation, high embryo quality and grading is not  a 100% guarantee. There are far more details included in the successful outcome. Sometimes an embryo does not implant because it has a genetic or chromosomal abnormality. It also happens that a lower grade embryo results in an unproblematic gestation because it has healthy genetics. A lot of clinics will suggest doing preimplantation genetic screening(PGS). This procedure checks chromosomal normality in the embryo.

Positive results in PGS and middle to high graded embryo already give a reasonable purpose to estimate a healthy pregnancy.