Multifetal Pregnancy Reduction

Multifetal pregnancy reduction (MFPR) is the medical procedure that reduces the number of fetuses carried during the multiple pregnancy.  It might be a very depressing subject for the intended parents to discuss, however, in long term perspective, MFPR can lead to a healthier pregnancy.

It is a fact that multiple pregnancy is a common occurrence during the In vitro fertilization treatment. The reason is that in order to increase the chances of a successful transfer, 2 or 3 embryos are often transferred at a time. When all of them implant successfully, intended parents are often surprised with twins of triplets. MFPR is not performed when a female carries twins, but may be done to decrease the number of fetuses from 3 or more to 2.

In most of the cases, the aim of the multifetal pregnancy reduction is to increase the chances of a healthy pregnancy. More fetuses are unfortunately  linked to higher chances of miscarriage, stillbirth and lifelong disabilities.



The procedure itself is performed early in the pregnancy (9-12 weeks), when the size of the fetus is very small. Widely used method includes injecting potassium chloride in the fetus via a needle, which is inserted in woman’s abdomen.

As already mentioned, multifetal pregnancy reduction is not performed during the twin pregnancy. The risk of this medical procedure is to unintentionally harm other than selected fetus(es). In order to avoid termination of the pregnancy, most of the fertility doctors and surrogacy agencies will strictly refuse to perform MFPR in case of twins.


How to feel about multifetal pregnancy reduction?

The procedure is undoubtedly mentally traumatizing and has a heavy emotional load. However, as strange as it may sound, intended parents should realize that it is done in  sake of a more successful and healthy pregnancy.


Meeting With the Anonymous Egg Donor

Egg donation regulations vary across the countries. According to law, egg donation can be known or anonymous. It may happen during a fertility journey that parents request meeting with the anonymous egg donor. Further, we will discuss whether is it possible and what other alternatives do intended parents have.

It is not hard to understand why intended parents want to meet their egg donor in person. However it is important to take several factors into consideration :

When intended parents request meeting with the anonymous egg donor, the personality of a donor has to be revealed. This step completely opposes the regulation and the idea of an anonymous egg donation, during which the anonymity and privacy of a donor are absolutely untouched. While parents might promise and claim that they respect their donor’s privacy and will not disclose any details from the meeting, it will still come in conflict with the initial agreement and country’s regulation.  

More importantly, in some countries egg donation is possible and allowed only when it is anonymous. The best of surrogacy and egg donation agencies operate accordingly, within the framework of country’s regulation. They do not allow revealing donor’s personal information.  At the same time, agencies will have a database of egg donors which contains all of the essential information for the donation procedure – such as donor’s medical history, medical records, proof of her mental health, information about her appearance – eye color, hair color and etc.


When can intended parents meet with the egg donor?

Meeting with an egg donor in person may be of high-priority for some intended parents.  If this is the case, it is essential to consider it before planning the program and choosing the destination. Intended parents will have to choose the country where surrogacy is regulated by the law, is legal and egg donation does not have to be anonymous. When anonymity is not a requirement in the country and donor can be known, intended parents can then get acquainted with her through the personal meeting.

One more factor to remember is that the possibility of known egg donation does not necessarily guarantee it. Egg donor herself might have privacy issues and  have no  desire to expose her identity. Surrogacy and egg donation agencies will first have to clarify this issue and choose the donors from the database,  who do not mind being introduced  to the patients. Intended parents should always consider contacting surrogacy and egg donation agencies first and discussing their priorities and inquiries before actually planning the program.


Surrogacy in Greece

In Europe, there is a lack of countries where surrogacy is allowed. In many cases, European couples have to leave the continent in order to find a suitable surrogacy destination. Greece is one of very few European countries where surrogacy is regulated and legal. Since 2014, surrogacy in Greece has been available for non-EU citizens too and has become an international destination for couples seeking surrogacy services.


In Greece, intended parents do not need to be married and single females are eligible for surrogacy services too. As for 2017, same-sex couples and single males are not currently allowed to become parents through a surrogacy program. Intended parents are required to provide medical proof that they are not able to have children without the assistance and fertility treatment such as IVF.


Although the law states that surrogacy should be altruistic, it is not completely so. Regulations allow surrogate mother to be paid up to 10,000 Euros. This amount is considered as a compensation for the loss of the regular job. It can be evaluated based on surrogate mother’s skills and qualifications –  how much would she earn as an employee.


Embryo transfer cannot occur without the permission of the court. Court has to allow a surrogate mother to participate in a program and intended parents should submit their medical records too. After about 8 weeks, court will notify the decision to the participating parties.


Of course surrogacy agencies and clinics will screen surrogate mother closely, however, it can happen that medical preparation of the surrogate does not go  as expected or she has to be replaced due to a private or medical reason. In this case, a new candidate will need to be presented to the court , whose approval will take an additional time. In this case, the total approval time may take up to 6 months.


Intended mother will be baby’s legal mother and her male partner – baby’s legal father. According to the Greek Civil Code, surrogate mother has no rights to request custody.


Total costs of surrogacy will of course depend on concrete services that intended parents need. Prices of surrogacy services are not very affordable in Greece and may sum up to 60,000 EUR.


Whether Greece is an attractive surrogacy destination depends on an individual case.  Intended parents will have to make a decision based on financial and other private matters, as well as after the communication with surrogacy agencies operating in the country. Meanwhile, we have provided several highlights that summarize surrogacy in Greece:  



  • Court approval and involvement prevents legal controversies
  • Intended parents are legal parents
  • Greece is a famous tourist destination with well known resorts



  • Approval process might get delayed
  • Not affordable
  • Surrogacy is not allowed for same-sex couples and single males


HIV and Surrogacy

Human immunodeficiency virus (HIV) is a kind of a virus that attacks immune system. Immune system is body’s way of fighting illnesses, bacteria, any unknown or threatening viruses. As HIV destroys the immune system, more concretely the cell called T-helper, body becomes gradually less capable to deal with infections and diseases.


HIV and surrogacy

HIV is found in breast milk, vaginal fluids and blood. For that reason, when we talk about HIV and surrogacy,in sake of safety, we refer to intended biological fathers only. As for males, HIV is found in semen, but after a procedure called ”sperm washing”, it is safe to proceed with IVF. Sperm itself, is resistant to HIV virus.


Sperm washing

During sperm washing, sperm is separated from semen. The procedure removes dead sperm, debris, white blood cells and other chemicals that may lead to unexpected or undesired reactions and results during IVF. Sperm washing is performed not only in case of HIV, but also when males have lower sperm count or decreased sperm mobility, even when they experience unexplained infertility.

Sperm wash is usually performed in IVF clinics. The method may vary according to the clinic and individual characteristics of each case. Techniques include: centrifugation wash, density gradient wash and swim up technique.

After the molecular based sperm wash is performed, the clinic will usually double check the sample on HIV virus. After completing and confirming the procedure successfully, there is practically no chance of transmitting the HIV either to carrier(intended mother/ surrogate) or to the baby.

As sperm washing requires special equipment, different facilities and strong skills. Surrogacy agencies will usually charge  a different fee for the HIV programs.


Requirements and communication with a surrogacy agency

Result oriented  and professional surrogacy agencies, have requirements before they admit an HIV positive father to a program. In order for the IVF to make sense and be successful, it is essential to be under a treatment. Antiretroviral therapy is used to control the virus. Agencies will also require results of the tests that confirm that viral load is undetectable. The test should not be performed earlier than 6 months and should be followed by the second one at the time of going to the agency. Surrogacy agency will require additional medical tests such as HIV in semen, HBV/HCV in semen and so on.

If the viral load is too high, agencies will not be able to currently accept an intended dad to the program.

Assisted reproductive technologies(ART) have undoubtedly reached a high level of development.Thanks to medical breakthroughs, more and more people are becoming able to enjoy the magnificent joy of parenthood. Before choosing a surrogacy agency, we would recommend to have a very detailed conversation, because the case of HIV and surrogacy is still different from other IVF cases. Make sure that the agency supports you, understands your case and has a very specific action plan.

HIV positive dads should not feel confused or offended if the agency asks for too much details or tests. Vice versa, this is all done in order to ensure baby’s safety.


Communication With Surrogate During Pregnancy

Surrogate pregnancy is a very emotional journey. On one hand, there are intended parents who have finally fulfilled their dream of becoming parents. In most cases, they have already gone through a lot of stress, disappointment, fear and struggle. On the other hand there is a surrogate mother, who independent from her motivation goes on a complicated journey of pregnancy and makes the dream of intended parents come true.


Surrogacy agency is responsible for informing intended parents about every single aspect of pregnancy : results of prenatal tests, condition of a surrogate mother, overall evaluation of course of pregnancy. While the information exchange process has to be regular, surrogacy agency should not be the only one having communication with surrogate mother. Intended parents too, should be involved in the pregnancy process. We have provided several reasons why parents might want to have communication with surrogate mother:


Express appreciation

During pregnancy, surrogate mother may not be feeling well. She might have nausea, lack of energy, change in appetite and mood swings. While this kind of discomfort is common during pregnancy, intended parents should express their appreciation that surrogate goes through this for them and their baby. Surrogate mothers need to be supported, know that their commitment is not taken for granted and that their health and condition matter a lot too. People are always more encouraged and motivated when their dedication has a value.


Why not double check?

While intended parents are getting all essential information from the agency, it is a good practice to ask surrogate directly. Intended parents might want to know how is she feeling, whether she has everything she needs. It is important to trust a surrogacy agency, however, hearing the same from surrogate is more calming and sometimes more valuable.


Discuss postnatal issues

After the delivery surrogate can be experiencing discomfort and weakness. This is not the best time for discussing issues that are needed to complete the surrogacy journey. For example parents might want a surrogate to breastfeed a baby for even a short period of time. This has to be clarified in advance because surrogate might be planning to dry up her milk with medication.


On the other hand, in some countries, completing the journey is only possible when the surrogate gives her consent and signs documents that confirm the parenthood rights of intended parents.  For example in Russia,where surrogacy is not regulated by law , there have been several court cases because of a surrogate refusing to abandon her parenthood rights and her role as a mother. Earlier communication with surrogate can help to avoid similar issues.


Often there establishes such a strong bond between parents and surrogate, that they stay in touch even long after the delivery.


There are several factors that may hinder the communication with surrogate mother. For example, it happens that surrogate is several countries away and intended parents can not visit her often. Parents should not be scared of distance and should arrange Skype/phone calls with their surrogate. Another issue that may arise is that surrogate and intended parents do not always speak the same language fluently. However, this should never be an obstacle. Sometimes just seeing and feeling that surrogate is doing good and baby is gradually growing in the belly can be as exciting as an hours of conversation and communication.


Intended parents should trust their surrogacy agencies, request and clarify all the information they need. However, at the same time, they should remember that establishing a communication with surrogate is always a step forward to having a good surrogacy experience. One more advice would be to keep the agency posted about the relationship with surrogate mother and arrange meeting through their mediation.


Ectopic Pregnancy

Ectopic or tubal pregnancy  is a noteworthy pregnancy complication. Fortunately it is not common but should be identified and treated as soon as possible.

After fertilization, egg implants to the inside of the uterus. Ectopic pregnancy occurs when egg attaches itself outside of the uterus, most commonly in the fallopian tube(that’s where the term tubal pregnancy comes from). Embryo can not continue proper development outside of the uterus and if left untreated, can be life threatening or cause serious damage to the mother.



As ectopic pregnancy occurs in the beginning of the pregnancy it may happen that a female does not yet know about her condition. Therefore, it is also possible that there are no present symptoms. When the pregnancy test is positive and there are other early pregnancy signs too (sore breasts, nausea..), it is important to watch out for following symptoms:

  • Vaginal spotting or bleeding – bleeding might vary from light to heavy. After getting a positive pregnancy test, beginning of red/brown bleeding or spotting should not be left inattentively. Ectopic pregnancy may also cause the fallopian tube rupture which may lead to severe bleeding. In this case doctor should be contacted immediately.
  • Pelvic pain
  • Abdominal pain  – pelvic or abdominal pain might be of different intensity(mild, sharp,severe) and appear irregularly. Pain may be on the one side of the body.
  • Shoulder or neck pain – ectopic pregnancy might cause internal bleeding. Blood will then gather under the diaphragm and irritate the nerves that go in the area.
  • Weakness, dizziness
  • Fainting


Causes and risk factors

In reality, it might be complicated to find out the cause of ectopic pregnancy. However, commonly, the problem is caused by the damaged fallopian tube that prevents egg from getting into the uterus, leaving it no other way but to implant outside of it. Common causes of blocked tube include:


  • Pelvic infection and inflammation
  • Scar tissue from previous surgery
  • Abnormal growth that changes tube’s shape


Ectopic pregnancy might happen to anyone, however,there are several risk factors that might increase the chances. They include :

  • Maternal age above 35
  • Having experienced ectopic pregnancy before
  • Pelvic inflammatory disease
  • Previous pelvic surgeries
  • Endometriosis
  • Smoking
  • Fertility drugs


Diagnosis and treatment

Ectopic pregnancy can be diagnosed through several methods :


  • Pregnancy test to confirm the pregnancy
  • Ultrasound – is used to check the location of the embryo, whether it is in the uterus or fallopian tube. Because an embryo can not continue proper development anywhere other than uterus, mother might have already miscarried before the exam. It is also possible than a female is on such an early stage of pregnancy that an embryo cannot yet be seen. Swollen fallopian tube or tissues left from the embryo will help to clarify the situation.
  • HCG levels – HCG is is a hormone that is produced during pregnancy. Provided that the pregnancy is confirmed, HCG levels should not be lower than expected.
  • Pelvic exam – will help to locate pain and check for tenderness in the abdomen.


If ectopic pregnancy is diagnosed, the treatment will vary according to the condition. Unfortunately, there is no way to transplant embryo in the uterus, so removing pregnancy tissues is the only way to support mother’s recovery. Remember that if the fallopian tube ruptures, it will cause severe bleeding and can lead to fatal consequences.


Treatment with Methotrexate

If ectopic pregnancy is identified on the early stage of pregnancy and there has been no damage to fallopian tube, the injection of methotrexate can be performed. It will stop cells from developing and allow the body to absorb remaining tissues instead.


Surgical Treatment

On later stages, medication might not be helpful and a small surgery will need to be performed. Laparoscope, a relatively thin instrument will be inserted through a very small incision in the abdomen. Remaining pregnancy tissues will be removed with the instrument. Surgery itself is called laparoscopy. According to the situation, fallopian tube might need to be removed during the laparoscopy.

When fallopian tube is already ruptured and a woman is experiencing heavy bleeding, emergency surgery will need to be done. It is called laparotomy and is performed through a larger incision.


Future Perspectives

Thinking about future pregnancy can be hard after a painful experience. Doctors may suggest to wait for 6 months approximately until the next try, however the duration may vary according to the treatment and the actual reason that caused the problem. If the fallopian tube was not removed, HCG levels should be checked regularly to see if the ectopic tissue was removed completely. If the results are 0, the recovery is progressing well and there is a good chance to have a successful pregnancy.

When the tubes are very damaged and a woman can not conceive naturally, remember that IVF treatment is a way to successful pregnancy and parenthood.


IVF Success Rates

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.

Embryo Quality and Grading

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.


Surrogacy – Possible Medical Risks

Gestational surrogacy is an emotionally overwhelming process. Finding a professional surrogacy agency, preparing for the program, going through IVF, transferring an embryo to surrogate and waiting for the positive results… There are more details in between these steps.


It is a great relief when everything is completed successfully and your gestational carrier(surrogate mother) is now bearing your baby. The most complicated and complex tasks are already left behind. The fact that embryo transfer and implantation was successful is already a huge step forward.


Gestational problems are not very likely to occur to a surrogate mother  and we will further explain why. However, because there is still a chance that pregnancy can go wrong, intended parents should be informed about possible medical risks of surrogacy.


Health of a surrogate mother is observed and monitored intensively before admitting her to the program. Her medical history must be absolutely suitable for a future pregnancy. A lot of agencies require that surrogate is already a mother to a healthy child. Unhealthy habits (smoking, drinking alcohol and etc) have to be absent absolutely. Intended parents are and should be allowed to request any information concerning their gestational carrier’s medical and mental health. After such a close observation and control, surrogate mother is very likely to have a successful pregnancy and deliver a healthy child.


However, let us address possible medical risks of surrogacy anyway.


Possible medical risks

Surrogate mothers, similar to any other females are likely to experience slight weaknesses that accompany nearly every gestation. Symptoms may include :

  • Sickness
  • Mood swings
  • Change in appetite
  • Nausea
  • Slight abdominal and lower back pain


If any of the symptoms are no longer mild and cause a serious discomfort, surrogate mother should address a healthcare provider and inform the surrogacy agency as soon as possible.


Severeness of any symptom may lead to miscarriage, preterm labour and other serious complications.  Pregnancy may seem healthy  but it is still possible for gestational carriers to experience common types of pregnancy complications (gestational diabetes,preeclampsia and so on). Baby might inherit genetic abnormality from intended parents that needs to be captured on time.


As already mentioned, surrogate mothers may experience mood swings. Sometimes it is emotionally intimidating to carry a baby for 9 months, monitor your and his/her health throughout the process, go through labour and finally have to give the baby up (independent of having no biological connection to the child).


If needed, surrogate mothers should have the ability to attend therapies. Agency should explain to them  the distribution of roles in surrogacy and reinforce the position of both sides in legal documents.


What should be done for the best results?

First of all, commissioning parents have to discuss all scenarios with their surrogacy agencies :


  • What are the medical risks of surrogacy?
  • What will happen if gestational mother has pregnancy complications?
  • How do we know that surrogate visits doctors regularly?
  • What is the backup plan?
  • How are we sure that surrogate will give up the child? (This is not an issue in countries where surrogacy is regulated by the law  – Ukraine and Georgia are perfect examples.)


Commissioning parents should request and receive regular information about :


  • Surrogate mother’s health
  • Baby’s health
  • The course of pregnancy
  • Test results


Surrogacy agency, on the other hand, is responsible for :


  • Controlling surrogate’s visits to health care provider
  • Collection of medical data
  • Informing intended parents


Independent from their motivation , surrogate mothers are doing an amazing job delivering babies to their biological parents.To avoid any kind of complications and medical risks, like any other female –  lifestyle, mental and physical health of gestational carrier  has to be monitored on regular basis.


Implantation Failure

Journey to parenthood is sometimes full of obstacles and challenges. Before reaching a healthy pregnancy, female organism has to complete several complicated stages. It happens that our bodies are not always capable of dealing with their tasks. Implantation failure is one of the most frustrating experiences on the way to parenthood. We have to learn about ways of helping our bodies to conduct required processes successfully.


What is implantation?

Once an egg is fertilized successfully, female body starts to prepare for pregnancy. Walls of the uterus start to thicken and grow in order to protect and nourish embryo throughout the following 9 months of gestation. Wall of the uterus is called endometrium and is where the fertilized egg attaches itself for further growth and development. The process of attachment is called implantation.

Accordingly, when we refer to implantation failure, we mean that fertilized egg was not able to attach itself to the wall of the uterus.

Implantation is probably one of the most complicated processes before the successful pregnancy.  Implantation failure may contribute to unexplained infertility in females. Abnormalities that occur during  implantation are indeed complicated to capture.

Assisted reproductive technology (ART) stands for procedures that aim to achieve pregnancy through surrogacy, in vitro fertilization (IVF), egg donation and etc. Throughout  ART programs, implantation failure is one of the most common occurrences. While IVF is an amazingly successful treatment of infertility, not all cycles tend to result in successful implantation.


Recurrent implantation failure

Recurrent implantation failure refers to inability to achieve pregnancy after four embryo transfers, provided that embryos are of a good quality. Unfortunately up to 10% of females experience implantation problems during their IVF treatment.


Some of the related tests and factors include :


  • White blood cells, leukocytes , are responsible for protecting body from infections and “invaders”. Increased level of white blood cells are found to contribute to recurrent failure of cycles. Doctors, however, may suggest to not treat this issue. It is a controversial and confusing task to treat infertility by suppressing the immune system – which is so important later during the pregnancy. Drugs suitable for treatment can be risky for mother and a child. Before the beginning of treatment, parents should consider discussing all of the possible outcomes with their doctors.
  • Endometrial scratch is the procedure when doctor passes a thin catheter through cervix. Disruptions caused by catheter rotation result in response within the endometrium and surprisingly is found to have a positive effect on endometrium ability of reception. Doctor may also pass a thin telescope into the womb and observe if there is a polyp or a scar tissue that needs to be removed.
  • It is available to observe a tissue from endometrium to find an underlying problem. Scientists claim that it is possible to analyze a number of genes (more than 200) that are associated with implantation.
  • Clotting of the blood is a further factor that can hold pregnancy from progressing. Doctor might prescribe medications to thin the blood as a part of treatment.


While controlling health of parents is essential, experience revealed that the cause of implantation failure is usually hiding behind egg quality and rarely behind sperm or uterus.

  • Preimplantation genetic screening is the process of removing a cell from IVF embryo and testing it for genetic conditions and chromosomal abnormalities. Studies suggest that maternal age is the typical reason behind chromosomal abnormality in embryo. If several IVF attempts are unsuccessful, using a young egg donor is likely to result in normal pregnancy. Together with female’s age, abnormalities in mature eggs increase correspondingly.


It is particularly hard to make predictions about implantation. Scientists still have a long way to go until they investigate this stage closely. However, above mentioned tests and facts are proved to be relevant while discovering and solving the issue.