Who might use Surrogacy?
A woman who is physically unable to carry a pregnancy to viability of over 30 weeks due to variety of causes like-
- Uterine abnormality
- Recurrent pregnancy loss
- Repeated IVF failure ( implantation failure) in spite of good embryo transfers
- Serious health problems which could result risk to the mother
Criteria for intending parents
- The couple must be in good health for them to care for the child, there should be no history of serious medical, genetic or behavioural disorders
- In order to apply for the parental order, one or both the parents must be residents of India
- The couple should have considered all other available options as surrogacy involves another person taking on the risk of a pregnancy
- The intended parents should be considered as donors if their gametes (eggs and sperm) are to be used hence they should undergo all the screening tests required by the Miracle Advanced Reproductive Centre.
- They should have a detailed consultation / counselling before the treatment is started
Initial consultation of intending parents
- Detailed history including the age of both the partners, parity, duration and cause of infertility, previous infertility treatment, genetic and serious medical disorders. Both the partners should attend the consultation.
- Psychological assessment may be required to ascertain that they are psychologically capable of looking after the child and not consider this to be an ordeal
- Any query the couple may have to be properly addressed
- The details of the IVF treatment, success rates and the cost of the treatment, cost of surrogacy, legal fees, term life assurance costs , antenatal & delivery costs should be discussed
- Screening tests for both the partners even if their gametes are not used HIV, Hep B, Hep C, Chlamydia, HVS,CMV, TPHA, day 3 FSH, E2 (if the partners eggs are to be used only), ultrasound scan
- Options to be discussed
- Use of the female partners eggs with male partners sperm and transfer of fresh embryos
- Use of donor eggs and male partners sperm and transfer of fresh embryos
- use of donor eggs or sperm as required and freeze the resulting embryos and transfer them into a surrogate in a hormone replacement cycle later
- Both the partners are examined
- The surrogate mother would be sourced through the legal advisor of the Centre
- The relevant consent forms are given and consents signed in presence of a witness. The disclosure of information consent should also be signed in case of overseas couple
- In case the Miracle Advanced Reproductive Centre clinician is not happy with the request for surrogacy, then the case may be discussed with the newly formed ethics committee.
- If the surrogacy is ill advised for the couple this would be discussed with the couple
Criteria For The Surrogate Mother
- A surrogate mother should be under the age of 35 and should be in good health and be able to go though the pregnancy with minimum of risk to her own health
- There should not be any medical contraindications for a pregnancy , should be non smoker, should not take alcoholic beverages or any narcotic or addictive drugs
- It is ideal if the surrogate has bourn at least one child and preferably completed her family
- The surrogate mother should be under the age of 35 because of the high success rates and if the eggs from the surrogate are to be used she is considered as egg donor and same criteria apply.
- Being a surrogate mother is both emotionally and physically demanding task. She should have the emotional support and help of her partner, family, friends and the legal team
- Consideration of handing over the child at birth, the effect on her existing children, partner and the family
- Detailed consultation / counselling are obligatory
Initial consultation of the surrogate mother
- Full medical, obstetric history is taken. A full physical examination including ultrasound scan is done.
- Screening tests are done: HIV, Hep B, Hep C, TPHA, CMV, HVS, Chlamydia test, Rubella, Pap smear
- Following health risks are discussed-
- The risk of transmitting infections such as HIV, Hep B & C. This is minimized by testing the intending parents. The surrogate mother herself is also tested along with her partner
- In surrogacy, more than one embryo is transferred into the uterus which has 15-25% risk of a multiple pregnancy. This carries associated risk to the surrogate mother as well as the baby- preterm delivery, operative delivery
- Even if she is not donating her eggs there is a risk to her own fertility because of the risk of infection, pelvic adhesions due to infection, operation etc.
- The surrogate mother should be aware of the risk of a pregnancy- ectopic pregnancy, miscarriage, high blood pressure, gestational diabetes, operative delivery, post natal infection, postnatal depression
- All the consent forms for the treatment are given and signed after due explanation in presence of a witness. Miracle Advanced Reproductive Centre's relationship with the Surrogate Mother and the Intending Parents:
- To provide information about the emotional, physical aspect of surrogacy and the clinical procedures
- To inform the intending parents legal & financial responsibility for the child born as a result of the surrogacy process
- To inform the intending parents about the medical, hospital, pharmaceutical, laboratory& therapy expenses incurred during surrogacy process as it is not covered by the state, the national health service or medical insurance schemes
- To assure for the financial package from the intending parents to the surrogate mother as agreed by both the surrogate mother and the intending parents in the legally binding contractual agreement
- To pay for the term life assurance of Rs.1,00,000 for the surrogate mother made payable to the beneficiary of her choice through the Miracle Advanced Reproductive Centre
- To pay for the related expenses like travel, communication etc
- To pay entirely for the subsistence, accommodation , antenatal care with a qualified obstetrician , delivery at a recognized hospital
- To pay total cost of surrogacy treatment package to Miracle Advanced Reproductive Centre
- To pay for the total cost of any paternity test which may be required
All couples applying for the surrogacy parenting are carefully evaluated to help and evaluate that the parties involved in the surrogacy agreement (surrogate mother, intending parents) are emotionally healthy & stable and physically healthy & venereally safe. The intending couple should also get the welfare of the child form signed by their family physician and also get clearance from the Criminal Records Bureau (CRB) or its equivalent document before any treatment is commenced
Agreement of the intending parents with the surrogate mother
- To be artificially inseminated with the sperm of the natural father (who is not her husband) but an intending parent until a pregnancy occurs, or until the agreement is terminated by both the parties
- To be prepared by hormone preparations to adequately develop the endometrial (uterine lining) lining and have an embryo created either by the intending parent mother's egg and father's sperm/ or a donor egg from another woman and intending father's sperm.
- To submit the medical and obstetric records for the review by the Miracle Advanced Reproductive Centre.
- To submit to a consultation at the Miracle Advanced Reproductive Centre with complete medical history, physical examination, laboratory screening tests and ultrasound examination as required by them to establish the surrogate mother's health prior to any treatment
- To provide genetic information about her family and submit herself for genetic testing if required by Miracle Advanced Reproductive Centre
- To submit to psychiatric and psychological evaluation
- Attempt not to establish emotional bond with the child born as a result of surrogacy procedure
- Once a pregnancy is achieved, to continue the hormonal treatment as long as advised by Miracle Advanced Reproductive Centre. Also to continue the antenatal care and delivery by the specialist designated by Miracle Advanced Reproductive Centre.
- To avoid all alcoholic beverages, consumption of tobacco in any form, any narcotic or addictive drugs not prescribed by Miracle Advanced Reproductive Centre sponsored Obstetrician
- To assume all the risks associated with a pregnancy
- To deliver the baby either naturally or by Caesarian section as required by the obstetric indication in a hospital identified by Miracle Advanced Reproductive Centre
The pathway to Surrogacy Parenthood:
- Both the partners of intending parents should submit to a detailed consultation
- They should get the welfare of the child forms signed by their family doctor and also the Criminal Records Bureau clearance certificate or equivalent. Without this no couple will be accepted for surrogacy programme.
- They should have all the screening tests done as required by the Miracle Advanced Reproductive Centre.
- They will then see the legal advisor of the Centre and get a detailed briefing from the legal aspect of surrogacy.
- They will be introduced to the prospective surrogate mother in presence of the legal advisor. This interview will be videotaped for record.
- They will then sign the legal agreement with the surrogate mother. In the event of the surrogate mother is not acceptable to the intending couple then an alternative surrogate will be sourced.
- The surrogate mother would have already gone through detailed consultation with medical, genetic and obstetric history. She would have under gone physical examination, ultrasound scan, screening tests as required by the centre's policy.
- Only when all the documentation and legal agreements have been signed both the intending couple will sign the necessary consent forms for their treatment.
- The surrogate mother will also sign the necessary consent forms for her treatment. A copy of the legal agreements and the consent forms will be passed on to the legal advisor for safe keeping. So will a copy of the legal agreements will be filed in the couple's clinic notes.
- Only then will the ovarian stimulation of the female partner be commenced. The surrogate mother will simultaneously start her hormonal treatment to develop the endometrial lining.
- The intending couple will pay all the legal fees at their interview with the legal advisor.
- The intending couple will pay the full package fees to the Miracle Advanced Reproductive Centre as soon as the legal agreements have been signed.
- The intending couple will also pay for the term assurance cover for the surrogate mother to cover any risk of death or severe physical or mental disability as a result of the pregnancy and its complications. This will be discussed with the intending couple during their consultation.
- In the event of not achieving a pregnancy, the intending couple will pay the Centre for their next treatment cycle. They will pay to the surrogate mother in the event of her not getting pregnant.
Frequently asked questions in surrogacy treatment
- What are the safeguards you have to hand over the baby to the intending parents?
There is legally binding contractual agreement between the surrogate mother and the intending parents before the treatment is started. The agreement is drawn up by our legal advisor and the full financial package is only paid in full to the surrogate mother after she hands over the baby.
- How many cases of surrogacy have you done at your centre so far?
We are a new centre in India and we started our centre in September 2008. We are the only centre in India to have dedicated legal advisor to source a surrogate mother and to draw up the necessary contracts and supervise the welfare of both the surrogate mother and the intending parents.
- Will the surrogate mother know who we are and we will know who she is?
Yes, you will meet the surrogate mother in the presence of the legal advisor and sign the necessary contracts. The legal advisor and / or Miracle Advanced Reproductive Centre's representative will always be present so that a healthy relationship will be maintained.
- Where will the surrogate mother come from?
Normally they come from lower middle class families who offer to be surrogate mother for the financial benefit they can get. We go through a large number of women who offer to be surrogate mothers to source the right one for you
- Can you guarantee a success in having a baby?
No. Like any other fertility treatment, in artificial insemination the success rate is around 25% for each attempt. For each embryo transfer the success rate is 40%. We restrict the age of the surrogate mother to under 35 to maximize the chance of a pregnancy.
- Do we have to pay the Centre again if as pregnancy does not occur?
Yes. For further info please contact the centre.
- What if the surrogate does not conceive?
It is same in our centre as in western world