Once you have confirmed the match with your surrogate, you will move into the contracting phase of your journey. During this time, you will be working with lawyers who are very well versed in fertility and reproductive law in the United States to draft and execute your surrogacy agreement.

Many states require a legal contract between the surrogate and the intended parents. This contract, commonly known as the surrogacy agreement, will be catered to suit the laws of the states/countries that are included as well as any specific requests you and your surrogate have agreed upon.

The main purpose of the contract is to specify and clarify the outcomes of any issues that may arise during the course of the pregnancy. 

Examples include:

• What will happen to the child should something happen to the intended parents before the baby is born

• What would happen if the baby were diagnosed with a genetic illness while in utero.

• How many fetuses is the surrogate willing to carry

The contract is designed to protect all parties and prevent potential disputes.

Most IVF clinics will stipulate that a surrogacy agreement be in place before any medical procedures begin.

Later on in your journey, you will need to manage more legal paperwork to establish parental rights. Final parental establishment for the intended parents is acquired via a court order declaring the parental rights and obligations of the intended parents. At this point, you will be identified as the sole legal parents. The court order will also include directions for the department of Vital Records to issue a birth certificate for the child, upon which will be placed the names of the intended parents. This is usually done before the end of the third trimester, though this may vary from state to state.

A surrogate will frequently be prescribed intramuscular injections of progesterone. These are the injections your surrogate is most likely least looking forward to taking, and if she mentions her injections, these are the medications she is most likely talking about. The hormone is used to help aid in sustaining a pregnancy achieved through IVF and is typically given daily for the first 10 to 12 weeks. The progesterone is mixed in an oil to create an injectable compound for IVF. 

PROGESTERONE IN OIL INJECTION: TYPICAL OILS USED

Several different types of oils can be used for the progesterone element of a surrogate's medical protocol. Here’s a breakdown of the most commonly used oils for this purpose. 

• Ethyl Oleate: You may not be familiar with the oil ethyl oleate. The body creates it from a human fatty acid when ethanol and oleic acid combine. It is, by far, the thinnest of the oil compounds for intramuscular injections, so a smaller gauge needle is used for injections. It is the most often prescribed oil compound.

• Olive Oil: Olive oil is also commonly compounded with progesterone. While it is thicker than ethyl oleate and requires a larger needle, many women report that this blend offers some of the easiest absorption into their muscles.

• Sesame Oil: This is typically a thinner compound than the olive oil blend, making it easier for the muscle to absorb. Better absorption limits the size and sensitivity of lumps that often form at the injection sites. Many of our surrogates tell us that sesame oil results in some of the most manageable injection site tenderness.

• Peanut and Cottonseed Oils: These are the least-used oils. Peanut oil tends to be rather thick, while cottonseed oil is a thinner compound and is reported to cause less intense pain at the injection site. 

Doctors tend to prescribe a certain oil time and time again due to their personal preference. No one oil has been shown to produce a significant benefit across the board when compared to another. While some patients report far less pain with one type of oil versus another, a different woman may report experiencing the exact opposite reaction to the same oil compounds. More important than the oil type is ensuring that the injection sites are properly identified and that injection site tenderness is not the result of an allergic reaction.

PROGESTERONE IN OIL SIDE EFFECTS

The most common side effects include pain and swelling at the injection site, breast tenderness, headache, weight gain or loss, acne, nausea, increased body or facial hair, loss of scalp hair, drowsiness, and dizziness. These typically resolve quickly. Call your doctor if they persist.

Allergic reactions can occur with sesame or peanut oils. If that occurs, you will usually be switched to progesterone in a different oil base, typically ethyl oleate.

Growing Generations is honored to support our surrogates every step of the way.  To learn more about the surrogacy process, including the medical protocol, contact Growing Generations.

Throughout your surrogacy medical cycle, you will be asked to keep multiple appointments at a clinic near your home. During these visits, you will typically have blood taken and have a transvaginal ultrasound. The purpose of the blood sample is to monitor and evaluate hormone levels in your blood. The ultrasound's purpose is a bit more involved. Typically, the ultrasound will check for just two things: the thickness of your endometrial lining and the presence of the “triple stripe” or pattern of your uterus. Sometimes, however, the ultrasound will highlight the presence of fluid in the uterus or other potential abnormalities. 

WHAT CAUSES BLOOD IN THE UTERUS?

Everything from leftover menstrual blood to normal bodily secretions can cause fluid to appear on an ultrasound. Many women will have some amount of fluid in the uterus, and this is not always a cause for concern.

WHEN IS FLUID IN THE UTERUS A CONCERN?

Fluid in the uterus is a concern when it remains there or when the amount increases as it can be a complication in IVF procedures. Excess fluid in the uterus can interfere with the implantation of a transferred embryo in the uterine lining. Additional fluids in the uterus generally lead to the current cycle's cancellation.

WHAT IS 'FREE FLUID' IN THE UTERUS?

Free fluid that shows in the uterus early in the pregnancy refers to any fluid that is not enclosed within a structure.

The clinical significance of free fluid depends on its volume, appearance, and the patient's symptoms. It is often a critical clue in diagnosing conditions such as ectopic pregnancy, pelvic inflammatory disease (PID), or ruptured ovarian cysts.

HOW TO REDUCE FLUID IN THE UTERUS SO IVF CAN CONTINUE

In some cases, the IVF doctor can drain fluid from the uterus in an effort to salvage the cycle. Your IVF doctor will work to determine the cause of the additional fluid in your uterus and take corrective measures to avoid having it occur in a future medical cycle. Sometimes a slight adjustment of your fertility or hormone medications can resolve the fluid retention in a subsequent cycle. There is nothing that you can, or should, attempt to do on your own to correct the fluid retention within your uterus. 

Rarely, doctors may be unable to determine the cause of the fluid, or unable to stop it from recurring. If this is the case, it may be recommended that you not proceed as a surrogate. Your nurse and IVF doctor can also speak with you about any medical questions you may have. 

Growing Generations is honored to support surrogates every step of the way. Contact Growing Generations to learn more about the surrogacy journey.

When your surrogacy journey ends with an extended hospital stay it can feel overwhelming and emotionally draining. This may be a challenging way to enter into your parenthood journey, but parenthood is rarely a smooth experience. We have faith that you can navigate this first hurdle. Here’s a look at what to expect if your surrogate-born baby must stay in the NICU, and how we can help you during this time.

WHAT YOU'RE FEELING

You may be feeling a whirlwind of emotions, including fear or anxiety if your new child needs time in the NICU. You could be feeling stress about the financial implications of extended hospital care for your child or your surrogate or feeling confused about what is expected of you and who to talk to when it comes to managing expenses. All of this is likely happening in a city you're not familiar with while your normal life goes on back home. It’s a lot to manage at once--we understand. Whatever you’re feeling is normal, and your mental health specialist is available to talk with you about your emotions and how to manage them if you’d like.

WHAT'S EXPECTED OF YOU

If your surrogate needs to be hospitalized for an extended period of time, be it before or after the delivery, you will be responsible for any additional medical expenses that occur as the result of the pregnancy or birth. Additionally, you will be responsible for additional lost wages, child care, and housekeeping expenses that may arise as a result of an extended hospital stay.

If your surrogate is going to express breast milk for your use, you will be responsible for the costs of a breast pump, nursing supplies, and compensation for your surrogate. These expenses are outlined in your contract with your surrogate.

HOW TO BALANCE IT ALL

You’re likely going to spend a fair amount of time in a city that you aren’t familiar with. The best thing to do is look into long-term housing options. We recommend looking into furnished apartments with a kitchen. Not only are they far more affordable than hotels, they’ll also give you a “home base” and sense of comfort in the days or weeks to come. If you know that you’ll need to be in your surrogate’s hometown for an extended period following the birth, it can be advantageous to look into this sort of lodging in advance of the delivery. This is prudent especially in the instance of multiples.

Next up, it is in your best interest to identify your hospital social worker and establish a good rapport with this person. Growing Generations will not be with you at the hospital, and the hospital social worker is your best link for on-site support and guidance. It is likely that you will meet this person during your 20-week hospital tour.

Finally, consider allowing your surrogate time with your new child. Quite often, surrogates feel as though they’ve failed in their mission to carry a child for you if the child needs to spend time in the NICU. She may also be jarred from a premature end to her surrogate journey. Allowing your surrogate time with the child that she carried for you is a kindness that will help with her emotional and physical recovery.

Growing Generations is here to support you as you welcome your baby into your family, however that occurs. If you're considering surrogacy agencies for your own journey, please reach out to us online or call us at 323.965.7500. Our team is known for our white-glove attention to detail and compassionate, knowledgeable support for intended parents, surrogates, and egg donors. 

During surrogate pregnancy, some women are advised to receive an Rh-immune globulin injection. This medication, more commonly known as Rhogam, is often given to women who carry a “negative” blood type.

All people have two elements to their blood type. There is first the actual type, represented by a letter (A, B, AB, or O), and then a positive or a negative designation. This designation refers to the presence or absence of Rhesus in the blood.

Rhesus is an antigen that rests on the surface of red blood cells and occurs in most people. An Rh+ designation denotes that your blood carries this antigen.

For women whose blood type is Rh-, issues can arise in pregnancy if there is any chance that the fetus you are carrying may inherit an Rh+ status. In the case of surrogacy, if either the egg donor or sperm contributor is Rh+, there will be a chance of the baby inheriting this antigen.

It may be entirely possible that, through the use of an egg donor, the child will have a blood type that differs from you or the intended parents.

This presents a problem if the Rh- carrier’s blood were to mix with the Rh+ fetus’ blood. In that situation, the Rh- carrier would begin to develop antibodies to the Rh+ blood. These antibodies could cause problems in the current pregnancy, and would be very likely to attack and kill the red blood cells of a future Rh+ fetus.

For this reason, many surrogates may be asked to accept the Rhogam injection. The injection is very common and considered standard care. It is administered in office by your OBGYN typically in during the twenty-eighth week of pregnancy. A second booster shot is often given immediately following the birth. In some cases, specifically if you experience bleeding early in your pregnancy, the Rhogam injection may be given earlier in the pregnancy.

You should note that previous administration of a Rhogam injection does not safeguard you for a future pregnancy. In that way, even if you’ve had the injection several times before, you’ll still need to be immunized again for each new pregnancy.

During your initial consultations you will be asked to consider and decide on any potential tests you’d like to have completed on your developing embryos. Most tests are performed after creation of the embryo and prior to their transfer into your surrogate’s uterus. These tests can highlight a number of things from sex of the fetus to presence of any potential genetic disorders. 

Understanding the different types of tests available is a bit like eating a bowl of alphabet soup; they’re all abbreviated and occasionally medical professionals can forget that this may be your first experience to these tests. Perhaps the most often confused tests are the Pre-Implantation Genetic Diagnosis (PGD) and Pre-Implantation Genetic Screening (PGS). Both tests require a biopsy be completed on your embryo on day 5 or 6. Here’s a look at how these two very similar tests differ. 

PGD 

This test represents the more exhaustive screening option as it screens for specific diseases. This test is often recommended for couples with a family history of genetic diseases or the knowledge that at least one contributor is a carrier for specific diseases. The test is able to identify a battery of genetic diseases including: 

• Cystic Fibrosis

• Huntington’s Disease

• Tay Sachs

• Hemophilia

• Muscular Dystrophy

• Sickle Cell Anemia

• Spinal Muscular Atrophy

• Muscular Dystrophy

• Marfan’s Syndrome

PGS 

PGS looks specifically at chromosomal numbers. A typical, healthy embryo should have 46 pairs of chromosomes. This test will identify if there are fewer or greater chromosomes that what is considered ideal. Abnormalities in chromosomal numbers can lead to failure to implant, increased odds of miscarriage, and genetic disorders including Downs Syndrome. This test is recommended for those wanting to attempt only single embryo transfers as a way to aid in the selection of the best embryo for transfer. 

Can We Do Both? 

A commonly asked question is if your embryo is able to have both tests completed. The general answer is yes. In patients who carry a single gene mutation, it is not only possible but recommended. Remember that if anyone you encounter during your experience begins to use jargon that is unfamiliar to you, it is perfectly acceptable to stop them and ask for clarification on terminology. These terms are foreign to most and you should not feel any hesitation to ask for explanation. Understanding your options will help you make the best choices possible for your growing family.