PELVIC REST: WHAT IS IT & WHAT DOES IT MEAN FOR YOU? PREVIOUS ITEM NEXT ITEM Nearly all surrogates will be ordered on “pelvic rest” for at least part of their surrougacy journey . Although it is a common requirement, this instruction can be a source of confusion and uncertainty for many surrogates. To clarify expectations, let's explore what pelvic rest means, when it is necessary, how long it generally lasts, and what it means for you and your surrogacy journey. WHAT IS PELVIC REST? In simplest terms, pelvic rest means that you are to abstain from sexual intercourse, orgasms (even those achieved by external methods), and insertion of anything into the vagina with the exception of medications. Do note that pelvic rest in pregnancy is not the same as bed rest. HOW DOES BED REST FOR PREGNANCY DIFFER FROM PELVIC REST? You may be placed on rest following the embryo transfer, usually for a 24-hour period. You could also be placed on bed rest or pelvic rest later in the pregnancy, to ensure that you reach the 35-week gestation mark before delivery. This type of rest means to simply relax and rest. While using the restroom and sitting upright to eat are OK, lifting more than 10 pounds or exercising are generally to be avoided. Your physician will discuss any restrictions with you. WHEN IS PELVIC REST NECESSARY? Pelvic rest will usually begin the day of your embryo transfer and will not end until your doctor clears you for normal sexual activity. This means that, just as every pregnancy is different, there will be a great varying of release times from pelvic rest. All surrogates are asked to maintain pelvic rest for at least four weeks. While some surrogates may be released as soon as heartbeat confirmation, others may be asked to continue pelvic rest longer, sometimes through the course of the entire first trimester. This variation can be caused by several reasons, including the following: Light bleeding Concerns over implantation Varying medical protocols Conduct preferences of the intended parents Because of these varying reasons, it is important that you do not follow guidelines given to any other surrogate or even given to you in another pregnancy or surrogacy. This pregnancy is unique to you, and the medical protocol will be adjusted uniquely to your current situation. If you have any questions about being released from pelvic rest or what allowances you may have, be sure to ask your individual nurse or care provider. They will have the best, most up-to-date information from your medical notes and will be able to provide you with the most personalized answer that ensures the best probability of success for your journey. As a premier surrogacy agency, Growing Generations is honored to support surrogates throughout their journey to make the experience as enriching as possible. For more information about surrogacy, please reach out to us .

DETERMINING THE AGE OF THE EMBRYO AFTER IVF PREVIOUS ITEM NEXT ITEM Human pregnancies are counted in weeks, with 40 weeks being considered a full term. Many people don’t realize that when using IVF, you don’t begin counting those 40 weeks on the day you transfer the embryo into your uterus. Gestation is determined by the age of the egg as opposed to the time spent carrying it. In this way, you are transferring an embryo into your uterus that already has an age assigned to it. In a traditional pregnancy, gestational age begins accumulating on the last day of your menstrual period. By the time conception occurs, the gestational age is already somewhere around two weeks. Therefore, gestational age in IVF, and by virtue in surrogacy, begins accumulating well before transfer. HOW OLD IS AN EMBRYO WHEN IMPLANTED WITH IVF? The nature of IVF allows for more specific date stamping. In these instances, the exact date of ovulation, fertilization, and conception are known. This adds up to a clearer picture of gestational age. Here are 2 examples: Transferring a 3-day embryo will leave you 2 weeks and 3 days pregnant as you leave the office. A 5-day embryo is equivalent to a gestational age of 2 weeks and 5 days. At the close of the 2-week wait between transfer and beta pregnancy test, you could be up to 5 weeks pregnant, depending on the age of your embryo at transfer. (You can learn more about an embryo's development before and after transfer in our related blog post .) Determining IVF Gestational Age & Due Date An exact gestational age and estimated due date will be determined at the first ultrasound based on the size of the gestational sac and the fetus inside. Multiple pregnancies are more common in IVF. These pregnancies are often delivered before 40 weeks gestation. Calculating gestational age in IVF can be confusing. There are a great number of online calculators to help you get an accurate age and due date. More reliably, your case specialist or nurse should also be able to help you nail down a specific date and gestational age. Contact Growing Generations for more information.

WHEN TO ARRIVE FOR THE BIRTH: INTERNATIONAL IP PREVIOUS ITEM NEXT ITEM Planning to arrive in your surrogate’s hometown in time for the birth of your child can be especially difficult when you’re traveling from another country. While it is important to arrive in town early, international intended parents also have to plan accordingly for the time they’ll need to be stateside following the birth as well. This can turn your stateside visit into a lengthy one. First of all, understand that most babies are not born on their due dates. In fact, studies estimate only about 5% of babies are actually born on their due dates, the rest falling within two weeks to either side of the due date. For this reason, we strongly urge our international intended parents to arrive in town no later than 38 weeks gestation for a singleton, and 36 weeks gestation for a multiples pregnancy. Many intended parents will choose to arrive even earlier as, in many cases, the travel time from their home to their surrogate’s home can be in excess of 24 hours, leaving little chance to make it in time for delivery if labor begins earlier than expected. If you are unable to travel this far in advance of your expected due date, we advise that you’re able to “drop everything and go” when you receive the call that your surrogate is in active labor. In the final weeks of pregnancy your surrogate and her OB will be paying very careful attention to your surrogate’s body as it prepares for labor and child birth. Her OB will be monitoring her swelling, blood pressure, and the heart rate of the baby to ensure that no one is in distress. Elevated levels could lead to a medical induction. The OB will also be performing internal exams on your surrogate’s cervical opening to check for softening, thinning, or dilation, as these can mean labor is approaching. Some women who have experienced childbirth many times say that they are able to tell when labor is nearing and may be able to share her instincts with you in the final weeks. Of course, there is no exact science and false alarms can happen to anyone. A defined plan of action leading into the final weeks of the pregnancy can provide the most relief possible as you await the birth of your child. Whatever your plan is, due try to relax and enjoy the final weeks and days of your journey as much as possible.

EGG RETRIEVAL- WHAT TO EXPECT PREVIOUS ITEM NEXT ITEM By the time an egg donor or IM reaches her retrieval day she very fertile and ready to have upwards of 30 eggs extracted! The idea of something coded as a minor surgical procedure can sound a little scary, but the truth is that this is a very routine in office process that is generally pain free. The donor or IM will be typically scheduled for a morning appointment at the clinic. It is usually a good idea to arrive a bit early in order to fill out any paperwork and have time to ask any questions you may have. As you will be placed under light sedation for the procedure, you should not consume food after midnight on the day of the retrieval. When it is time for the procedure you will be put under light sedation for comfort. The doctor will then use a very small needle, guided by an ultrasound, to retrieve the eggs. The needle is inserted through the vagina where it will pass into the follicles and ovaries. The needle then extracts the eggs with a gentle suction action. The fluid surrounding the eggs is also extracted. After the eggs have been safely captured the needle and ultrasound wand are removed. The entire procedure takes between 15-30 minutes to complete. Despite the quick procedure you should plan on spending another two to three hours at the office. The doctor will want you to come out of the light sedation state and monitor you for a while before releasing you. Plan on having someone at the clinic with you in order to drive you home. Once you’re home you are encouraged to spend the rest of the day resting and recovering. You can expect to feel menstrual cramping and to see some light blood spotting when you wipe. If the pain or bleeding become extreme you should call your nurse to let her know what you’re experiencing. Painful urination, a temperature above 101.0 degrees, fainting or vomiting are all highly unlikely but should also be reported if experienced. Normal activities can typically resume the day following the retrieval. Occasionally the doctor will ask to see you in office one final time following your next period. This is just a precaution to make sure you’ve healed properly.

WHAT IS A PRE-BIRTH ORDER PREVIOUS ITEM NEXT ITEM Pre and post-birth orders are items of extreme interest in gestational surrogacy. Both assign parentage to the intended parents and remove any rights or obligations from the surrogate. These birth orders can also cause a great deal of stress for both intended parents and surrogates when they’re not properly understood. In the simplest of terms, a birth order is a legal document assigning parentage to a child. Depending on the state in which your surrogate lives, these documents can be started in the fourth month of pregnancy and are often signed by the seventh month in pre-birth order states. In post-birth order states, intended parents are usually seen in court within three to five days following birth. The most important thing to understand about the pre-birth order is that while it may be issued by the court prior to the birth, it is not effective until the birth occurs. So, while having this court order signed two to three months prior to the birth may offer you some peace of mind, it is not an absolute necessity and should not cause you distress if early labor occurs before your pre-birth order is finalized. Parentage will be protected by other guardianship documents even if the pre-birth order is not in place at the time of the birth. Some states do not offer the option of a pre-birth order. These states, post-birth states, do not allow the filing of parentage documents until after the birth of the baby to file parentage documents. In these post-birth order states, there will typically be a court hearing held after the birth, and the intended parents may be required to attend. Even if a hearing is required, know that these hearings are typically a formality and agreed upon easily by the courts as all parties are in agreement over the desired parentage of the child in question. Court hearings can just as easily be required in states offering pre-birth orders. This reality, paired with the fact that pre-birth orders aren’t considered active until the birth of your child, makes the real-life difference between pre-birth and post-birth order states insignificant. In general, don’t let fear of working with a post-birth state scare you away from someone who could be your ideal surrogate. If you do choose a pre-birth state, everything will work out with or without your pre-birth order in hand at the time of the delivery. Additional questions about birth orders should be directed to the attorney's office helping you establish your parental rights.

SKIN TO SKIN CONTACT AFTER BIRTH PREVIOUS ITEM NEXT ITEM There have been multiple studies in recent years highlighting the importance of immediate and continued skin-to-skin contact in newborns. Skin-to-Skin contact is your first opportunity to embrace your new child, and doctors say these first cuddles are as enjoyable as they are beneficial. Doctors note both physical and emotional benefits from the contact. Skin to skin contact is defined as placing a naked baby, not one wrapped in a blanket, to your bared chest. Most researchers recommend that this be done as soon as possibly following delivery. Many hospitals will now even clean the newborn and cut the cord while skin-to-skin contact is happening. Physically, the contact often allows the newborn to transition from fetal phase to newborn with less observed stress. The contact can equalize their temperature more quickly and with less effort as well as help the newborn manage respiratory transitions and glucose stability. Also, if you and your surrogte comfortable allowing her some skin-to-skin time, research shows that the newborn will be able to colonize the same bacteria as the surrogate. If a newborn is placed into an incubator, colonization will still occur, but it will differ from the bacteria present in the surrogate. Bacteria colonization is one of the key elements shown to reduce instances of allergic diseases forming. There are noted emotional benefits to skin-to-skin interaction as well. Often these newborns display less violent crying, suggesting that they are under less stress and anxiety during their first moments of life. As the days and weeks move forward, your newborn will learn to mirror your steady breathing during skin-to-skin contact, promoting calm and content behavior. Additionally, prolonged skin-to-skin interaction has been shown to lead to babies and toddlers with less separation anxiety and better self-regulation over time. Having a surrogate birth does not need to complicate your desires to engage in immediate and prolonged skin-to-skin contact following birth. However, it does mean you need to be more deliberate with your planning. If you plan to do skin to skin, make sure you wear clothing that enables ease of contact. Plan to wear (or pack) button up shirts, and intended mothers can also bring additional blankets or sweaters to provide any desired modesty. It is a good idea to share your plan with your nurse well in advance of the birth so that they can make plans and arrangements to encourage skin-to-skin interaction during the first moments of life. Things like not automatically swaddling the newborn after initial weighing & measuring and doing initial cleaning and cord cutting on the surrogate’s chest may be contrary to the hospital’s typical routine, but should not be considered impossible. Research notes the most benefits come from as much skin to skin contact as possible for the first hour, and then eventually the first 24 hours, as possible. Unless medical restrictions cause you to need to be separated, this is a great time to begin bonding with and cuddling your newborn.

MOCK CYCLE VS. DROPPED CYCLE PREVIOUS ITEM NEXT ITEM Another bit of jargon you may encounter on your way to transfer day includes the terms, “mock cycle” and “dropped cycle.” Both are terms that are used when a surrogate takes medications as directed but does not transfer an embryo at the end of the cycle. Here’s a look at what each term means and how they differ. A Mock Cycle is when a doctor will put a surrogate on full or partial medicines and monitor her as if she was planning to transfer with the clear intent that she will not transfer an embryo. This can be ordered for a number of reasons with the most common being that the doctor wants to observe how the surrogate’s body responds to a certain medication. A mock cycle allows the doctor to ensure that the body, most specifically the endometrium lining, is capable of reaching levels that will support pregnancy and make implantation likely without the cost of preparing an egg that could potentially be lost to unfavorable conditions. At the conclusion of the mock cycle medicines or dosages may be changed or fine-tuned in order to create optimum results in the real cycle. A Dropped Cycle is when a surrogate is taking all prescribed medications with the intent of transferring an embryo at the end of the med-cycle, but the transfer is canceled. This can be ordered because of many factors. Occasionally it will have to do with the egg donor or intended mother’s response to medicines, a mistake in properly following protocol, the quality of the eggs retrieved or having eggs lost to the thawing process. However, a surrogate with a thin lining can also be a cause for a transfer to be canceled, or “dropped.” If you do experience a dropped cycle in your journey, you will most likely consult with your IVF doctor, make changes to the medical plan, and try again in the next month.

FUTURE CONTACT BETWEEN DONORS AND FAMILIES PREVIOUS ITEM NEXT ITEM Choosing an egg donor is an exciting and important decision. Intended parents consider many attributes before coming to a final decision, and among them are a donor’s thoughts and feelings about future contact with any offspring created from their donation. An openness to future contact most often stems from a parent’s desire to provide their child with access to current medical and family history information. In addition, many intended parents are interested in making sure their child has access to information that will allow them to understand who they are and where they came from. Growing Generations has created our donor profiles with this in mind—to help supplement the need for future contact as the only way by which donor-conceived people can understand who they are and where they came from. It's why we offer extensive photo galleries and videos of each donor. However, some intended parents have a strong desire for their donor to be open to future contact from offspring in addition to the profile they’ll have. Many donors are comfortable with the concept, but like intended parents, they want to understand how future contact is managed. Thanks to The Donor Sibling Registry (DSR), we’re able to refer our intended parents and egg donors to an independent registry where future contact can be initiated without revealing full contact details for any party. DSR is a website facilitating safe, direct contact with an egg or sperm donor. It was created to bridge the gap between seeking information and forming genetic connections for those conceived via assisted reproduction. Not only does DSR give people the potential to ask questions about where they come from or characteristics they’ve inherited, but it can also serve as a tool for those desiring information about family medical history. Modern-day DNA tests can only supply a limited amount of information. Obtaining answers to donor-specific questions can be reassuring, especially when the questions are so personal and details may feel unattainable. Using DSR is simple. Users create a profile they use to post to the database or search for potential connections. There is also a search engine where people can look for connections using keywords, donor information, and facility information. If a connection occurs among the 78,000+ registered members, users have the option to upgrade their membership. Paid members can interact and communicate with connections they've made. The best part? All parties can do this without sacrificing personal privacy, because DSR works like a virtual post office box. It’s a non-intrusive option for those looking for answers to interpersonal questions. If intended parents and their chosen egg donor agree to future contact, most often a provision will be added to their legal contract.

WHEN DO YOU GET YOUR PERIOD AFTER A D&C OR MISCARRIAGE? PREVIOUS ITEM NEXT ITEM The time following a miscarriage or D&C (dilation and curettage) can be both physically and emotionally challenging, and many surrogates wonder when their menstrual cycle will return following either a miscarriage or D&C. Attuning yourself to your body’s health and response over the next several weeks helps you understand how you are recovering and what your next steps in surrogacy will be. Doctors will generally monitor your blood hormone levels to ensure that your human chorionic gonadotropin (hCG) levels return to zero on their own. Your body will typically experience a slow bleed for up to a week following the miscarriage or procedure. The cessation of the bleeding is generally an indication that the hCG levels have returned to zero. HOW SOON AFTER MISCARRIAGE OR D&C DO YOU GET YOUR PERIOD? Your first period will generally return within four weeks of your hCG levels returning to zero. However, it is not uncommon for some women to experience prolonged return to ovulation and menses, which can last up to eight weeks. For many women, ovulation will not occur during your first cycle, as the body is still recovering. In most cases, your IVF doctor will want to wait for your body to experience one or two cycles before starting medications for a repeat medical cycle and embryo transfer. Your cervix will remain soft and open during this time and may make intercourse painful. EXTENDED BLEEDING In the cases of a natural miscarriage especially, you’ll want to pay special attention to how long your initial bleed lasts and how frequently you experience a recurrence of bleeding. In these cases, it is possible that some tissue may have been retained in the uterus and is preventing your body from healing. If you continue to experience light spotting over an extended time , it could be possible that your body is having trouble returning to regular hormone levels. You will want to speak with your doctor if you experience any case of extended bleeding. PROLONGED ABSENCE OF MENSES A prolonged return of menstruation is not normal. While it can take up to eight weeks for your body to properly recover and return to having regular cycles, some women will experience an even longer delay. This is typically experienced after a D&C as opposed to a natural miscarriage and may indicate the presence of new scar tissue or fibroids inside of the uterus. If you have not experienced a menstrual bleed by 10 weeks following the miscarriage or procedure, it is important that you notify your doctor. At Growing Generations, we are here for you every step of the way. Contact Growing Generations to learn more.

MY TUBES ARE TIED. CAN I DONATE? PREVIOUS ITEM NEXT ITEM Occasionally, a woman will come to our egg donation program with the desire to donate her eggs after completing her family. If the potential donor has had her “tubes tied,” she might feel that she is unable to donate as a result, but this is a myth. Following a tubal ligation, women are still able to donate eggs because the process of egg retrieval removes the eggs directly from follicles, before they are released into the body. Cut fallopian tubes do not have an impact on the body’s ability to produce mature, fertile eggs. In fact, the egg donor process will be no different for a donor that has undergone a tubal ligation than it will be for any other donor. You will still be required to take injectable medications and attend several monitoring appointments leading up to the retrieval. The medical process for retrieval will be completed the same way it would if your tubes remained intact. Recovery will also be similar, and side effects will still consist of mild cramping and bloating. Interestingly enough, a woman who has had a tubal ligation is also able to be a surrogate. With the help of science, it is entirely possible for a child to be born without the use of fallopian tubes. Click here to apply to be an egg donor with Growing Generations.