The surrogacy procedure involves the following steps:
A. Matching of menstrual cycles of genetic and surrogate mothers and starting of IVF treatment:
For IVF surrogacy or gestational surrogacy, the cycles of the genetic mother (or egg donor) and the surrogate need to be matched. This is done by adjusting menstruation dates through oral contraceptive pills. When the cycle starts, the surrogate is put on estrogen tablets to prime the uterus. The protocol used for the genetic mother/egg donor is day 2 protocol or day 21 protocol depending on the age of the genetic mother and other test results.
For the day two protocol called the short protocol, oral contraceptive pills are given to both surrogate and genetic mother/egg donor or either one of them to match their cycles in the previous month. On the second day of periods, gonadotropin injections are started for the egg donor/genetic mother. USG monitoring is done at intervals on day 1, 5 ,8, and 10. When the size of the follicle reaches 20 mm, the genetic mother is given hCG injection to attain the final maturation of the egg.
For the day 21 protocol called the long protocol, GnRH analogues are started from last four days of the contraceptive pill in the previous cycle. Once the genetic mother/egg donor gets her periods, gonadotropin injections are started. In both cases, the patients are monitored daily.
B. Oocyte retrieval and sperm deposition:
When the follicle reaches 20 mm, hCG trigger is given. The surrogate is started on progesterone tablets on the day of hCG injection to the genetic mother. Oocyte (egg) retrieval from the genetic mother/egg donor is done 34 hours later, which is generally day 12/13 of the cycle. On the same day, the genetic father gives his semen sample.
C. IVF procedure to produce embryos:
The eggs of the genetic mother are fertilized with sperm of the genetic father in the laboratory by IVF/ICSI procedure.
D. Embryo transfer:
If embryos are produced, they are transferred to the womb of the surrogate under ultrasound guidance. The surrogate is then put on luteal support using progesterone tablets/injections. Tests are done to confirm pregnancy in about 15 days.
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