Category: Gestational Surrogacy Process

How Many To Transfer? FET (Gestational Carrier/Surrogate)

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With our upcoming FET to our gestational carrier (my sister!) tomorrow!!!, we’ve been asked many times, how many will you transfer?

I probably haven’t thought about this as much as most do because any time I have ever tried to have a transfer or had a transfer, we had no choice. Because of my damaged uterus, one embryo was my only option. Twins would be way too risky in this uterus. So going into this FET(with a “normal” uterus), I realized, we actually need to decide…one or two?

Obviously, this isn’t only my choice. My sister has a lot to do with it, as well as my RE’s opinion too.

So we talked. My sis and I talked and talked and decided….let’s go with 2 🙂 I was older when these embryos were created(36) and the chances are much slimmer when you bring the age factor in along with my DOR diagnosis too. So that’s, that….2 it is….right?

Well, after the last appointment, my RE was concerned about transferring 2. He said my blasts looked beautiful before they were frozen…even used the words “donor-like”….what?? I mean, in my 2nd round of IVF, I was fortunate to have 9 eggs collected and ended up with 6 blastocysts(!)…I was SHOCKED…and honestly,I still am shocked(and wonder if they are truly mine…I’m kind of serious) because we got zero on my 1st cycle and zero on my 3rd…..weird. But I digress….and I will take them!

My RE’s concerns are normal, I suppose…when you are dealing with “normal” patients. His concerns are that we have great looking blasts and they would most likely both implant(ummm…really?) and then he went into detail about risks with twin pregnancies and right then….I could see my sisters worry and shock on her face. He kept talking and trying to convince us that one would be safer for the baby and my sister. I definitely want the safest for them both…

But….I, on the other hand, am NOT normal. I don’t fall on the “normal” side of statistics and it’s usually not good.  I’ve been a patient of his for over 3 years…and I’ve never had a BFP. And this might be our only good shot. I mean, obviously, I would NEVER want to put my sister’s or babies health at risk but using a gestational carrier is not normal or easy. If we were using my uterus, obviously, we would only transfer one…even if I had a great uterus…because I could go back and transfer more into me.

But unfortunately, we don’t have that luxury.

I started being more set on 2 also because we have 5 blasts left. I used one on me (selfishly 🙁 ) and so we are left with 5. And if we transfer one…and are blessed enough to have a baby with that one blast, we still have 4 left…with no where to put them….and I want to give them a chance at life too. I know SO many (too many) of you would die for just one blastocyst, so please don’t take this as me complaining or worrying about something that makes you upset. That’s the last thing I want to do.

Please remember, I’ve been through hell and am giving up my dream of being pregnant, of growing my child inside of me, of wearing pregnancy clothes, of getting the congratulations, of having pregnancy pictures taken, of receiving the loving looks, of getting the experience of being pregnant, something most of you fortunately will be able to experience one day, all at a “chance” for my embryos to have a life. I’m just thinking it all through…..

And it’s all just so overwhelming…

After the appointment and after she researched a little more, my sister called me and said…”I think I only want to transfer one now…I’m scared”. And I get it. I truly do. She listened to my RE, read all of the statistics, read the message boards(yikes) and for “normal” people, it’s a pretty good chance that they would both take. I’m not convinced mine would…but that’s just me and the trauma I have been through. I am so beyond blessed that I even have a sister willing to do this that I want her to be happy and comfortable.

So finally last night, my husband and I decided…..that it will be up to my sister how many embryos are transferred….

All up to her…..100%.

And that’s that. It’s her body and her decision. And we are at peace with that….

Again, we are so blessed with her gift, that I want her to feel good about the decision and not pressure her into anything.

So she called me last night and………one embryo it is.

We will transfer our strongest A graded embryo tomorrow(!!!!)

I am happy with this. I am hopeful.

I am simply blessed to have a chance at having a baby.

Finally….we will have a chance.

(Prayers, baby dust, blessings, positive vibes, more prayers….all are welcome 🙂 )

I’ll update tomorrow!!

 

 

Part Two-The Gestational Surrogacy Process: Step-By-Step

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Part One of The Gestational Surrogacy Process was finding your surrogate. Now here is Part Two, the step-by-step process.

I left you off with us finding our gestational surrogate, my amazing sister <3

Now, this is where using an agency would obviously make it a much smoother process, not 100%, but maybe a little easier than my sis and I navigating through it all.

I was VERY blessed and fortunate to have my two wonderful ttc sisters, Suzanne(ourjourneytoababybump.com) and Jennifer(2daymightbetheday.blogspot.com ). Without these women and their guidance through this process I would have been lost a lot longer than I was, so thank you both SO much! My TTC Loves!!

Now, here is the step-by-step process for using a gestational carrier/surrogate….hold on…it’s a little overwhelming!

Gestational Carrier/Surrogate:

  • Send prenatal records & delivery records from ALL pregnancies(gestational carrier should have already had at least one child to be considered to be a carrier).
  • Clearance letter from 0B (must be MD, not NP, PA, CNM).
  • The gestational carrier nurse coordinator will review all records and determine if process can continue.
  • Complete phone interview with gestational carrier nurse coordinator.

Schedule clinic visit between cycle days 5-13, her husband/partner will need to attend.

The clinic visit includes:(sometimes it takes more than one visit).

  • Baseline ultrasound including Doppler flow of the uterus.
  • Hysteroscopy(visual but if deemed necessary, operative hysteroscopy will be scheduled before proceeding to confirm clearance).
  • Blood & urine tests per the FDA communicable diseases for gestational carrier and her husband/partner.
  • Additional blood tests include: Blood type with antibody screen, rubella titer, varicella titer, CBC, complete metabolic panel, TSH, free T4, vitamin D & urine drug screen.
  • Annual exam & Pap smear
  • Herpes culture
  • Schedule a Psychologist appointment with a Dr. familiar with infertility and the gestational carrier process (gestational carrier and her husband/partner)
  • Personality tests: MMPI & PAI
  • Mammogram (once between 35-40yrs, yearly >40 yrs)

After the clinic visits and clearance:

  • Secure your own lawyer for representation (paid for by the Intended Parents) and have them contact Intended Parents lawyer to review gestational carrier/surrogate contract.
  • Returned signed consents and finalize contract with intended parents.
  • Mock cycle with next period.

***Once ALL of the above is completed, we can finalize the calendar for a retrieval and transfer.

 

And that’s just for your Gestational Carrier/Surrogate….this is what you have to do as the Intended Parents:

Intended Parents(if you don’t have frozen embryos and need IVF)

  • Baseline ultrasound with resting follicle count
  • Blood work, AMH, communicable diseases (both partners), blood type, CBC, TSH, free T4, vitamin D, Prolactin, complete metabolic panel (can do through PCP), genetic carrier testing if you choose
  • Semen analysis with Anti-sperm antibody testing (ASAB), Culture for bacteria, Sperm Chromatin Assay (if applicable)
  • Psychologist (both partners)
  • Day 3 hormones
  • Pap smear current within the year (we need the pathology report from your doctor)
  • Annual exam current within the year
  • Mammogram report (once between 35-40yrs, yearly >40yrs)
  • Return consent forms
  • Genetic carrier testing consents/waivers, other waivers (if applicable).
  • Lawyer-Finalize contract with gestational carrier & her husband (Clinic needs a letter, not the contract, from the attorney stating the contract has been signed by all parties)

Per FDA guidelines:

  • Female partner will repeat her FDA communicables and do an FDA risk assessment physical within 30 days of retrieval
  • Male Partner will repeat his FDA communicables and do an FDA risk assessment physical within 7 days of retrieval

** *Once ALL of the above is completed, we can finalize the calendar for IVF retrieval and transfer to gestational carrier.

Intended Parents(when doing an FET)

  • Blood work, FDA communicable diseases, genetic carrier testing, if you choose.
  • FDA Risk Assessment Physical (see below) evaluates for high risk behaviors that put you at risk for contracting communicable diseases or other contagious diseases that could be passed on to a gestational carrier and/or a fetus

Meet/speak with:

  • Physician–regroup to discussing using a GC and how many embryos to thaw and transfer
  • Psychologist–to discuss emotional aspects of using a GC; if done over the phone, both partners will need to meet with a licensed mental health provider in person.

Sign consents

  • Return signed consents— Couple using a GC consent, Known consents x3 signed by all parties, Genetic carrier testing consents
  • Waivers (if applicable)
  • Lawyer- Finalize contract with gestational carrier & her husband (Clinic needs a letter, not the contract, from the attorney stating the contract has been signed by all parties)

Per FDA guidelines

* When embryos are created with the intent to use a gestational carrier, FDA mandates that the female partner (egg source) do FDA communicables and an FDA risk assessment physical within 30 days of retrieval and the male partner (sperm source) do FDA communicables and an FDA risk assessment physical within 7 days of retrieval

* Your original intent was not to use a gestational carrier so FDA testing was not completed.

*Now that the embryos are frozen, the FDA want to ensure that both partners are still negative for any communicables they were originally tested for and a few FDA mandated additional ones. It is also required that both partners do the FDA risk assessment physical as well.

OR

*You did complete FDA testing at the time the embryos were created but they have been frozen for more than 6 months. In this case, FDA considers this a quarantine period and wants both partners to redo FDA communicables and the FDA risk assessment physicals to ensure that both partners are still negative for all communicables as you could convert from negative to positive in that 6 months.

** *Once ALL of the above is completed, we can finalize the calendar for a transfer.

WHEW!

It’s a lot…right?! Now, do you get why I’m a “little” overwhelmed?!

We started this process in April of 2015(after our failed 3rd IVF cycle). During my sister’s first ultrasound, my RE noticed a lining that was “too thick”…I mean really, here I have “too thin” lining and my sister has “too thick” lining. I couldn’t believe it. And it honestly scared her a bit. We followed that up with a biopsy, that came back non-cancerous(thank God!), and then a sonohystogram that showed some scar tissue and bumps in her uterus(boo 🙁 ). That confirmed she needed to have surgery…her very first surgery. Because of me. But she did it, she had an operative hysteroscopy and my RE cleared out any scar tissue he saw and confirmed a clear, healthy looking uterus.

3 months later, she was officially cleared to be our gestational carrier….

And here we are.

My sister has been on birth control pills and started Lupron. This is all getting very real.

Next up….prepping for our FET…..I can’t believe we are finally almost there…finally….