On January 27 we hosted a webinar “Preparing a Surrogate Mother’s Endometrium for IVF programs?” with Dr. Shiyanova, Chief Assisted Reproductive Technology, ADONIS Medical Group
Based on questions we discussed and those that were asked by guests, we decided to public this article with all answers.
Question: Generally speaking, how does ADONIS Medical Group prepare surrogate mothers for embryo implantation?
Answer: ADONIS begins maximizing the chances of a successful transfer long before there is even an embryo to implant. ADONIS employs rigorous selection screenings and several rounds of evaluations for potential surrogate mothers to safeguard every attempted implantation. After a candidate is approved for the program, we conduct numerous ultrasounds to evaluate the surrogate mother’s cycle and the current working of her ovaries and endometrium. ADONIS’ doctors then control the growth of the endometrium and monitor the surrogate mother’s sensitivity to the process.
Question: Does ADONIS Medical Group test surrogate mothers for anti-Müllerian hormone?
Answer: Yes. Testing for anti-Müllerian hormone is required by the Ministry of Healthcare of Ukraine, and is also one of ADONIS’ benchmark tests for surrogate mother candidacy. This testing also tells us about the regularity of the candidate’s ovulation and blood supply rejuvenation, which gives us valuable information about the candidate’s cycle.
Question: Does ADONIS Medical Group test surrogate mothers using endometrial pipelle biopsies?
Answer: Yes. This test is not required by the Ministry of Healthcare of Ukraine – it is one of the many things ADONIS does in order to optimize the chances of successful implantation. The endometrial pipelle biopsy offers nuanced insight into the state of the surrogate’s endometrium that could increase the chances of a successful embryo transfer. The biopsy is also minimally invasive – this procedure is performed with such precision, and with such a small aspirator, that there is no bleeding or scarring afterward. The walls of the endometrium are not affected in any way, as there is no scraping involved. This procedure is completed only after thorough gynecological testing to confirm that there is no risk of infection.
Question: What reasons might there be to delay preparing the surrogate mother for embryo implantation?
Answer: Sometimes, delaying preparation is part of the normal, healthy surrogacy process. Doctors may want to delay preparation so that they can analyze the dynamics of the mother’s cycle before and after ovulation. The surrogate mother may also need to take medication to shut down her natural ovulation, which will alter the timing of the preparation process.
Question: How long does a surrogate mother have to go through hormone stimulation before implantation?
Answer: The length of hormone stimulation depends on the surrogate mother’s sensitivity to estrogen and progesterone. Some mothers are sensitive enough to these hormones that their endometrium is the appropriate size after 7-10 days; some are less sensitive and require 14-21 days of stimulation; still others must undergo this process for up to 28 days. This is relatively normal, and it is no reason to worry about whether or not the implantation will be successful.
Question: In what form are hormones taken by surrogate mothers?
Answer: Some surrogate mothers take pills or tablets; others receive hormones through the skin. Some may use both methods. Sensitivity to each method varies from mother to mother.
Question: What roles do estrogen and progesterone play in preparing the surrogate mother for implantation?
Answer: Both estrogen and progesterone are utilized strategically and specifically throughout the preparation process. In the first phase of preparation, estrogen is used to grow the endometrium to the proper size; progesterone is used in the second phase of preparation to affect the composition of the endometrium so that it is as receptive as possible to the embryo. These hormones also act as immunomodulators for the surrogate mother.
Question: When preparing for the embryo transfer, does the surrogate mother take supplements?
Answer: Folic acid is an integral part of preparation from the moment the surrogate mother begins taking medication until the fetus has fully developed (in the twelfth week of pregnancy); doctors also prescribe supplements of omega-3 and vitamin D. The surrogate mother also undergoes biochemistry testing as she transitions into pregnancy care so that Adonis can advise which particular supplements that surrogate mother should be taking.
Question: At what point after the transfer does ADONIS Medical Group conduct testing of the surrogate mother’s human chorionic gonadotropin (HCG) levels?
Answer: HCG levels can be tested as soon as they begin rising, which takes place 7 days after embryo transfer. However, ADONIS generally tests HCG levels 10-12 days after the transfer. If HCG levels are too low, doctors will order another HCG test in 48 hours (ideally, HCG levels would increase by 50% every two days). ADONIS tests HCG levels through the surrogate mother’s blood – not urine – for maximum accuracy.
Question: Is there any correlation between successful implantation and the age of the surrogate mother?
Answer: ADONIS accepts surrogate mothers between 20 and 36 years of age, and we have seen no particular pattern of success rate and age. Generally, success is less common in surrogate mothers older than 40.
Question: What determines whether or not a frozen embryo is acceptable for transfer?
Answer: ADONIS uses very discerning criteria when determining whether or not to use frozen embryos. Age is not much of a concern, but quality is crucial. Quality is assessed in terms of specific lettering (AA being the best, and DD the worst). Anything above CC offers a good chance of successful implantation. There is no correlation between genetic quality and physical implantation viability.
Question: Is there a limit on the number of times a surrogate mother can participate in the surrogacy program?
Answer: Ukraine does not legislate the number of times a woman can be a surrogate mother, but ADONIS does have internal limits to protect the health and life of the surrogate mother. The maximum number of deliveries that Adonis allows is 5.
Question: How does ADONIS proceed if the transfer attempt fails?
Answer: Because of the extensive preparation work that Adonis Medical group does with surrogate mother before the attempt, there are only a few tests that our doctors must run if the attempt is not successful. These include a pipelle biopsy and a number of ultrasounds. Doctors will also hold a Concilium to analyze all relevant parameters and discuss whether or not that surrogate mother may continue in the program.
Question: If a surrogate has previously had a C-section, can she be accepted into the surrogacy program?
Answer: C-section and surrogacy are not necessarily incompatible, but every surrogate mother who has had a C-section will be accepted. ADONIS will conduct a thorough evaluation of the C-section scarring and the potential impact on the uterus to determine whether or not a particular candidate will be accepted into the program.