Head of ADONIS’ gynecological department, doctor Mariya Sokolova gave answers the most frequently asked questions about psychological side of IVF and surrogacy programs.
What is included in a pregnancy observation for both IVF and surrogacy?
We always observe two sides: psychological (or emotional) and physical (or medical).
Both sides are equally important. During pregnancy it is important not only to be healthy philosophically but also to be in a quiet mind. So we always advise our patients to talk to the obstetrician about their lifestyle, behavior habits, meal, work-life balance, quality of their sleep.
Are there any other specific parts in the evaluation of the candidates for a surrogate?
In ADONIS, during the evaluation of the surrogate, we ask about their values as well. It’s important to make sure that the surrogate understands she is fulfilling the very important responsible mission.
We make sure she understands that she has to give away the baby and she will not be breastfeeding the baby. The surrogate needs to understand that.
Have you met many surrogates that are from a physical perspective are good, but they realize in the process that this mission is not for them?
About 30% of surrogates are usually not continuing after psychological evaluation.
What are the questions that future parents should ask their providers and medical team?
One of the first things that parents should consider in the surrogate journey is if they deeply understand that this child is yours even if it is carried by another woman. That the child will not have a genetic connection to the surrogate.
Another thing that is important to understand is that you can communicate with a child. For example, you can send audio with your voice, lullaby songs, reading children’s books, etc.
One more point to know and think about as a parent if you understand the bonding process during the birth and 2 days after it. Your smell, sounds, and senses are being installed into the subconscious of your child.
And the fourth one is to have a high level of trust in your clinic and providers.
How to be sure that the surrogate does not take any drugs or alcohol?
We do a lot of blood and urine tests, so if there are any drugs or alcohol we will see it immediately.
Is there a difference between IVF or surrogate pregnancy with regular pregnancy? Or is it the same?
Sure it is not the same from both sides physically and psychologically.
For example, for assisted technologies, there are two critically different methods: fresh embryo and thawed embryo protocols. Artificial pregnancy is more fragile than our natural one. Because the process of natural selection during the natural pregnancy is not our obligation. And during ART we should pay more attention to the whole process.
What about hormonal additional support? Is it always needed for women?
Usually, we use natural progesterone till 6 weeks, but sometimes we should continue till 8 weeks if there are any difficulties with the level of hormone. We always keep eye on progesterone deficiency. It depends on the quality of the eggs. If we have natural eggs from our biological parents and unfortunately it is a frequent situation that it is late reproductive stage.
What are the important steps for future parents for bonding with a child from pregnancy to delivery and after? What are the recommendations?
Apart from recording their voice for the child, they can print pictures of the ultrasound before the delivery.
They should be prepared to care about their baby, they should be familiar with the basic life support of newborns from feeding to making vaccinations. They should find a pediatrist, buy all the necessary beautiful things for the baby.
If they can not be present at the delivery and the first days after, they should have first real videos and photos of the baby. And should realize they become parents.
How do you calculate the due date so that parents can plan their visit and be present?
Usually, we have an estimated delivery date which is approximately the 40th week of the pregnancy, but we would advise parents to present in the country of delivery from the 37th week if the pregnancy has no complications. If we have some signs of preterm birth for example, for 35-36 weeks we try to notify parents about that as soon as we can.
Our team will help to organize their stay in Ukraine for how long they need.
Is there is a way for a biological mother to be able to breastfeed herself?
We have few medicines that can increase prolactin levels to start lactation. But a very important part of this procedure is to be involved psychologically in the pregnancy to have her prolactin level enough for the medicine to work.
It is not guaranteed, only 10-20% lactation can happen, but it is possible.
There are more chances to succeed when the mother is near the baby, because the baby’s smell, his or her voice increases her prolactin level. But anyway even if she is far from a baby and she has a strong wish she should try.
How to be transparent about the difficult feelings or doubts that can come up for parents and the surrogate during the process like being jealous of the surrogate mother or feeling frustrated, etc?
In any case, they should share their feeling with any member of our team, but most important with a doctor. We do our best to make all participants understand that it is important to be transparent about their feeling and do not feel guilty about having any uncomfortable emotions. And if they follow this advice the whole process will be much smoother.
What is the role of a father in the process?
The role of the father is giant both for the future mother and for the baby.
Fathers are equally involved in the whole process from the beginning, being supportive of his wife.
They should also record their voice for the baby and sing different songs.
How much recovery time there should be between attempts of IVF or between deliveries of surrogacy in case of the wish of siblings?
It depends on the way of delivery. If the surrogate has a c-section then the recommendation is 2 years. If it was a natural birth then it should be at least a year.
The surrogate should fully recover before going through the process again.
In the case of IVF, the woman should wait at least 1 month / 1 cycle and then do another attempt. But need to take into consideration the psychological recovery and make a pause from 3-4 months to 12 months. And we always advise addressing the psychological issue to the professional, to a psychologist.