Step 2: Medical Evaluation
Advocates for Surrogacy will coordinate with Intended Parent(s)’ fertility clinic or physician and the Guatemalan fertility clinic to ensure necessary medical information is reviewed by the Guatemalan clinic prior to beginning the process.
Step 3: Egg Donor Matching Process
Advocates for Surrogacy will provide Intended Parent(s)’ who will be using an egg donor with comprehensive profiles of egg donors that include medical, social, work, academic, and family history of each donor. Egg Donors are prescreened medically (blood tests including screening for sexually transmitted diseases and ultrasound). Genetic testing is also available for egg donors. Once a potential match is made, Donors are screened by a licensed psychologist who administers a psychological test similar to the MMPI generally used in the United States and conducts a clinical interview of the Egg Donor.
Step 4: Assignment of Surrogate
Advocates for Surrogacy will provide Intended Parents with a comprehensive profile of each Surrogate that includes medical, social, work, academic, and family history of the Surrogate. Once assignment is made, the Surrogates is prescreened medically (blood tests including screening for sexually transmitted diseases and ultrasound). Surrogates are also screened by a licensed psychologist who administers a psychological test similar to the MMPI generally used in the United States and conducts a clinical interview of the Egg Donor. Surrogates have received thorough education through workshops presented by our team’s licensed psychologist and other medical professionals prior to matching and will continue to receive counseling throughout the process.
Step 5: Review and Finalization of Contractual Conditions Between Intended Parent(s) and Surrogate
The Executive Director of Advocates for Surrogacy, an attorney, will review the Agreement between the Intended Parent(s) and Surrogate, discuss issues that are negotiable and draft provisions addressing issues particular to the situation and coordinate with our Guatemalan attorney.
The attorneys will negotiate with the surrogate concerning those issues that need to be detailed in the agreement. Issues such as the number of embryos to be transferred, multiple birth, insurance availability and coverage and birth certificate details will be gone over in detail with you. An attorney in Guatemala will consult with your proposed surrogate as well, assuring that her expectations are addressed and dealt with in the wording of your agreement. The surrogate will then review the contract with her own, independent legal counsel. Once all parties are in agreement and the contract is consummated, we can proceed rapidly with the arrangements to begin the treatment cycle. Informed consent is obtained from all parties, and the treatment course begins.
Step 5: Coordination of Visit to Guatemala
This trip is for 3 purposes:
- Introduction of Surrogate to Intended Parent(s)
- Finalization of Agreement between Intended Parent(s) and Surrogate
Once the surrogate has received independent legal consultation and all issues are settled, the Intended Parent(s) will enter into agreement with the Surrogate and both parties will sign the Agreement.
- Clinical Procedures
Advocates for Surrogacy will coordinate with Intended Parent(s) and fertility clinic in Guatemala for the transfer procedure (if Intended Mother’s eggs and/or Intended Fathers’ sperm are being used), with storage facility abroad and fertility clinic in Guatemala (if frozen embryos are being used).
Steps To In Vitro Fertilization
Stage 1: Egg Production (Ovarian stimulation, monitoring, and ovulation triggering)
The process begins with the synchronization of both donor and carrier's menstrual cycles and may require using the medication Lupron. The goal of the first stage is to create a large number of mature follicles so as to increase the chances of fertilization. Since a woman's body normally releases one mature egg every month, a medication is used to stimulate the ovaries to develop more follicles. Follicles are fluid-filled sacs in which eggs mature. During this stage, the healthcare provider may use ultrasound to monitor the number and size of maturing follicles in the Intended Mother’s (or donor’s) ovaries. Blood tests may also be used to monitor hormone levels which will help determine the best time to administer medication and to retrieve the eggs. At a time determined by the physician an injection of medication (human Chorionic Gonadatropin (hcG) is given to bring the eggs to final maturity. Approximately 35 hours after this injection, the donor will undergo the egg retrieval that is done in the clinic on an outpatient basis.
Stage 2: Egg retrieval
The health care provider will identify the mature follicles using ultrasound and hormone levels and the, with a needle, withdraw the eggs while the Intended Mother or Donor is under light sedation. The Intended Father, on the same day, will be expected to produce a sperm sample that will be used to inseminate the eggs. The eggs are then held in an incubator until the time of insemination in the laboratory.
Stage 3: Fertilization
As eggs are retrieved, a semen sample is collected. Approximately 50,000 sperm are placed with each egg in the incubator where they will hopefully form an embryo. When only a few sperm are available, Instracytoplasmic Sperm Injection (ICSI) may be attempted. In this procedure, a single sperm is injected into an egg to facilitate fertilization. The next day, the eggs will be examined under a microscope to determine whether fertilization has occurred. If it has, the embryos will be ready to transfer into the uterus in between 72 and 96 hours.
Stage 4: Embryo transfer
The embryos are placed in a tube and transferred back into the uterus. The procedure is usually painless, though some women may experience some cramping. The number of embryos transferred depends on the quantity and quality often determined by a woman's age, cause of infertility and pregnancy history, if using Intended Mother’s eggs, and other factors. The uterine lining is prepared for implantation, often by supplementing with progesterone medication. At this point, there may be an opportunity to cryopreserve any remaining embryos that continue to develop normally, for possible transfer in future cycles.
The embryo transfer is done under sterile conditions, in a reclining position with legs up, as if having a pap smear. The transfer is easy and virtually pain free in most cases. Following the transfer the carrier is required to lie flat for a half hour and afterwards may return home to relax for the remainder of the day.
Stage 4: Testing for Pregnancy
Approximately 2 weeks after the transfer, the carrier will take a blood pregnancy test.
What to Expect After the Pregnancy is Confirmed
Each month the surrogate attends her medical examination, receives a small but fair and adequate stipend, receives her psychological consultation and attends her monthly workshop. A member of our team will always be present for the medical examination. If any special instructions are provided by the physician such as special diet, restrictions, medications, special procedures, our team will assist the Surrogate.
Advocates for Surrogacy will provide monthly updates and status reports on the results of the medical examination.
If special medical procedures are required, Intended Parent(s) will be notified and follow-up status reports will be provided.
Intended Parent(s) will fly to Guatemala for the delivery. Once the child/ren is delivered, we must obtain DNA samples to prove paternity/maternity, a birth certificate and prepare documents necessary for obtaining the child’s passport with the U.S. Embassy. Parents should anticipate a 2-3 week stay. Both parents are not required to be present for the entire stay and if only one parent is the biological parent, then only that parent is required to be in Guatemala for the U.S. Embassy passport process.
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