How does gestational surrogacy work? Step-by-step guidance

Married couples who come to Vittoria Vita pass through several surrogacy steps. It all starts with a call or email to the agency, and ends with the birth of the baby.  This process takes about 12–15 months: 1-2 months will be spent on the initial preparation of documents, examinations and medical procedures, then 9 months for pregnancy and another 1-2 months for paperwork for the child. Let’s take a closer look at how does the surrogacy process work.

Step 1. Preparation of documents

In the first stage, potential parents contact the agency and get advice about how does surrogacy work legally. To start the program, future parents need 3 documents:

Marriage Certificate with an Apostille*
Medical certificate

In the medical certificate, doctor indicates the reason why a couple cannot become pregnant. Under the Law of Ukraine, couples are accepted into the surrogacy program if a woman has:

  • no uterus
  • deformed uterus or cervix to the point that it is impossible to carry the baby
  • incurable changes in endometrium
  • serious diseases in which pregnancy threatens her health or life. At the same time, diseases do not affect the health of the unborn child
  • more than 4 unsuccessful IVF attempts (although the embryos were of high quality, pregnancy did not occur)

The certificate is issued by a gynecologist, cardiologist, general practitioner or other specialist who can confirm the diagnosis.

* Apostille is an international form that confirms the authenticity of a document. It is valid on average for 3 months (depending on the country of origin of the couple).

Step 2. Program selection

There are 2 types of infertility treatment using surrogate motherhood: with own eggs or donor. We choose the appropriate program based on the age and health of future parents.

Surrogate motherhood using own eggs – if a potential mother has a good amount of eggs, and a potential father has normal sperm count.

Surrogate motherhood using donor eggs – if potential mom:

  • has no eggs (from birth or because of menopause);
  • at risk of transmitting hereditary disease;
  • IVF was performed several times, but the ovaries did not respond well to stimulation, and the eggs and embryos were of poor quality.

Stages of the program

The couple chooses a donor from the catalog among 250 candidates. All of them – healthy pretty women from 20 to 30 years. Each of them has a child, which proves that their gametes are in order. We recommend choosing a donor that resembles a potential mother in shape, face, hair. Surrogate mothers also passed a rigorous selection and any of them can be considered an ideal candidate.

Surrogacy motherhood using own eggs
Surrogacy motherhood using donor eggs

Oocyte donor selection

Preparation of a stimulation plan (protocol)

Intake of drugs in accordance with the protocol

Visit to the puncture of the oocytes

Step 3. Visit to Ukraine

Future parents spend 3 days in Ukraine. This is the start of the program: a couple undergoes a medical examination, meets a surrogate mother and signs documents. The coordinator informs about the visit plan in advance.

Future parents are met by a personal manager-translator and driver at the airport in Kiev.

Consultation with a doctor and analyzes

Couple donates blood to test it for AIDS, Syphilis, Hepatitis B and C. Their blood type, Rh factor and karyotype will also be determined. At the doctor’s appointment, a woman donates blood for hormone testing.

Sperm donation

Father-to-be gives his sperm. If it is of high quality, it is cryopreserved for further use. If it is of poor quality (low sperm count) then the doctor makes recommendations for treatment and prescribes to repeat the procedure or suggests using fresh semen.

The appointment of the ovarian stimulation protocol (If the couple uses their own eggs)
The doctor prepares a stimulation protocol for a woman (a hormonal regimen) to obtain eggs. Stimulation of the ovaries begins on the 2-3rd day of the cycle and lasts from 10 to 14 days. At this time, the woman should be under the supervision of a doctor, so a return visit to Ukraine will be necessary.

Meeting with a surrogate

Upon request, future parents meet with a surrogate mother. You can get to know her on Skype.

Visit to the notary

Potential parents, surrogate mother and VittoriaVita sign several contracts. They define the rights and obligations of the parties, as well as describe the surrogacy process and how it works. So, VittoriaVita:

  • organizes all necessary medical procedures as part of the gestational surrogacy process (examinations, IVF, embryo transfer, pregnancy management, childbirth, DNA test);
  • provides potential parents with accommodation and meals during their stay in Ukraine;
  • performs legal operations (assistance in obtaining a birth certificate for a child, escort to the embassy);
  • provides translation services and more.

Surrogate mother undertakes to:

  • lead a healthy lifestyle (eat right, do not smoke, do not drink alcohol);
  • fulfill all the requirements of the attending physician;
  • sign a voluntary relinquishment of parental rights and more.

Potential parents agree to:

  • pay for agency services on time;
  • do not change their marital status during the program;
  • take responsibility for the newborn and more.

Couple flies back home. The next visit (egg retrieval) comes after taking a course of hormonal drugs (if a surrogacy program is carried out using own eggs) or either after 9 months for a delivery. You can also fly in during the pregnancy of a surrogate mother to see her and visit the ultrasound.

Step 4. Production of embryos

Among the eggs obtained, the embryologist selects the best ones and fertilizes them with the sperm of a potential father. Thereafter, the doctor monitors the development of embryos, conducts genetic diagnostics, and after receiving the results, transfers healthy embryos (from 1 to 3) to a surrogate mother.

Embryo cultivation

The embryologist fertilizes the eggs in vitro using ICSI and cultivates them to the blastocyst stage (usually for 5–6 days).  The obtained embryos will be examined under a microscope and the highest quality ones will be selected – with even cells and without structural changes.
A couple can use:

  • Own oocytes. There are two ways:
    1. Synchronization of cycles. The doctor prescribes hormonal drugs to the potential and surrogate mother to synchronize their cycles. A potential mother takes pills so that the ovaries can produce as many eggs as possible. Surrogate mother needs hormones to prepare the body for pregnancy. The doctor counts the program to the day. This is necessary so that after the creation of the embryos, the uterus and the endometrium of the surrogate mother are ready for embryo transfer and pregnancy.
    2. Without synchronization of cycles. The doctor creates embryos, conducts PGD and cryo-preserves them. After that, the surrogate mother takes a course of hormonal drugs and, when her body is ready, the doctor performs embryo transfer. That is, a woman is prepared for transfer only after PGD, when we know which of the embryos are healthy.
  • Donor oocytes. In this case, the donor and the surrogate mother undergo a similar hormonal preparation.

The cost of drugs is included in the cost of the program.

At 5-6 days of development, selected embryos undergo Pre-implantation genetic diagnosis (PGD). This study determines with an accuracy of 99.7% whether the embryo has a Down, Patau and Edwards syndromes or other chromosomal abnormality. PGD shows the gender of the unborn child, so parents can choose which one to transfer.

Surrogate mother’s preparation
Within 10–14 days before embryo transfer, the surrogate mother takes hormones. These drugs lead the body into a full state of readiness for pregnancy. The endometrium of the uterus grows to the desired thickness, acquires a certain stickiness and structure.

Embryo transfer
Embryo transfer is carried out in the so-called”implantation window.”This is the most favorable period of the menstrual cycle in order to become pregnant, and it lasts 2-3 days. The doctor introduces 1–3 embryos into the uterus of a surrogate mother using a thin needle. The transfer itself is a painless procedure and is performed without anesthesia. Genetic parents are not required to attend it.

* If the embryos do not attach, the procedure is repeated starting from “Surrogate mother’s preparation” (valid for the “Guarantee” program).

HCG test
On the 10th day after embryo transfer the surrogate mother passes the hCG test. Human chorionic gonadotropin is a hormone secreted by embryonic tissues after implantation to the uterus wall. If its level is increased, then the surrogate mother is pregnant. If the pregnancy has not occurred, the procedure is repeated starting from the stage “Surrogate mother’s preparation”.

Step 5. Pregnancy

Further care about the health of the child and the surrogate lies on VittoriaVita and our clinic. During pregnancy, surrogate mother undergoes at least 10 ultrasound examinations, two screenings, regularly undergoes blood tests, and also passes tests for smoking and alcohol. During a visit to the clinic, the doctor advises the surrogate mother on her state of health and regulates the dosage of drugs.

Surrogate mother survey schedule looks like this:

First Trimester
  • Ultrasound examination 12 days after the hCG test.
  • Ultrasound examination every two weeks until the 12th week of pregnancy.

Second Trimester
  • Ultrasound examination at 11–12 weeks of pregnancy + 1st screening *
  • Ultrasound examination at 16–17 weeks of pregnancy + 2nd screening.
  • Ultrasound examination at 21–22 weeks of pregnancy.

Third Trimester
  • Ultrasound examination at 30 weeks gestation.
  • Moving to Kiev for childbirth and registration in the hospital.
    • With multiple pregnancy: moving to Kiev on the 32nd week and registration at the maternity hospital – on the 34th.
    • With a singleton pregnancy: moving to Kiev on the 34th week and registration at the maternity hospital – on the 36th.

* Screening – blood test (done by a surrogate mother), which helps to identify genetic abnormalities and pathologies in the development of the child: Down syndrome, Edwards syndrome, Patau syndrome, anencephaly and other diseases.

For medical reasons, the doctor may recommend moving to Kiev at any stage of pregnancy.

Step 6. Birth visit

Approximately 10–14 days before the expected date of birth, parents arrive in Ukraine. They are settled in a comfortable apartment with a maid and are preparing for the appearance of the baby.

Birth partnership
After birth, the child must be placed on the breast of the mother or father. That way the baby gets warm (he lived in the womb at 37 degrees) and exchanges bacteria with his parents (this is one of the stages of formation of immunity). Biological mother can attend childbirth from the onset of labour, or come to the room a few minutes before the baby arrives. A surrogate mother signs a waiver of parental rights and does not contact with the baby without the consent of biological parents.

Hospital Stay after Birth
If the child was born naturally without complications, the parents spend 3 days in the maternity hospital in a separate ward. In the case of cesarean section – up to 5 days. There is a baby crib, bath, toilet. Hospital staff helps to care for the newborn: select the mixture, learn to handle the navel and wash the baby. Also, mom and dad receive a baby box – a set of children’s essentials: diapers, towels, clothes, a blanket.

Baby care after discharge
From the hospital parents return back to the apartment. There, the family will spend another 3-4 weeks until the paperwork for the child is completed.The apartment has a baby crib, changing table, chest of drawers or wardrobe for children’s things. To control the condition of the baby, a pediatrician visits the parents weekly. A housemaid helps mom and dad: she cleans and cooks food.

Step 7. Paperwork

At the last stage of the program, parents confirm the kinship and draw up documents for the child to go home. It takes about 2-3 weeks (depending on the country of origin), and our lawyers coordinate the whole procedure.

Documents preparation
After the birth of the child will need:

  • Passports of parents.
  • Marriage certificate with an Apostille.
  • Documents that confirm the citizenship of the parents.

Our lawyers help to prepare documents that will later be needed at the Embassy:

  • Child’s birth certificate (issued in the Registry office. Parents provide a translation of their documents, a certificate from the maternity hospital, a statement of the surrogate mother). We translate everything into the desired language and assure it with an Apostille.
  • Certificate of genetic relationship with the child.

DNA test
In most European countries, the mother is the one who gave birth to a child. Therefore, the surrogate mother writes an official statement, in which she waives parental rights. After that, the parents undergo a DNA examination, which confirms that:

  • a man and a woman are the genetic parents of a child;
  • the man is the genetic father of the child (if donor oocytes were used);

In the second case, after arrival in the native country, woman submits an application for the adoption of a child.

Visiting Embassy and receiving a travel document for a child
On the basis of parents’ passports, marriage certificates, birth certificates, as well as certificates of genetic relationship, the Embassy draws up a travel document for a child (passport).

This is a detailed description of how does surrogacy work in the  VittoriaVita surrogacy agency. We accompany couples at every stage and do  everything so that they become parents.

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