Surrogacy (Third-Party Parenting)
· Ovum (Egg) Donation
· Classic Surrogacy
· IVF Surrogacy
· Toward the Bioethics of IVF Surrogacy
· Embryo Adoption

For many couples who are unable to achieve pregnancy through conventional treatments, third-party parenting offers tremendous hope for success. Third-party parenting is a collective term for egg donation, embryo adoption, gestational surrogacy, donor insemination, and adoption of a child. These procedures are options for the infertile couple to consider when the woman, for some reason, cannot produce healthy eggs or the proper gestational environment for a pregnancy, or when the man cannot produce healthy sperm.

Classic Surrogacy
In classic surrogacy, a healthy young woman (usually under 35) agrees with an infertile couple to be artificially inseminated with the male partner's sperm, carry the baby to term, and then turn the baby over to the couple shortly after birth.

IVF Surrogacy
Candidates for IVF/Surrogate Parenting
Selecting the Surrogate
Screening the Surrogate
Follicular Stimulation and Monitoring the Female Partner (Egg Provider)
Synchronizing the Cycles of Surrogate and Aspiring Mother
Building the Surrogate's Uterine Lining with Hormonal Injections
Egg Retrieval, Fertilization and Embryo Transfer
Management and Follow-up after the Embryo Transfer

IVF surrogacy involves the transfer of one or more embryos derived from the infertile woman's eggs and from sperm of her partner (or a sperm donor) into the uterus of a surrogate. In this case, the surrogate provides a host womb but does not contribute genetically to the baby. While ethical, moral, and medico-legal issues still apply, IVF surrogacy appears to have gained more social acceptance than classic surrogacy. We offer IVF surrogacy as an option in most of our programs.

Selecting the Surrogate
Many infertile couples who qualify for IVF surrogate parenting solicit the assistance of empathic friends or family members to act as surrogates. Other couples seek surrogates by advertising in the media. Many couples with the necessary financial resources retain a surrogacy from IVF centers to find a suitable candidate. We leave this option to our patients. Because the surrogate gives birth, it is rarely possible or even realistic for her to remain anonymous.

Screening the Surrogate
Once the surrogate has been selected, she will undergo thorough medical and psychological evaluations, including:
A cervical culture and/or DNA test to screen for infection with Chlamydia, urea plasma, gonococcus, and other infective organisms that might interfere with a successful outcome.
Blood tests (as appropriate) for HIV, hepatitis, and other sexually transmitted diseases, She will also have a blood test performed to ensure that she is immune to the development of rubella (German measles) and will have a variety of blood-hormone tests, such as the measurement of plasma prolactin and thyroid-stimulating hormone (TSH).
Whether recruited from or by an IVF Center, family members, or through personal solicitation, the surrogate should be carefully evaluated psychologically as well as physically. This is especially important in cases where a relatively young surrogate or family member is recruited. In such cases, it is important to ensure that the surrogate has not been subjected to any pressure or coercion.

Follicular Stimulation and Monitoring the Female Partner (Egg Provider)
The procedure used to stimulate the female partner of the infertile couple with fertility drugs and monitor her condition strongly resembles that used for an egg donor.

Synchronizing the Cycles of Surrogate and Aspiring Mother
The surrogate will receive estrogen orally, by skin patches, or by injections, and then progesterone to help prepare her uterine lining for implantation.

Building the Surrogate's Uterine Lining with Hormonal Injections

Egg Retrieval, Fertilization and Embryo Transfer
The egg provider (aspiring mother) undergoes transvaginal ultrasound-guided egg retrieval, egg fertilization, and embryo culture. Approximately 72-120 hours following egg retrieval, the embryos are transferred to the surrogate's uterus. She then lies perfectly still for approximately 4-5 hours to enhance the chances of implantation and is then discharged from the clinic.

Toward the Bioethics of IVF Surrogacy
The determination of ethical guidelines has not kept pace with the exploding growth and development in IVF. However, some centers in this field are working together, sharing experiences and advice, in an attempt to formulate a code of ethics.
The genetic combination of the male and the female provide two of the essential elements which, along with gestation, are necessary to produce a human being. The two-out-of-three rule basically looks at these three elements: the egg, the sperm, and the gestational component.

Embryo Adoption
Embryo adoption refers to the situation in which a woman receives embryos to which she and her male partner have not contributed biologically. When both partners are infertile, both donor sperm and donor eggs must be used if the woman is to become pregnant. Previously, adoption of a child would have been such a couple's only option. Now, however, "prenatal embryo adoption" can be an alternative to adoption of a baby or child.

Donor embryos can come from several sources. For example, a woman who cannot produce her own eggs might choose to adopt one or more embryos from a donor and have them transferred into her uterus.