The pregnancy

The pregnancy is an exciting time.  You'll find out whether the surrogate is pregnant about 2 weeks after the transfer.

Getting Updates

Keeping updated on your surrogates pregnancy may be difficult, especially when your surrogate may be illiterate, may not speak English, and in a different time zone.  Your main conduits will potentially be:

  • The clinic's doctor.  The infertility specialist at the clinic is likely the doctor you worked with for the egg transfer process.  While it is good that you already know this doctor, she probably won't be the one conducting check-ups.  The clinics doctor is your most likely conduit, but will be very busy and may not always give you immediate updates.
  • The Ob Gyn doctor.  This is the doctor that will be doing the check-ups.  This doctor is used to seeing pregnant women and giving them an update.  They're often not used to communicating with a second mother.  
  • The surrogate's handler/agent.  Some clinics work with an agent to manage the surrogate and especially the surrogates routine check-ups.  Often, the handler will be managing multiple surrogates at one time.  The handler is generally very junior and is unlikely to be a good conduit.  The handler generally represents the surrogate, not the clinic.   
  • A third party, hired specifically for the purpose of monitoring the surrogate's pregnancy and updating the intended parents about the progress of the pregnancy.
  • The Surrogate.  While the surrogate will always be in the know, she may be illiterate and may not speak English. 

It's likely that the clinic's doctor will be your main point of contact.  When you are in India, discuss with the clinic how you'll get updates.  And then follow-up appropriately checking on planned appointments and request scans and faxes of hospital results.

To address this communication issue, Rotunda has recently launched a "Pregnancy Tracker Program" through a third party facilitation company called OGI.  For an (additional) fee of Rs. 100,000 (about US$2,300), OGI will provide regular health updates after every clinical examination, representing the intended parents during scans and tests.

Tests

The pregnancy will include normal checkups.  These include screening tests (like the double marker and triple marker tests) and diagnostic tests (like amniocentesis or CVS).  These tests check for common birth defects including Down syndrome, trisomy 18 and open neural tube defects.

Screening tests are designed to check whether there are any defects and they:

  • detects of about 80-90% of babies with Down syndrome, trisomy 18 and open neural tube defects, depending on the particular test your doctor uses and how far along you are in your pregnancy
  • shows a high risk, which is defined as more than 1 in 250 (or more than a 0.4% chance of a problem) even when the baby does not have one of these problems
  • does not tell you any information about other birth defects
  • does not cause miscarriages

Women with “high risk” screening results are offered diagnostic testing. Women with a “low risk” result usually choose not to have diagnostic testing

Diagnostic tests are more accurate than screening tests, but also more invasive, and are performed on samples obtained by amniocentesis or chorionic villi sampling (CVS).  These tests:

  • have a 99% accuracy on whether your baby is affected with Down syndrome or trisomy 18.
  • have a 90% accuracy on whether your baby is affected with an open neural tube defect.
  • look for other (less common) chromosome abnormalities
  • do add risk; the tests can cause miscarriage in as high as 1 in 100 tests
  • even these tests are not perfect; there is still a (smaller) chance of abnormalities

The diagnostic and screening tests are not perfect; there is still a 3% chance of abnormalities even if the tests show negative results.

Routine Checkups

Check with your clinic on how often the gestational surrogate will have routine checkups.  These may be every month or every two weeks.  If anything is detected, additional medication or tests may be required. 

Additional Treatments

During check-ups, various medical issues that require treatment may be identified.  The doctor will identify and treat these as appropriate.  Typically, because of time zone differences, routine treatments will often be implemented without consulting the intended parents.  It may be worth discussing with the clinic which treatments will be completed with the intended parents consent and which ones will require consent.   

For peace of mind, you may want to brush up on the Food and Drug Administration (FDAs) system to rate the safety of drugs during pregnancy.  Many other countries have their own pregnancy categories for pharmaceutical agents.  The fact is that most medicines have not been studied in pregnant women to see if they cause damage to the growing fetus, but you can research any medication given to the surrogate to determine how it is classified.  The FDA's classifications include:

  • Category A: includes drugs where adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters). This category includes folic acid, vitamin B6, and thyroid medicine in moderation, or in prescribed doses.
  • Category B: includes drugs where Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women OR Animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester.  This category includes some antibiotics, acetaminophen (Tylenol), aspartame (artificial sweetener), famotidine (Pepcid), prednisone (cortisone), insulin (for diabetes), and ibuprofin (Advil, Motrin) before the third trimester. Pregnant women should not take ibuprofen during the last three months of pregnancy.
  • Category C: includes drugs where animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.  This is something a woman would need to carefully discuss with her doctor. These drugs include prochlorperzaine (Compazine), Sudafed, fluconazole (Diflucan), and ciprofloxacin (Cipro). Some antidepressants are also included in this group.
  • Category D: includes drugs where there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.  These include alcohol, lithium (used to treat manic depression), phenytoin (Dilantin), and most chemotherapy drugs to treat cancer. 
  • Category X: includes drugs for which studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits.  This includes drugs to treat skin conditions like cystic acne (Accutane) and psoriasis (Tegison or Soriatane); a sedative (thalidomide); and a drug to prevent miscarriage used up until 1971 in the U.S. and 1983 in Europe (diethylstilbestrol or DES).
     

Note that the FDA requires more data than other agencies, so pharmaceuticals defined as pregnancy category A in other countries may be in the FDA's pregnancy category C .

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