During the past several years surrogacy has become a hot topic in the media and especially now newspapers, magazines and TV are full of reports and talk-shows revealing the drama and hype surrounding this type of reproductive treatment. Surrogacy frequently pops up as quasi news stories related to one celebrity or another who has used surrogacy to have a baby. Not long ago Newsweek interviewed Dr. Smotrich for a cover story regarding surrogacy and a cascade of other media then jumped on the bandwagon to leverage off this article. The lay media predominantly chooses to focus on the sensationalist aspect of this treatment by having headlines such as “Womb for Rent”, “Outsourcing Labor”, “Surrogacy For Love but not for Money”, “Gays buy twins” and so on. But for all the tabloid-like headlines and media rhetoric, surrogacy itself is and will continue to be a viable, efficient and successful reproductive option for certain medical and societal indications.

Surrogacy is the practice whereby a woman becomes pregnant and gestates (carries) and delivers a child for someone else or for another couple. Surrogacy itself is not a new phenomenon. References to surrogate mothers and commissioning (intended) parents can be found in the Bible and as far back as Greek and Roman times. Throughout the ages there have been many cultures where a relative or friend carrying a child for an infertile relation or acquaintance was not that uncommon. Commercial surrogacy began in the United States in the late 1970’s when a lawyer named Noel Keane arranged the first third party surrogate cases.

There are two types of surrogacy: traditional surrogacy and gestational surrogacy.

Traditional surrogacy: in which the surrogate either undergoes insemination or IVF with sperm from the male or from a sperm donor. The surrogate herself provides the eggs and is therefore genetically related to the child. This form of surrogacy is the older method and because of the genetic link between the surrogate and the baby there is some downside risk to this form of surrogacy.

Gestational surrogacy: in which the surrogate carries a pregnancy and delivers a child that is created from the egg and the sperm of the intended parents and /or donor egg and /or donor sperm and/or donated embryos in any combination. The key to this type of surrogacy is that the gestational surrogate is not genetically related to the child and acts only as a gestational carrier for the pregnancy.

Two years ago Dr. Smotrich gave a talk at a conference on Third Party Reproduction. For the purpose of helping potential patients to understand surrogacy we are going to use his talk as a framework to summarize surrogacy from A to Z. The title of the talk was; “Managing a Surrogacy Program—It Takes a Village” and indeed it does!!!! In summary here is the talk:

• The surrogate herself must be willing to undertake this journey.
  
  
• Intended parents are made up of : traditional couples, male-male couples, female-female couples and single men and single women.
  
  
• It is paramount that the physician who is managing the surrogate cases has experience doing so. This is one of the single most important factors in managing a successful Third Party Surrogate program.
  
  
• It is also vitally important that the nurses coordinating the surrogate and the intended parent(s) cycle need to have experience with these types of cycles and with working with people from other states and other countries.
  
  
• Since May 2005 all surrogate cycles are now monitored by the Federal Drug Administration. The FDA regulates and sets out the requirements for determining donor-eligibility, including donor screening and testing for donors of human cells, tissues and cellular and tissue-based products. What this means for people who are going to use a surrogate is that whoever is giving the egg and sperm that will result in the embryo(s) which will be transferred to the surrogate needs to undergo donor-eligibility. All donors of eggs, sperm or frozen embryos are subject to a questionnaire, a physical examination and communicable disease testing.
  
  
• The actual specific diseases to be tested are prescribed by the FDA as is the timing of the testing with respect to the use of the eggs or sperm.
  
  
• A donor-eligibility determination is a conclusion that a donor is either eligible or ineligible to donate cells or tissues based on the results of the donor testing and screening. According to the FDA however, even if someone is ineligible based on the testing and screening the eggs and/or sperm and/or embryos can be used for implantation if the HCT/P (for reproductive purposes, eggs, sperm and/or embryos) consists of reproductive cells or tissue from a DIRECTED REPRODUCTIVE DONOR. (A directed reproductive donor means a donor of reproductive cells or tissue, including semen, oocytes, and embryos, to which the donor contributed the sperm or oocyte, to a specific recipient, and who knows and is known by the recipient before donation.) The key here for people who are going to use a surrogate and who fall into the ineligible category is that they have to know and be known by their surrogate before starting their treatment with that surrogate.
  
  
• The FDA regulatory issues are quite complicated and for more information on this subject please call Diane at (858) 558-2221. La Jolla IVF has spent hundreds of hours and thousands of dollars to ensure FDA compliance in terms of our third party cycles (both egg donor cycles and surrogate cycles). It is of the utmost importance that all patients undergoing third party reproductive cycles (egg donor and surrogate cycles) understand the FDA regulations and how these requirements affect and impact their treatment cycles.
  
  
• In order for a surrogacy program in an IVF clinic to be successful, the IVF laboratory needs to have experience with the newest and latest advances in embryology techniques such as Intracytoplasmic Sperm Injection (ICSI), Preimplantation Genetic Diagnosis (PGD), Blastocyst Transfer and the newer freezing techniques. It is very important that the IVF lab be staffed with the best and have the most up-to-date equipment available. La Jolla IVF has made a commitment to make sure that the lab is always at the forefront of technology and the IVF lab functions as the hub of the wheel from which the other spokes of the program emanate.
  
  
• At La Jolla IVF we consider it a conflict of interest for the physician and clinic to own a surrogate agency or to procure surrogates. Over the past several years surrogate agencies have fulfilled the role of finding and matching patients with surrogates. We are very grateful for the wonderful role and support that the agencies we work with provide for and to the patients in their search for surrogates and in finding the best and most competent surrogates available. The agencies fulfill the role of helping commissioning parent(s) with finding legal representation, health insurance for the surrogates, life insurance and in performing background checks on surrogates and in sending the surrogates to the appropriate professionals for psychological screening. By having a well-rounded competent agency involved with all the steps of surrogacy (excluding the medical), this frees La Jolla IVF up to do what we do best and that is the medical treatment of the commissioning parent(s) and the surrogate. Please call our office at (858) 558-2221 and ask to speak to Diane to get references to agencies that La Jolla IVF works with on an on-going basis.
  
  
• RESULTS: In an abstract that was submitted to the American Society for Reproductive Medicine (which was accepted as a poster for the ASRM Meeting in November 2008), we discussed La Jolla IVF’s results. From March 2005-March 2008, 324 gestational surrogate embryo transfer cycles were performed. Indications for surrogacy were: 35% anatomic uterine issues (such as hysterectomy or congenital malformations or absence of uterus), 20% systemic disorders (such as diabetes, liver disease, kidney disease, hypertension etc), 12% multiple failed IVF cycles (usually more than 8 failed IVF cycles), 3% recurrent miscarriages, and 30% alternative patients (gay male couples, lesbian couples, and single males and single females). A clinical pregnancy confirmed by fetal cardiac activity on ultrasound was seen in 244 of the 324 surrogates for a pregnancy rate of 75% on the first attempt.

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