Monday, April 20, 2009

First Trimester Combined Screening results say we are High Risk

Screening test and Diagnostic tests. You'll receive lots of screening and testing results during the surrogacy process, pretty much the same as any other pregnancy. Screening tests are the first ones done, and they're the ones that scare you. Diagnostic tests are done later, and these give more accurate results. The main thing we were worried about was Downs Syndrome which is indicated by an increased calculated risk of trisomy 21. If you read the books, these screenings more often rasie unwarranted alarms (false positives) rather than quell fears. And they did for us too. Here's why.

The Double Marker screening was done around week 11 of our surrogate's pregnancy. It checked the Free Beta HCG, Serum by CLIA and PAPPA by CLIA. I don't know what that means either. But they take figures from these tests, the biological wife's age, and an ultrasound measurement of the nuchal translucency and run it through some predictive analytical software. Because it is predictive and not diagnostic, this is called a screening.

What I do know is that the email and scanned results came back showing the pregnancy was high risk, that "the calculated risk for Trisomy 21 is above the cut off which represents an increased risk." This was enough for my wife to start crying and pass me the paperwork.

This is what you have to realize: any risk calculated at higher than 1 in 250 is considered an increased risk. For us, the calculation was 1 in 107, which by that definition is an increased risk. But what that really means is that 1 in 107 births like ours will have Downs syndrome, which is less than 1 percent. That's why this test raises so many false fears.

More interesting is that if you only look at my wife's age, all the charts show a risk of 1 in 50. So, although the risk is "high" by the arbitrary definition of more than 1 in 250, when looking at not just her age, but also the additional medical information above, the odds had actually moved in our favor from 1 in 50 to 1 in 107. That was good news. And my wife was relieved.

The Amniocentesis test is the diagnostic test. Those provide more definitive results. I'll post on those separately.

Saturday, April 18, 2009

Surrogacy success!!!

Yes, our Christmas trip to Rotunda has been successful. Our baby is reaching 16 weeks and all tests indicate a healthy pregnancy in our surrogate mother! We didn't want to write anything earlier for fear of jinxing this good luck after many, many years of trying to have a baby.

What we've learned over the past several months:
1) First, there are a number of "screening" and "diagnostic" tests done during a pregnancy. Screening tests don't prove anything, they are just "indicators". Diagnostic tests prove whether a problem exists or not. If you are over 40, the odds of downs syndrome exceed 1% and go up pretty quickly with age. The screening tests all use age (the egg donors) as one of several factors to determine if the pregnancy is high risk. But, high risk is defined as 1 in 250. So, age, by itself, moves a pregnancy into high risk. So, when you get your screening results back and they say your pregnancy is "high risk", read the fine print. Ours said that the risk was 1 in 100, which is actually better than the 1 in 50 rate you get based on our age. So, although the screening test said the pregnancy was high risk, the risk was getting lower when additional factors beyond age were added. Although high risk, the odds were moving in our favor. The good news is that the amniocentesis test, a diagnostic test done later in the pregnancy, just came back okay.

2) They won't tell us the sex of the baby until it is born. Because of problems with infanticide in India, doctors are legally prohibited from divulging the baby's sex until it is born. This is true for all births, including surrogate births. So, we're going old school and won't know the sex of the baby until it is born.

3) It does seem that it's possible to breast feed the baby even if you didn't carry it. We're checking into and learning more about "induced lactation"...

If everything continues well, we'll be off to India in September. Now to research the passport and travel issues, and dig deeper into the baby books.

We've also been in touch with two of the couples that we've met on our trips. One is also pregnant, and the other is not pregnant after two tries.