Saturday, October 3, 2009

Selecting the surrogate

Because we'd like our new baby to have a sibling, so we're looking at another round of surrogacy. Having finally gone through a successful round, we're re-thinking the criteria for selecting a surrogate.

Many of the clinics, including Rotunda who we've worked with, will either email you surrogate profiles or, if you are in Mumbai, provide a book of profiles to look through. The information in the profiles themselves are rather limited and include age, religion, education, number of children and a photo.

Having gone through a round of this already, this is what we think of the different criteria one can consider and the ones that are important to us:

1) Successful pregnancies. To us, more is better. Both her own and also through surrogacy. Successful pregnancies show that the surrogate can carry a baby to term and has experience doing so.

2) No unsuccessful pregnancies or complications in pregnancies. During our pregnancy, our surrogate had gestational diabetes, high amniotic fluid levels, and low T4 levels (related to the thyroid). It is our understanding that she had not exhibited any of these signs in four previous pregnancies. So, on the one hand, successful previous pregnancies are a good sign. On the other hand, they don't guarantee a trouble free pregnancy. One possibility is to speak with the gynecologist that handled the surrogates previous pregnancies to understand if there were any complications with those pregnancies.

3) Vegetarian/diet. India has a high percentage of vegetarians. Our understanding is that this can lead to low iodine levels which may have caused the low T4 levels in our surrogate. While this can be overcome with vitamins, we may consider a non-vegetarian surrogate for our next round.

4) Education level. We have mixed feelings on this. On the one hand, the education level one attains is really based on how one did in the lottery of birth. If you're born in the U.S., you probably got an education. If you are a woman born in the Indian countryside, you may not have had the good fortune of access to formal education. From that perspective, education is irrelevant. On the other hand, a higher education level may impart more knowledge that would help ensure a safe and successful pregnancy. But trumping that is whether the surrogate has had past successful pregnancies. So, overall, education is a non-issue for us.

5) Previous transfers. Some of the surrogates have had multiple previous unsuccessful transfer attempts. It's valuable to ask how many unsuccessful transfer attempts a particular surrogate has had. Medical science doesn't understand everything, and certainly doesn't understand what does and doesn't cause a successful transfer.

6) Religion. Aside from any diet restrictions that religion imposes, religion is a non-issue for us.

7) Age. For us, age is secondary to successful pregnancies and limited unsuccessful transfers. However, age in the mid to late 20s are probably in the sweet spot.

8) Medical tests. Clearly, standard medical tests to check for any diseases should be undertaken. Most of the reputable clinics seem to do this.

9) Height/weight/etc. Some Indian women are more petite and some IPs may have genes that could result in bigger babies. While not a factor for us, some couples may want to pursue a "bigger" surrogate. It would seem that a big baby in a little woman could increase risks during delivery, much as the larger babies caused by gestational diabetes can increase risks during delivery.

10) Choice of surrogates. Even with the above, if the clinic has very limited choice, you're going to get what is available. We wanted to have some choice, or have a sense that the clinic did some filtering based on the criteria that was important to us.

11) Colostrum/Breast Milk. Colostrum is the initial milk produced for newborns and helps jump-start the baby's immune system. If you would like the surogate to express colostrum or breast milk for some period of time, consider including this as part of the selection process and also include it in the contract with the surrogate. Asking any time after the transfer leaves you at greater risk of the surrogate declining.

Of course, you have to trust that the clinic and surrogate are giving you accurate information. We worked with Rotunda, where we did observe a conversation about "no longer working with a surrogate that had complications in a transfer". From that, it would appear that Rotunda has a high enough supply of surrogate candidates that it can be selective about which it offers for intended parents to work with.

Also important is how the surrogates health and progress will be monitored during the pregnancy. Some of the clinics have housing for the surrogates (Rotunda is one), some find or rent housing, some provide a caretaker to periodically visit the surrogate during her pregnancy, and some do none of the above. For us, it was important that the surrogate have housing where her pregnancy could be monitored more frequently.

So, top issues for us are medical tests, history of previous pregnancies, history of previous transfers, diet and willingness to express colostrum.

[This post was slightly edited and added to the Surrogacy India Guide.]

Please add your criteria in the comment section.