WIXLIB

MEDICALASPECTS OFSURROGACY

ModeratorDr. Guy Ringler California Fertility PartnersThe Medical ProcessDr. Anate Brauer Shady Grove FertilityPanelistsInside The IVF Lab: Embryo Creation & EvaluationDr. Susanna Park San Diego Fertility CenterSelection and Screening of Egg DonorsDr. Jeff Wang American Fertility ServicesScreening & Preparation of Gestational CarriersDr. Mark Leondires RMACTEmbryo Transfer and Early Pregnancy MonitoringDr. Daniel Skora Fertility Specialists of TexasMen Having Babies 2021

Safe and Ethical PracticesClinics play an important role not only in success rates for your journey but in thesafety and ethics of a surrogacy journey for all parties involved.Intended parents Creating your family, with your considerations in mindEgg donors Overseeing safe and effective medication doses, egg harvesting andfollow upGestational carrier Ensuring safe, successful and supported pregnancies and future supportChildren Minimizing obstetrical and pediatric complicationsMen Having Babies 2021

Dr. Anate BrauerShady Grove FertilityTheMedicalProcessMen Having Babies 2021

Medical Treatment Process Single spermSourceSplitInseminationEgg Donor: Known /Anonymous / Semi-KnownSelect an eggdonor MedicalScreeningPsychologicalScreening PsychologicalScreening Legal Contracts Legal Contracts FDA Screening Embryo Transfer Embryo Creation Medical Screening Requires 1 day at theclinicFreezing sperm doesnot impact qualityGestational Carrier:Family / Friends /Surrogacy AgencySelect SurrogateSpermCryopreservation FDA Screening Complete Pre-cycleTesting UterusOocyteSpermMen Having Babies 2021

Strictly defined FDA screening tests fordonor and dads are absolutely required tominimize the actual and theoreticalchance of disease transmission to yourgestational carrier via placement of theembryo in her uterus.FDATestingFDA Testing Blood work and urine test Infectious disease questionnaire Physical examinationBoth egg donor and sperm provider arepre-screened before the actual FDAinfectious disease tests are performedthrough an approved US lab.FDA screening timing Sperm provider: within 7 days of spermproduction Egg donor: within 30 days of eggretrievalMen Having Babies 2021

In Vitro Fertilization1. Ovarian Stimulation3. Create Embryos2. Egg Retrieval4. Transfer EmbryosMen Having Babies 2021

Ovarian StimulationWhat your donor needs to do? FDA screening Injections of gonadotropins Ultrasound monitoring & blood tests (4-6 times) Egg retrievalMen Having Babies 2021

Egg RetrievalWhat your donor needs to do? General anesthesia The procedure takes about20 minutes Performed under ultrasoundvisualizationMen Having Babies 2021

Creation of EmbryosThe expected yield from typical egg retrieval in young healthydonor varies widely but the average is usually : 12-20 eggs10 eggsOocyteà7-8 fertilize à 6-8 embryos à 3-5 blastocysts à 2-4 “Normal”Day 1EmbryoDay 3EmbryoBlastocystPGTNote: Divide everything in half if eggs are dividedbetween two dadsMen Having Babies 2021

Dr. Susanna ParkSan Diego FertilityCenterInside the IVFLab:EmbryoCreation andEvaluationMen Having Babies 2021

Inside The IVF Laboratory:Embryo Creation and EvaluationWhat happens in theembryology lab,encompassing embryocreation and progressionfrom Day 1 ---- 6?How are embryosevaluated, graded andchosen for transfer?Men Having Babies 2020How and when testing isperformed? Pros andcons for those using eggdonors and gestationalcarriers.

Inside The IVF Laboratory:Two Types of FertilizationConventionalICSI: Intracytoplasmic SpermInjectionMen Having Babies 2021

Men Having Babies 2021

EmbryoEvaluationHow are embryos evaluated, graded,and chosen for transfer? Embryos can be graded based ontheir appearance Stage of development Symmetry FragmentationMen Having Babies 2021

Importance of Embryo Grading Embryos with the best grade are morelikely to implant than those with lessergrades. Many critical features of an embryocannot be seen and are therefore notconsidered when grading an embryo. Among these features are thechromosomes.Men Having Babies 2021

PGT - Preimplantation GeneticTestingHow and when is PGT performed, what are its pros and cons,and does it really improve outcomes when using a young eggdonor and gestational surrogate?Biopsy of the Blastocyst Biopsy of the trophectoderm (not inner cellmass) Biopsy of 4-6 cells from one location 1% damage Tests for chromosomal abnormalities Can tell you the sex of the embryoMen Having Babies 2021

Men Having Babies 2021

TypicalDown’s SyndromeDetection of SpecificChromosomal AbnormalityMen Having Babies 2021

Normal Attrition Rate1spermsource# follicles before retrieval2spermsources20# eggs retrieved18# mature eggs158/7# fertilized116/5#blastocysts74/34-53/2#euploidMen Having Babies 2021

Dr. Jeff WangAmerican FertilityServicesScreeningand Selectionof Egg DonorsMen Having Babies 2021

What characteristics define anoptimal egg donor, and why?SelectionandScreeningof EggDonors What medical and genetic testsdo donor applicants undergo intheir screening to determinewhether they should be allowedto donate? How important are factors likeproven versus first-time and freshversus frozen eggs?Men Having Babies 2021

Selection and Screeningof Egg DonorsWhat characteristics define an optimal egg donor, and why ? Age : 20-28 ideally Physically and mentally healthy Non-smoker, no drugs Excellent family history Good ovarian reserve Appropriate motivation and desireMen Having Babies 2021

Selection and Screening of EggDonors- Medical Clearance- Complete history and exam- Ovarian reserve testing- Infectious disease screening- Genetic Clearance- Carrier screening- Detailed Family History- Psychological Clearance- Reproductive Professional- Standardized exam- Legal Clearance- Contracts- Outlines your rights and wishesMen Having Babies 2021

Selection and Screening of EggDonorsEgg donors and age – chromosomal errorsMen Having Babies 2021

Proven and First-Time DonorsPROVENKnown “track record”Less chance of surpriseTypically have a highercompensation but less likelyto have donor errorsPotential to know outcomes ofpast cyclesMen Having Babies 2021FIRST-TIMEWider selectionUsually younger andpotentially better ovarianreserveTypically have lowercompensation rates

Fresh Cycles and Frozen EggsFRESHFROZENMany more eggs andresulting embryosCan be less expensiveHigher success ratesConvenient and typically largeselectionCan likely freeze embryos forfuture sibling cyclesCan access donor’s eggs longafter she “ages out”Men Having Babies 2021

Dr. Mark CarriersMen Having Babies 2021

Characteristics of an OptimalGestational CarrierHistory of uncomplicated pregnancies This predicts a very good prognosis for future pregnanciesLess than 5 previous vaginal deliveries or 3 cesarean deliveries Number of previous deliveries can increase risk for future pregnanciesAge less than 44 (almost always) Maternal age is associated with multiple obstetrical complicationsNonsmoker, excellent health, BMI 30, negative drug screen Essential factors for health of the fetusStable lifestyle and financially stable with intact support systems GC’s ability to maintain doctor’s appointment, stay on medications andattend prenatal visitsNo significant history of mental illnessRisk factors for complianceMen Having Babies 2021

Experienced or First-TimeGestational CarrierExperiencedKnown “track record”Understand the processFirst TimeWider selectionTypically highercompensationTypically youngerTypically older, perhaps lesslikely to do sibling journeysTypically lowercompensationMen Having Babies 2021

Medical Review and TestingComplete physical examination Assess the health status of the GC and her partnerComprehensive record review of every prior pregnancy Previous complications is a strong predictor of future outcomesSaline sonohysterogram to evaluate the uterine wall and lining Structural abnormalities can impact pregnancy successInfectious disease screening Reduce the risk of transmissible infectionsPsychosocial assessment Identify risks for poor complianceFull medical instruction about surrogacy process, procedures and risks GC understands the entire processMen Having Babies 2021

COVID Testing and VaccineTypical COVID screening protocolCOVID vaccine and pregnancy Does the child gain any protection against COVID? Does it matter if the GC is vaccinated beforepregnancy or during? Are there any risks if the GC is vaccinated during thepregnancy?Risks of COVID during a pregnancyMen Having Babies 2020

MedicationCycle Your surrogate will takemedications (includingprogesterone injections, pillsand/or suppositories) toprepare the uterine lining forimplantation. Preparation for the embryotransfer can take anywherefrom 3-6 weeks or more(depending on theprotocol)Men Having Babies 2021

GestationalCarrierMonitoringYour surrogate willundergo several uterinelining checks consisting ofvaginal ultrasounds andbloodwork to ensure idealtiming for the embryotransfer.Men Having Babies 2021

Dr. Daniel SkoraFertility Specialists ofTexasEmbryoTransfer andEarlyPregnancyMonitoringMen Having Babies 2021

Embryo Transfer and EarlyPregnancy Monitoring How is the embryo transferred? When in the cycle is the embryo transferred? What are the potential risks? Are fresh transfers still an option?Men Having Babies 2021

MedicationsSide effects: bloating,mood effects, weightgain, constipation, painin the injection site.There is no provenassociation betweenthese balancedhormones and any typeof cancerEmbryo transferRisk for GestationalCarriersMen Having Babies 2021Side effects and risks :essentially none. Thegreatest potential risk isdirectly related to thenumber of embryos thatare transferred, whichdefines the risk ofsubsequent multiplepregnancy.

Single versusDouble EmbryoTransferWhat are the pros and cons ofsingle versus 2-embryotransfer, including relativesuccess rates and risks to GCand babies?Embryo Transfer CategorySET 1Cycles (n)13721271Mean number of embryos1.01.7transferredFetal Sacs (n)867708Implantation rate63.2%55.7%Delivered766773Live Birth rate55.8%60.8%The chi-square statistic is 6.7473. The p-value is .009389. The result issignificant at p .05.SART 2017 Live Birth RateDonor Eggs and GC100.0%90.0%80.0%P 0.0570.0%60.0%50.0%40.0%30.0%20.0%10.0%Men Having Babies 20210.0%SET 1

Risks of a Twin PregnancyIncrease risks to your carrier: pregnancy complications Preterm labor, diabetes, pre-eclampsia, prolonged bedrest, placentaprevia, extended hospitalization(s) and eventual C-section.Increase many risks to the babies (when compared to single pregnancy) PREMATURITY , sometime life-threatening that can have short- andlong-term physical, mental and emotional challenges: Brainhemorrhage, kidney failure, intestinal complications, infectionExtended stay in the NICUIt can be difficult to reconcile all these risks with our models of safe andethical surrogacy and the protection of all four of the parties we careand advocate for : you, your babies, your carrier and your donor.Men Having Babies 2021

Embryo TransferMen Having Babies 2021

After theEmbryoTransferPregnancy test is usuallydone 9-11 days afterthe embryo transfer.Testing is through ablood test to measurebeta HCG levels.Men Having Babies 2021

Early Pregnancy Monitoring,Prenatal Care, and DeliveryHormone and beta HCGlevels are monitored forseveral weeks after transfer. Risks of early miscarriage? Discontinuing Medications Discharge to OB – clinic“graduation”Men Having Babies 2021

Thank you to our amazing panelof Medical Experts!Men Having Babies 2021

Men Having Babies 2020

Dr. Guy Ringler California Fertility Partners The Medical Process Dr. AnateBrauer Shady Grove Fertility . Selection and Screening of Egg Donors Dr. Jeff Wang American Fertility Services Screening & Preparation of Gestational Carriers Dr. Mark Leondires RMACT Embryo Transfer and Early Pregnancy Monitoring Dr. Daniel Skora Fertility .