Monday, 22 November 2010

SCI – How we maximise every opportunity for you to have a baby - part one (updated)

We, at SCI understand both the emotional, physical and monetary costs of all our families undertaking this journey. Our research tells us that we are in the middle of the road when it comes to our costs and fees, so we thought we would take the opportunity to share with you what we do to maximise every chance of you having a baby.

We start at the beginning; we have many couples who choose to self cycle, we are aware of the evidence through hormone levels (especially AMH* levels) that are predictors of the likely hood of a viable pregnancy and live birth. The heart breaking facts of diminished Ovarian Reserve are that a women can still produce eggs, they can still develop into wonderful looking embryos ( but not always), but the chances of getting pregnant are greatly reduced and if you do get pregnant the chances of miscarriage are very high. This is why we insist on all clients who are looking at self cycling and egg donors undertake this test. We are aware that some couple choose to proceed with this information, but we believe that clients should make informed decisions. Sometimes we are in the unfortunate position to being the first to tell unsuccessful egg donors ( Indian and Non- Indian) of their poor fertility outcomes.

Sperm quality is something that is not often talked about and presumed to be “OK”. With a sperm culture and analysis, this assumption can be tested. Poor sperm quality can have as significant impact on becoming and staying pregnant as egg quality.We want all couples to be aware of this. Excellent embryo grading is what we all want, with men we hope for average or better sperm quality, but one of the most common age related factors is poor motility. One of the many ways we assist with this is making ICSI** a part of our package, so all clients benefit.

All these discussion are difficult to have with clients, but we do not want to give anyone false hope by undertaking treatment ( or multiple attempts at treatment)with a likelihood of a poor outcome.

We are in the fortunate position (through good practice and management) of being one of the few agencies that does not need to advertise for surrogates and having a surplus of screened surrogates at any one time. Through word of mouth from past surrogates and their families, we have women and their families approaching us daily for the opportunity to become a surrogate. Potential surrogates often come with their own mother, husband and extended family to enquire about this opportunity. All surrogates (and their husbands) are screened by our medical team and our psychologist.

We look to the evidence which guides us in best practice and therefore best outcomes for these women and their families and as a consequence, our IP's. As previously described:

“SCI, we do not believe that surrogates should be separated from their
immediate families, nor do we believe in dormitories for accommodation. This
is backed by research which tells us that surrogates have poorer health outcomes,
increased anxiety and greater recovery times if separated from their immediate
family. Mr. Singh provides us with spacious Studio Apartments that are fully
furnished; have cooling to cope with the Delhi heat as well as fridges and cable
televisions in each apartment, the cost of which is met by IP’s.
..The teams (of Social workers/supportworkers/cleaners) meet with surrogates and their families on a daily basis at the surrogate housing. They look after the daily
up-keep of the studio apartments and ensure that the surrogate and their
families have all their needs met. Fresh Food, drinkables and supplements are
provided every second day for all in the apartment. If a surrogate chooses to
have her children with her (often the case for younger children) then a second
family member must be available to provide care..”
We believe because we treat the surrogate as part of her family and her community, not as an individual or a body part, extending this care to the surrogate’s children and other family members, is one of the many reasons for the successful word of mouth campaign that has allowed us to be in the privileged position of having more surrogates than we are able to use. A proportion of the fees that you pay cover these additional items that ensure a higher quality of care for the surrogate and her family.

This includes, but is not limited to individual air conditioned studio apartments rather than dormitories, individual cable TV’s so surrogates or their children can watch what they want, fridges for consumables, school fees, with uniforms, textbooks and school supplies, food & supplements for extended family members, recreational activities for all, additional child care, medical care for the surrogates children, children’s carer and extended family, transport for extended families to visit the surrogate etc.

This makes up our costs, but is of course separate to what the surrogate actually receives in compensation which is paid throughout the surrogacy process . We are very aware that this word of mouth holds us to account, if we fail to provide the quality of care, opportunities or outcomes as promised or described, this surplus of potential surrogates would cease to exist.

For IP's, this means that we have healthy emotionally robust surrogates, with supportive families who want to become pregnant. As with best practice in relation to surrogacy, our choice of surrogate occurs three to four weeks prior to egg collection. We aim to match as closely as we can, the cycle of our self cycler/egg donor with our surrogate.

This usually means that we are monitoring the cycle of a number of potential surrogates to find the best match possible. A proportion of your fees go towards compensating the potential surrogates who do not successfully match.

But even with this care, there are times when the surrogate cycle is not optimum, the uterine lining may not be thick enough or too thick, the hormone levels may not be quite right or there may be some other personal factor that impacts on the likelihood of a successful outcome.

If this occurs, we simply do not proceed. Unless planned, we do not offer a back up surrogate because we know the importance of matching cycles. At times, this may mean that your egg collection is delayed, in rare cases this may mean that your embryos will be frozen, but we will not transfer to a surrogate unless we believe that there is every chance of the surrogate becoming pregnant and having a live birth.

At SCI, we will do everything to maximise all opportunities for you to have a sucessful outcome,what we all want, above all else is for you to go home with your baby in your arms.

*AMH - Anti-Mullerian hormone is a hormone produced by the granulosa cells of the early developing antral follicles. These are the immature eggs that wake up from their dormant state and develop into mature eggs. As a woman runs out of eggs, the number of these small antral follicles decline in number and as a result the serum Anti-Mullerian hormone falls. This is why serum Anti-Mullerian hormone testing is a good estimate of residual egg number. Women with diminished ovarian reserve have diminished fertility and an increased risk of miscarriage.

**Intracytoplasmic sperm injection (ICSI) is an IVF procedure in which a single sperm is injected directly into an egg.

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