SURROGACY: A NIGERIAN EXPERIENCE

ABIOLA J. ADEWUSI – MEDICAL ART CENTER, LAGOS

BACKGROUND

Women may be unable to provide a gestational environment for their pregnancy for medical or non-medical reasons. This is where SURROGACY comes in. Consequent use of a gestational carrier or a traditional surrogate is widely debated and practice varies throughout the world. But before we begin, there is need to explain the meaning of some terms you might come across in this article.

DEFINITION OF TERMS

  • Commissioning Couple – Intended Parents
  • Surrogate – Gestational Carrier or Host
  • “Screening”- refers to specific historical factors that place an individual at a higher risk for a given disease e.g. HIV and transmissible spongiform encephalopathy (TSE)
  • “Testing” – refers to specific laboratory studies, such as serologic tests.
  • “Ineligible” – does NOT mean excluded, but eligible with appropriate informed consent

DEFINITION OF SURROGACY

Surrogacy is when another woman carries and gives birth to a baby for the couple who wants to have a child. A surrogacy arrangement or surrogacy agreement is the carrying of a pregnancy by another woman for the intended parents.

TYPES OF SURROGACY

  • Gestational surrogacy(also known as Host, Carrier or Full surrogacy)
  • Traditional surrogacy(also known as Partial, Genetic, or Straight surrogacy).

INDICATIONS FOR SURROGACY

  • Absolute Medical Contraindication (e.g. Pulmonary Hypertension)
  • Uterine Anomaly (e.g. Ashermans Syndrome, Unicornuate uterus, absence of the uterus)
  • Congenital Absence of the Uterus e.g. Mullerian agenesis
  • Serious Medical Condition (maternal or fetal risk) e.g. Lupus
  • Non Medical Reasons- Biologic inability to conceive or bear a child (e.g. single male or same-sex couples)
  • Congenital ovarian dysfunction (e.g. Turner syndrome)
  • Recurrent IVF implantation failure (good embryos)

Criteria for Qualifying as a Carrier

  • Healthy female (age 21 – 45 years)
  • Previous successful full term pregnancies
  • At least 1 term pregnancy, not more than 5 vaginal deliveries and/or 2 C-sections
  • Stable Supportive Environment(stress of pregnancy)
  • Psychosocial Evaluation (community and family dynamics)

Screening and Testing

  • Complete personal & sexual history (questionnaire)
  • Complete medical evaluation (not pregnant)
  • FDA does not require screening and testing of possible transmissible infectious diseases to the fetus, ASRM recommends testing all GC and their partners 30 days before ET

 

Factors that makes GC “Ineligible”

  • Altruistic commitment
  • Problematic personality
  • Lack of support system
  • History of conflict with authority
  • Inability to accommodate other opinions
  • Motivation to solve own infertility

 

Intended Parents or Commissioning Couple

This refers to a couple or individual who is unable to provide a gestational environment for pregnancy.  A commissioning couple may be of the same sex.

Criteria for Qualifying as an Intended Parent/Commissioning Couple

  • Complete history
  • Physical Examination
  • Physicians to strongly recommend counseling
  • Genetic evaluation
  • Screening and Lab test
  • Complete medical evaluation(like egg donor)
  • Psychosocial Education
  • Psychological Evaluation

Factors that makes intended Parents/Commissioning Couple “Ineligible”

  • Physical risk of sexually transmitted disease e.g. genital ulcerative lesions, herpes simplex
  • Evidence of syphilis
  • Physical evidence of anal intercourse
  • Physical evidence of percutaneous drug use
  • Physical evidence of tattoos (12months)
  • Unexplained mouth thrush
  • Blue and purple spots (Kaposi sarcoma)
  • Large scab consistent with smallpox immunization

Laboratory Testing for Genetic Parents and Gestational Carriers

  • HIV I antibody
  • HIV II antibody
  • HIV group O antibody (strain from W & C Africa)
  • Hepatitis C antibody
  • Hepatitis B surface antigen
  • Hepatitis B core antibody(IgG and IgM)
  • Serologic test for syphilis
  • Blood type and Rh factor (risk of incompatibility must be discussed)
  • Gonorrhea, Chlamydia, cervical cultures
  • Pap Smear
  • Mammogram
  • Rubella (GC only)
  • Drug screening (Illicit)

Additional Tests for I-P & GC

Male                                                                                     Female

  • Neisseria gonorrhea Neisseria gonorrhea
  • Chlamydia trachomatis Chlamydia trachomatis NAT on urine or swab
  • HTLV-1 and HTLV-2
  • Cytomegalovirus (CMV) (IgG and IgM)

Managing Lab Test Results of I-P

  • A positive result should be confirmed before informing the genetic parent.
  • Referral to appropriate counseling
  • False-Positive to Syphilis and confirmed negative using treponemal essay are eligible
  • Testing positive to syphilis, gonorrhea and Chlamydia should be treated, retested and deferred for 12 months
  • Men who test positive to CMV infection should be excluded until active signs of infection is no longer present
  • Individuals who test positive for HIV I & II, HTLV I & II, HIV group O, Hep. B, Hep. C, Syphilis are considered INELIGIBLE.

To be continued…