Unexpected events that could arise from fertility tourism – What could go wrong in surrogacy and how to prepare for it?

There are a number of reasons behind an infertility treatment ending up in a failure. A combination of factors starting from selecting the wrong egg donor, imperfections in the IVF and ICSI procedures, a flaw in the PGD and incompetence of the surrogate mother, could all be responsible for a pregnancy never materialising.

Let us explore these factors categorically and see if we can initiate preparatory measures to prevent an infertility treatment from turning out unsuccessfully:

  1. A woman’s age is a chief factor that determines the egg’s chromosomal integrity. As age her age increases, the chromosomal integrity reduces lowering its chance of being fertilised by male sperms.

    Preparatory steps: Always insist upon selecting a young egg donor whose egg yielding capacity is high. They have a high potential ovarian reserve, able to produce plenty of healthy eggs at the time of egg retrieval. The chance of fertilisation is very high in these cases.

  1. Too young egg donors are not good either. Eggs retrieved from this group are of poorer quality, thus giving rise to incompetent embryos. Besides too young egg donors are inclined to ovarian hyper stimulation on administration of fertility drugs. If such is the case, the quality of eggs would certainly deteriorate.

    Preparatory steps: Always try to find an egg donor who is young but not too young for that matter. Age group between 25 to 30 years would be an ideal choice.

  1. Even a flaw in the system of the recipient could deter an infertility treatment. They may suffer from embryo implantation dysfunction which normally goes undiagnosed. The endometrial lining might be abnormally thin which is common with aged women having uterine surface lesions, scar tissues or polyps that would pose problems with a successful implantation.

    Preparatory steps: Too old recipients/surrogate mothers must not be selected for reasons already explained above. In general, every egg donor and the male partner must be thoroughly appraised before launching upon an infertility treatment program where the eggs and sperms interact in order to achieve fertilisation. The quality of both the male and female gametes is of crucial significance for the yielding a successful pregnancy.

  1. The embryos have failed to develop inside the womb. This is the prime reason behind an infertility treatment being unsuccessful. Sometimes there is no straight explanation for this but the likely cause seems to be that the eggs might not have divided properly as it should have after fertilisation. This reduces the chance of a satisfactory implantation. Poor supply of blood to the womb might also lead to unsuccessful pregnancies even if there is apparently no fault with the quality of the embryos.

    Preparatory steps: Total bed rest after transplantation of the IVF created embryos to the uterus would impede a healthy flow of blood to the womb. Emphasis is always put by fertility specialists for the recipients that they should keep themselves occupied in the regular chores. Obviously picking up heavy loads or doing strenuous activities is not advocated. But pre delivery light exercises would be very beneficial. It will boost the flow of blood to the womb.

  1. Poor quality of male sperms could also lead to failure in infertility treatment. The semen, in this case, contains much lower sperm count with a low egg penetration potential.

    Preparatory steps: To resolve this issue, the sperms are artificially made to penetrate the eggs by a procedure called Intra-cytoplasmic sperm injection (ICSI).

  1. Sometimes premature ovarian failure, which hits one among a hundred women less than 40 years, could be a cause of af failed infertility treatment.

    Preparatory steps: These cases should be properly diagnosed by blood and other medical tests to see if the ovary is producing estrogen and the pituitary glands are producing FSH and LSH. Estrogen therapy could be a solution.

Problems faced by intended parents

Surrogacy is ideally an excellent association between intended parents and the surrogate mother with the infertility clinic doing their bit with professional consulting and dedication. The outcome is a healthy pregnancy and later the delivery of a healthy baby.
However, the rosy picture portrayed might get marred by certain factors leaving everyone involved unhappy. Let us explore the underlying causes:

1) A failed transfer:

The intent behind using a gestational surrogate mother to successfully carry a pregnancy resulting from embryos created by IVF and implanted inside the womb may lead to a failure. The surrogate mother and the intended parents drift apart breaking the wonderful bond created initially. This gives the surrogate mother a feeling of incompetence.

2) Chances of miscarriage:

Surrogacy is not a guaranteed baby production method. We are after all human beings with physical and mental limitations. Chances of miscarriages cannot be ruled out. Development of multiple fetuses is not that uncommon in surrogacy, which in turn can lead to a higher chance of premature births. Even unhealthy triplets are sometimes born and infant mortality rates climb in these cases.

3) Chances of disagreement between the intended parents and surrogate mothers:

A split in the association built between the surrogate mother and the intended parents cannot be ruled out when there is a miscommunication or misrepresentation. One becomes apprehensive about the intentions of the other. Polite words and smiling faces become nothing more than a camouflage. Expectations get shattered-ending a dream in ugly suspicion and bad feelings. In the above cases, break ups harm the relationship beyond repair.

4) Laws and other legal issues:

Where there are loopholes in the surrogacy laws in a country the outcome balances on a thin line as the surrogate mother can always change her mind to keep the baby for herself. Therefore it is important that:

– The legal arrangement and the paperwork before going into a surrogacy program should be well knit not allowing any room for misunderstandings that could go against the interests of the intended parents in the advanced stages of pregnancy.

– Legal service is used to make your deal foolproof, and for this the intended parents may need to accept some extra expenses. Parents usually try to avoid that and consequently problems may arise.

– Seeking surrogacy services in a country where it is illegal can make the entire procedure land in deep trouble with litigations and penal actions awaiting the intended parents, the clinic involved and the surrogate mother.

Remedial measures

Recently, the High court has envisioned the consequences if a surrogate mother refuse to hand over the child after birth to the intended parents. It observed that the fertility clinic that plays a key role in the entire process has certain responsibilities such as:

– It should properly introduce the intended parents with the surrogate mother, spelling out the exact terms and scope of the agreement and what one expects from the other.

– Any misconceptions and misunderstandings should be eliminated at the beginning so that a serious issue doesn’t arise after or close to the birth of the child.

– The intended parents should see the surrogate mother as a part of their family. Emotionless and perfunctory professional relationship may invite damage in the future. The surrogate mother should be treated with respect for the service she offers.