This is a BIG issue that surrogates discuss often.
IP’s and surrogates visit their fertility specialist as they are preparing for transfer and are told that they need medication in order to support their cycle and subsequent pregnancy. There are various legitimate reasons that a medicated cycle is recommended:
- Scheduling lab times for testing embryos once thawed
- Previous issues with surrogate conceiving
- Surrogate who in in early menopause or who has gone through menopause (yes it is possible to carry a child post menopause!)
- Inconsistent ovulation or cycles
- Legitimate time frame considerations
There are plenty of other reasons why medicated cycles have been suggested (these are a little more dubious):
- “We want to throw everything at this to make a pregnancy work”
- “This is the done thing at the clinic”
- “You only have a limited number of embryos”
- “Your intended parents have asked for it to be a medicated cycle”
- “If you have a natural cycle and it doesn’t work, IP’s will blame you”
- “A natural cycle means more scans and blood tests”
- “It means you can book flights/accommodation/time further in advance”
Quite often, both surrogates and IP’s are led to believe that it will hurt their chances of achieving a pregnancy and if a surrogate is to raise her concerns about the medications, she is subsequently hindering her IP’s ability to get pregnant. This emotional blackmail should not happen! It puts both surrogates and IP’s in a difficult position.
I don’t pretend to be a medical professional, nor do I make any claims about what should or shouldn’t be done with surrogacy to achieve a pregnancy. I do however have first hand experience of a medicated cycle and have heard a LOT of stories in the community from both surrogates and IP’s about medicated and natural cycles.
It is important that surrogates and IP’s discuss the various methods for conception and seek assistance and information from specialists before a commitment is made.
- Fertility specialists are used to dealing with infertility, not with women who have conceived without too many dramas.
- Medicating a cycle unnecessarily can add thousands and thousands of dollars onto the cost of a surrogacy journey.
- Most medications need to be maintained from before transfer/ovulation until around the end of the first trimester. This is up to 15 weeks.
- Medications have side effects.
Surrogates know that Intended Parents are taking a HUGE risk in trusting someone else to carry their child. Surrogates also take a HUGE risk. We understand that you want to do as much as you can to get the best outcome. However, is this outcome at the expense of a surrogates mental health? Meds are NOT easy. I know this from bending over in front of a GP twice a week to get injections in the bum. This was in addition to daily vaginal pessaries and gels and 3 times daily tablets. This was for 14 weeks. Yes, the outcome was great- a baby was born!- but it also took its toll. I had side effects and it took a lot of extra time to get those shots. And for us, a medicated cycle was necessary. I wouldn’t go into another surrogacy begging for a medicated cycle again, that’s for sure.
I looked at a handful of meds that might be prescribed to surrogates before/during/after transfer and their side effects. This is what one needs to consider before saying yes to a medicated cycle. NOTE: Some surrogates have zero side effects, others have many.
- Local irritation or itching may occur in sensitive persons, at the site of insertion when treatment is started.
- Abdominal cramping, bloating, swelling face, ankles and feet.
- Unusual tiredness, or weakness or weight gain.
- Nausea and vomiting.
- Acne, breast pain or tenderness, hot flushes.
- Mild mood changes, nervousness, changes in libido, and insomnia.
- Increased blood pressure in susceptible individuals.
- Loss or gain of body facial or scalp hair or brown spots on exposed skin.
- Headache, dizziness, and drowsiness.
- Dry mouth, frequent urination, loss of appetite, and unusual thirst.
- Mental depression.
- Skin rash, itchiness.
- changes in body weight
- feeling depressed and/or anxious
- changes in sexual drive
- visual disturbances such as partial or complete loss of vision, bulging eyes, double vision
- intolerance to contact lenses
- irregular heartbeat
- muscle cramps
- changes in vaginal bleeding pattern including spotting
- vaginal secretion
- premenstrual-like syndrome such as mood swings, bloating, breast swelling and tenderness
- breast pain
- stomach pain
- increased appetite
- various skin disorders such as itching, hives, acne, excessive hairiness, hair loss or red, painful lumps
- swelling of the hands, ankles or feet
- feeling tired
- Abdominal or stomach pain
- decreased amount of urine
- feeling of indigestion
- nausea, vomiting, or diarrhea
- pelvic pain
- shortness of breath
- swelling of feet or lower legs
- weight gain
For a surrogate who is experiencing these side effects, this has an impact on her family, her children, her physical and mental health and possibly her relationship with her IP’s. No one wants to resent anyone else through this journey.
So what can we do about this?
- Ask questions- lots of questions!
- Question- “Is this medically necessary?”
- Question- “Are there any other options?”
- Question- “Can you show me some studies to indicate that there are benefits to a medicated cycle for a surrogate?”
- Get a 2nd opinion if you are unsure about the information supplied
- Research, research, research!
- Have open conversations about your options. Seek the guidance of a counsellor if necessary
On the flip side, a natural cycle usually follows a protocol such as this (all at FS discretion of course):
- Call clinic on 1st day of period (called “Day 1” of cycle)
- Have a day 1 blood test
- Have a vaginal ultrasound on or around day 10 of cycle
- Start pee test ovulation tracking post day 10
- Have an additional scan 3-5 days after initial scan
- Commence blood tests to track ovulation surge from day 12/13 onwards (at recommendation of FS). Usually every 2 days
- Have additional scan if required
- Continue until ovulation is confirmed and transfer is booked
Is this inconvenient? A little. But for many, is not as inconvenient as a medicated cycle. It is also cheaper, less invasive and more natural. As an average, most surrogates have 2 scans and 2-3 blood tests. There are some medical professionals who still like to prescribe progesterone in this cycle. There is also debate about whether it is necessary… https://blog.ivf.com.au/progesterone-and-pregnancy
“There is no evidence to suggest that giving progesterone supplements to otherwise healthy women in early pregnancy has any additional benefits or reduces the risk of spontaneous miscarriage.”
As I mentioned, I am not a medical professional. I am not telling you that a natural cycle is the best, because for some, it is not an option. That is okay, as long as all parties are aware of the possible implications of a medicated cycle. All I ask is that you question the necessity of a medicated cycle, not just accept it as the status quo.