Peter's blog

First Trimester Combined Screening results say we are High Risk

Screening test and Diagnostic tests. You'll receive lots of screening and testing results during the surrogacy process, pretty much the same as any other pregnancy. Screening tests are the first ones done, and they're the ones that scare you. Diagnostic tests are done later, and these give more accurate results. The main thing we were worried about was Downs Syndrome which is indicated by an increased calculated risk of trisomy 21. If you read the books, these screenings more often rasie unwarranted alarms (false positives) rather than quell fears. And they did for us too. Here's why.

The Double Marker screening was done around week 11 of our surrogate's pregnancy. It checked the Free Beta HCG, Serum by CLIA and PAPPA by CLIA. I don't know what that means either. But they take figures from these tests, the biological wife's age, and an ultrasound measurement of the nuchal translucency and run it through some predictive analytical software. Because it is predictive and not diagnostic, this is called a screening.

What I do know is that the email and scanned results came back showing the pregnancy was high risk, that "the calculated risk for Trisomy 21 is above the cut off which represents an increased risk." This was enough for my wife to start crying and pass me the paperwork.

This is what you have to realize: any risk calculated at higher than 1 in 250 is considered an increased risk. For us, the calculation was 1 in 107, which by that definition is an increased risk. But what that really means is that 1 in 107 births like ours will have Downs syndrome, which is less than 1 percent. That's why this test raises so many false fears.

More interesting is that if you only look at my wife's age, all the charts show a risk of 1 in 50. So, although the risk is "high" by the arbitrary definition of more than 1 in 250, when looking at not just her age, but also the additional medical information above, the odds had actually moved in our favor from 1 in 50 to 1 in 107. That was good news. And my wife was relieved.

The Amniocentesis test is the diagnostic test. Those provide more definitive results. I'll post on those separately.

Surrogacy success!!!

Yes, our Christmas trip to Rotunda has been successful. Our baby is reaching 16 weeks and all tests indicate a healthy pregnancy in our surrogate mother! We didn't want to write anything earlier for fear of jinxing this good luck after many, many years of trying to have a baby.

What we've learned over the past several months:
1) First, there are a number of "screening" and "diagnostic" tests done during a pregnancy. Screening tests don't prove anything, they are just "indicators". Diagnostic tests prove whether a problem exists or not. If you are over 40, the odds of downs syndrome exceed 1% and go up pretty quickly with age. The screening tests all use age (the egg donors) as one of several factors to determine if the pregnancy is high risk. But, high risk is defined as 1 in 250. So, age, by itself, moves a pregnancy into high risk. So, when you get your screening results back and they say your pregnancy is "high risk", read the fine print. Ours said that the risk was 1 in 100, which is actually better than the 1 in 50 rate you get based on our age. So, although the screening test said the pregnancy was high risk, the risk was getting lower when additional factors beyond age were added. Although high risk, the odds were moving in our favor. The good news is that the amniocentesis test, a diagnostic test done later in the pregnancy, just came back okay.

2) They won't tell us the sex of the baby until it is born. Because of problems with infanticide in India, doctors are legally prohibited from divulging the baby's sex until it is born. This is true for all births, including surrogate births. So, we're going old school and won't know the sex of the baby until it is born.

3) It does seem that it's possible to breast feed the baby even if you didn't carry it. We're checking into and learning more about "induced lactation"...

If everything continues well, we'll be off to India in September. Now to research the passport and travel issues, and dig deeper into the baby books.

We've also been in touch with two of the couples that we've met on our trips. One is also pregnant, and the other is not pregnant after two tries.

Christmas in Mumbai...hoping for good news from Rotunda...

Unfortunately, our go with a frozen cycle in the Fall was unsuccessful.

We did decide on one more try - we'd really like to have kids; many of our friends children are growing up very quickly and we'd love to have that experience before we get too old.

We feel like pros - repeating the same steps over the past several months - select a surrogate, start on the medication, travel to Mumbai, lots of visits to the clinic and then the transfer. We spent a lot of time doing ultrasounds, being excited about the good number of eggs (14) and their reasonable quality (4 As). The retrieval was two days before Christmas, with the transfer completed the day after Christmas. We've spoke with Dr. Kadam at Rotunda, and everything is proceeding smoothly.

Great news for another couple - they learned that their surrogate was successfully pregnant while we were there. Another success case out there. We're keeping our fingers crossed that we can be added to that list... We'll hear whether the pregnancy is positive about January 10th.

Lessons learned on this trip:
1) We paid more attention to getting lots of protein and water after the transfer, which made the post-transfer recovery go much faster.
2) Staying at the Marriott was much more pleasant than staying in a 3 star hotel. With all the stresses, and the holidays, this trip was much more enjoyable than our first Mumbai trip. And they have really, really great service.
3) I don't know about most people, but the list of tourist sites we missed on the first trip was quite small, so we didn't actually see much that was new.
4) We continue to love the Indian food, but stayed extra safe and ate only at very reputable places that cater to many westerners. No sense in getting sick in the middle of a cycle.
5) After the Mumbai bombings, security is up, and visitors are down. This was good for us - less traffic and better hotel rates.
6) Even if you've done this before, the whole process is nerve wracking. Our hopes are high...

Surrogate with frozen embryos: another try

Well, unfortunately, our first try with surrogacy was not successful.

We've decided that we would keep pursuing the surrogacy option. While the doctors quote success rates as high as 50% (which is probably optimistic), we were in the other 50% this time.

We've been going back and forth with both Rotunda and Kaival (Akanksha), trying to decide what we want to do next. After talking to both, the choice was pretty easy.

Dr. Patel at Akanksha said she doesn't have any openings until February. So between now and then, we'll be focusing on options with Rotunda.

We've been emailing back and forth with Rotunda. As usual, it still seems to take about two emails sent for every 1 response. So it pays to be persistent and keep following up.

Some good news. Rotunda did recently come back and say they'd found a potential surrogate. We'll use the frozen eggs from our last cycle, which also means we don't have to go through the chemicals of an IVF cycle gain, athough odds of a successful pregnancy are somewhat lower. So, we've reviewed, signed and mailed the legal documents, wired the funds, and are crossing our fingers that maybe, this time, we'll have a bit more luck.

It was fun watching parents teaching their kids to swim over at the pool earlier today. Hopefully we'll be doing the same soon.

Surrogacy through Rotunda - our experience

After several years of trying to get pregnant, another several years of IVF, never really medically understanding why we can’t get pregnant, we decided to try our hand at surrogacy. We did a fair amount of research and decided to pursue surrogacy in India at Rotunda.

We started the IVF cycle at home, so will spend about a week in India for the end of the cycle, retreival, and implantation in the surrogate.

We have been to India before, so largely know what to expect when we arrive on Friday night. A very busy city with extremes of wealth and poverty. The little kids asking for dollars or rupees at the car window. The taxis trying to over charge you. A longing for the fixed prices we're used to plus the incessent need to bargain in order to avoid paying inflated tourist prices. The air pollution. The cars always honking their horns. Staying away from tap water or any food washed in tap water. The smells. Many good things too though - the really great food, friendly people, and new experiences. The vibrant city full of people with high energy trying to make a better life for themselves. Just like anywhere else.

Hotels in India are expensive, a lot of demand in a growing economy with limited supply. The Hyatt an Marriott are US$300 per night. We are staying at a three star for US$110 per night - the hotel is fine. AC, clean, hot water, room service breakfast included. Internet access in the lobby for 50 rupees per thirty minutes with quite good speed. I downloaded 30MB of emails in 10 minutes.

On Saturday morning we're off to Rotunda, which was slightly tricky to find the first time. The rickshaw (three wheeled taxis) and taxi (normal taxi) drivers don’t know exactly where everything is in a city of sixteen million people. The hotel security guy explained to the rickshaw driver to go to the Otters Club, which the drivers know, but from there we had to find it. We had studied the map on the Rotunda web site and could figure out where to go from the Otters Club - around the corner and up the hill.

Rotunda is a specialty practice (like a dentist or most IVF clinics) so the office space is small, but busy and compared to the rest of India, reasonably efficient.

We met with Dr. Kadam on Saturday morning. We checked on the progress of the IVF cycle and asked another round of questions about surrogacy. She was quite nice and patiently answered all of our questions. We did notice that you have to ask lots of questions. There doesn’t seem to be a standard "these are the steps and this is what you should expect" speech. Among other things, we can implant seven eggs. We'll have to discuss the ethical implications of a reduction should a multiple pregnancy ensue a bit later. Rotunda has had more success with day two rather than day five implants, so Dr. Kadam recommends day two. We can stay for implant day, but Rotunda doesn’t allow you to meet the surrogate. Our surrogate's profile indicates she has two children and learned of the opportunity from one of her friends who successfully gave birth several months ago. We reviewed the IVF progress and the news is good - 10 eggs on each side.

We try to pay, but our credit card is new with a chip and isn’t accepted. It worked at the hotel, so that’s not an issue. We'll try again on Monday.

On Monday we visit the clinic and do another ultrasound. Dr. Allahbadia comes in for an instant and proclaims good progress. Eggs seem be growing well. We will trigger tonight and collect on Wednesday.

Like most doctors offices, there is a fair amount of waiting at the clinic. Bring a book, or your laptop. Today Indian MTV (it is all music) is on TV, so you can watch that too. Yesterday was news - a girl goes to a rave party, one of her friends laced her drink with drugs and then she was raped. Could have been back home for that news.

The patients at the clinic are a mix of Indians and Westerners, Indians seem to be in the slight majority.

We asked Dr. Kadam again about multiple pregnancies. She said that half of surrogates become pregnant. Of those, ten to fifteen percent are multiple pregnancies (twins or more). They don’t separately measure triplets or more, but the math suggests to us about two percent of pregnancies, or one percent of attempts, could result in triplets or more.

Tuesday is a day off from visiting Rotunda. So we make it a shopping and tourist day. We go out with Mr. Ali, who Bobby, the concierge at the Marriott, scheduled and recommended for us (we ate lunch there). For shopping - recommend stopping in at FabIndia, a clothes store, that has a great variety of cotton clothing. We see the Gate of India and several other tourists sites, and lots of traffic as we go from place to place. We do stop for a great lunch - naan, dhall, palak paneer and lassi. Overall, Mumbai has less poverty than we expected. Seems the slums are being torn down to make way for office buildings. Mr. Ali informed us that Mumbai is now the fourth most expensive city for real estate. I think London, Moscow and Tokyo were ahead.

We arrive back at Rotunda on Wednesday for the retrieval. About twenty eggs. Similar to IVF retreival, it is a quick procedure. Seems like less anesthesia used here, as the recovery was quicker than our previous IVF cycles. It seemed there were several retrievals scheduled today, so we weren’t in the main recovery room but a secondary one that shared space with a fridge storing medical supplies and a storage cabinet. The nurses came in on several occassions to get things. The procedure started a nine and we were leaving for lunch at noon.

In order to be safe with food and ensure our weak western stomachs didn't have any problems, our strategy was to eat big brunches at the Marriot and Hyatt most every day. We liked the Marriot's brunch better at about 850 Rupees per person on a weekday. Drinks extra. And the Marriott is about a 35 Rupee and fifteen minute rickshaw ride from Rotunda. We always had the security guy at the Rotunds parking lot hail us a rickshaw and help talk to the drivers. The rickshaw drivers are less educated and don’t always speak, or even read, much English.

We generally felt the hospital sanitation practices were sufficient, but still below what we would see in the west. In one instance, after drawing blood, the nurse put the needle and vial on the hospital bed, leaving a trace of blood. While sheets were washed, they sometimes had light stains from prior use. But needles were disposed of safely and we observed doctors and nurses using latex gloves and/or washed their hands frequently.

The credit card never did work. So we'd made a lot of cash withdrawals from the ATM to cover part of our payments. Nothing like carrying an inch thick wad of money around. We agreed that we'd wire transfer the remaining balance after we got home.

During the process we also signed and left the surrogacy contract, which was quite professionally written yet still understandable. One clause even asked who the guardians would be in the event of our passing away prior to the child's birth. A lot of thought went into it.

Because of conflicting flight times and other commitments, we are unable to stay until fertilization and implantation, so we will discuss egg quality and number of eggs to implant over the phone with Dr. Kadam or Dr. Tambe after we arrive back home.

On Friday we discuss egg quality. We have a mix of grade As and grade Bs, and decide to implant 5 grade As and 2 grade Bs. We freeze the rest for a potential follow-on cycle. Now it's yet another waiting period...

It's a good trip. The staff is friendly and helpful. We're still somewhat concerned about not being able to meet the surrogate mother, or really see much about the implantation, but there are a lot of locals using the service, and the business looks very legitimate.

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