Welcome to Bridge Surrogacy

Surrogacy Acceptance Criteria

Commissioning Women/Intended Mother : Medical Indications

Absent uterus
Pregnancy contraindications
Recurrent consecutive miscarriages

Following the HFEA guidelines on age, the genetic or commissioning women considered for Host Surrogacy should be no older than 35 at time of treatment, unless there are exceptional circumstances (max 40).

Host Criteria

Age - under 42
Must have proven fertility
Normal medical history
Has, ideally, completed own family
No medical contraindications to pregnancy

The Initial Consultation

The intended parents and host (with partner if applicable) will be seen separately for initial consultations and the following steps will be taken.

Full medical histories of all participants
Appropriate investigations ordered
Written communication to the host's GP to obtain medical history
Letters sent to GPs of both intended parents and host regarding the welfare of the unborn child
Discussion about the general implications of treatment and pregnancy

Baseline Investigations

Intended Mother

If the Intended Mother is using her own eggs, the following investigations will be undertaken: -.

Blood group
Hormone profile
HIV (at assessment stage and again during the week before embryo transfer)
Hepatitis B & C
VDRL
CMV
HVS
Chlamydia
Chromosome Analysis
Cystic Fibrosis
Sickle Cell/Thalassaemia if appropriate

Intended Father

Semen samples are to be quarantined for 6 months. It is to be recommended that several samples of sperm are frozen to ensure continuity of treatment if necessary .

The following tests will be undertaken: -

Blood group
HIV (at assessment stage and again at the end of quarantine)
Hepatitis B & C
CMV
VDRL
Gonorrhoea
Chlamydia
Chromosome Analysis
Cystic Fibrosis
Sickle Cell/Thalassaemia if appropriate
Semen analysis

If the sperm samples are taken over an extended period of time (more than 4 weeks), CMV, Hep B, Hep C, VDRL, Gonorrhoea and Chlamydia should be repeated after the last sample.

Host

The surrogate mother (host) will undertake the following tests: -

Straight Surrogacy	Host Surrogacy
Vaginal Ultrasound Blood Group, atypical antibodies Hormone profile Full Blood Count Rubella CMV HVS Chlamydia Swab HIV (as routine at assessment stage and again during the week before embryo transfer) Hepatitis B & C Sickle Cell/ Thalassaemia if appropriate VDRL Smear test	Vaginal Ultrasound Blood Group, atypical antibodies Full Blood Count Rubella CMV HVS Chlamydia Swab HIV (as routine at assessment stage and again during the week before embryo transfer) Hepatitis B & C VDRL Smear test

Host's Partner

No tests are required.

Counselling Sessions

Discussions with the counsellors will follow. Each party (commissioning/host) will be seen by a qualified counsellor in separate sessions for implications counselling. This may take a number of sessions depending on the issues raised and concerns to be explored.

The counsellor will explore their understanding of the implications of the steps being taken. Aspects to be considered are their feelings about the treatment, their fertility, surrogacy and the possible impact it may have on their lives and that of the potential child in a wider family context.

Counsellors Report

With the co-operation of all parties involved a report will be compiled, together with an outline of the possible implications for treatment and for the potential child. It will be made clear to the commissioning couple, host and partner that this report will be available to the medical team who are currently providing the medical treatment and it will also be available at the case conference when their case is discussed.

If any counsellor has any concerns over any couple, then another counsellor will be sought for an independent view.

Case Conference

There will be a case conference attended by appropriate members of the team. Medical reports, the counsellors report and relevant information received from the GPs of the commissioning couple and the host surrogate will be discussed.

An appropriate plan of action will be agreed. The wishes of all parties will be considered with particular attention to the implications for the welfare of the unborn child.

Once the case has been approved, the commissioning couple and host will be contacted and given an update on the treatment proposals at a final pre-treatment consultation.

Members of staff at Bridge will retain the possibility to opt-out from the treatment process at this stage.

Pre-treatment Consultations

The commissioning couple and host will then be seen individually by a Bridge specialist.

Results will be discussed
The possible implications for treatment and pregnancy for the host following receipt of written information from her GP/Consultant
If the couples are ready to start treatment, they will be informed to contact Bridge with their next LMP

Final Information Sessions

The commissioning couple and host will meet the programme coordinator and a fertility nurse who will finalise any outstanding arrangements and explain the medical aspects of treatment i.e. IUI, IVF, ICSI or Frozen Embryo replacement treatment.

Once the commissioning couple and host feel fully informed and prepared for treatment, the consent forms will be signed.

Patients will be expected to attend an information session for IVF or frozen embryo replacement, as well as specific surrogacy information sessions with the programme coordinator and fertility nurse.

Any specific aspects will be explained and clarified further, as necessary.

The Surrogacy Checklist

Before we commence a treatment cycle, the commissioning couple must be confident that they have taken every necessary step - and the checklist below is a useful guide: -

Legal Aspects

Advise of the necessity of counselling a solicitor where the following issues will be discussed (written confirmation required):

Ensure life insurance for all concerned especially the surrogate whose policy should be for one to two years and a minimum of £200,000.
Update wills to ensure provision is made for any resulting child/children.
How Parental Orders work.
Their legal standing concerning parentage.

Medical Aspects

Blood testing.
Medical preparation of the host.
Types of replacement i.e. natural or hormone supported.
Numbers of embryos to be replaced.
Risk of multiple birth.
Testing during pregnancy i.e. amniocentesis and possible termination.
Genetic testing after birth.
Risks to the surrogate during pregnancy.
Need reliable barrier contraception for the host.
Discourage breast feeding as bonding is likely to take place.

Pre-treatment

Timetable of treatment.
When will the couple themselves be needed.
Consent form signing.

Aspects to be covered in the information session for the surrogate and partner (if applicable)

Legal Aspects

Advise of the importance of consulting a solicitor where the following issues will be discussed:

Ensuring life insurance for all concerned especially the surrogate whose policy should be for one to two years and a minimum of £200,000
Updating her Will once pregnancy is confirmed to ensure that the genetic parents are able to take custody of the child/children, should something happen in childbirth
To ensure that her own children (if applicable) will be catered for in the case of anything happening during pregnancy and birth
How Parental Orders work
Her legal standing concerning parentage

Medical Aspects:

Blood testing
What tests are done for the intended parents
Types of replacement i.e. natural or hormone supported
Numbers of embryos to be replaced
Risk of multiple birth
Testing during pregnancy i.e. amniocentesis, CVS, Trisomy scanning, and views on termination

Pre-treatment

Timetable of treatment
Drug regime and possible side effects
Consent form signing

Please note that this website gives general information only and individual cases may vary. No legal advice is given and anyone considering or intending to participate in a surrogacy arrangement must take qualified legal advice on every aspect.