Medical screening for surrogates... What should I expect?
OK, so you are making progress. You have met with several agencies and picked the one you felt best served your goals and expectations. You have filled out the application and the personality profile. You have consented to a background check and you passed. The agency found you this amazing single soon-to-be mom who was everything you were looking for in an intended parent. You are a perfect match and cant wait to get started. You have scheduled your psychological exam and now are going in to meet with the fertility doctor. So close yet worlds away and you feel nervous. What should you expect at the IVF Clinic? What are they testing for exactly? What makes me a good surrogate, medically speaking?
When first meeting with the intended parent or parents' IVF doctor, they are going to want to see your prior pregnancy records. You will more than likely need to go into your doctor's office in order to release them and then, typically, they can be mailed or emailed. Contacting your OB/GYN and having these available for your agency and the IVF doctor can speed along the process. The R.E. (Reproductive Endocrinologist) (IVF doctor) will go through your records and check for a healthy past pregnancies. He or she is looking for 'red flags' such as placenta previa, early delivery, placenta bleeding, gestational diabetes, calcification of the placenta, low amniotic fluid, leaking fluid, etc. Any of the above issues ( and a host of others) make you a less than desirable candidate for surrogacy and you more than likely will not be accepted by the doctor, even if you have been accepted by an agency.
When you arrive for your initial screening, depending on the clinic, there may be a series of blood tests, a hysteroscopy, uterine measurements, cervical cultures and a toxicology screening. What does all of this mean? Well, here is the breakdown.
Blood tests: The blood tests that are performed outside of the toxicology screen are related to health, disease and general "wellness". Examples of blood screenings are: HIV, Syphilis, Chlamydia, Hepatitis B and C, Rubella, Varicella (chicken pox), Blood type, Ab screening, CBC (complete blood count) with differential, CMV (common virus that can be passed to an infant at birth) a comprehensive metabolic panel, THS (thyroid functioning test), Prolactin (hormone produced by pituitary glad in the brain related to reproductive health and milk production) and vitamin D. With this panel of tests, the R.E. can make a prognosis on your general health.
Hysteroscopy: A relatively painless procedure (similar to a pap smear), the R.E. uses a hysteroscope, a thin lighted tube, to look at the health of the cervix, the uterus and the uterine lining. In this procedure, (s)he is looking for abnormalities, tears in the uterus, abnormal size or shape of cervix or uterus and general health of these organs. The clinic may give you a sedative to relax you a little before the procedure. The hysteroscopy is performed by opening the vaginal canal with a speculum and inserting the hysteroscope into the vagina, through the cervix and into the uterus. After the procedure, you can expect to have some mild bleeding and cramping, similar to cramping during your period. Because of the sedative, you will need someone else to give you a lift home.
Uterine Measurement: You uterus will be measured to make sure it falls within a normal range for size and shape pre-pregnancy.
Miscellaneous Screening: A panel of tests will also be run to test for ethanol (alcohol), common illegal drugs and nicotine. Any positive results in the drug or nicotine categories will be an immediate disqualification for surrogacy. Elevated alcohol levels or indicators of alcohol abuse will result in the same disqualification.
If you have a significant other or are married, your partner will also need to be tested for contagious diseases, alcohol, nicotine and drugs. Your partner is an integral part of this process and will need to pass both medical as well as the psychological portions of process in order for you to move forward.
Regardless of your emotional and psychological readiness, the medical screening is the make or break for most surrogates. Your agency can research your past and prepare you for the emotional journey of surrogacy but the medical screening is the ultimate decision in whether you qualify under ASRM Guidelines. Clinics vary in acceptance with some being more lenient than others but ultimately, these tests, guidelines and limitations are put in place to protect you during pregnancy and to protect the baby from potential risk factors.
Once the medical screening is over and the R.E. is comfortable that you are a good candidate for surrogacy, you can go on to the final step... the psychological interview, evaluation and testing. In certain cases, the medical screening may come after the psych testing in which case, assuming you passed both... you're a qualified surrogate and ready to enter into legal contracts!
Stay tuned tomorrow for "What to Expect During the Psych Exam".
Sincerest gratitude to the amazing staff at Northern California Fertility Medical Center for their contribution to this article.