Synchronization of a patient's and a surrogate's menstrual cycles.

To start surrogacy program both a patient and a surrogate mother have to be in the beginning of their menstrual cycles. To make this possible, birth control tablets (combined oral contraception tablets) are prescribed to the both. The tablets are taken according to the doctor's plan and finished at the same day by the patient and a surrogate. After cessation of tablets menstruation comes in both women they can start their treatment.

Treatment of the patient.

The treatment of the patient takes about 2 weeks.

Once the patient's period begins, an ultrasound examination is performed to make sure that the ovaries are inactive and the uterine lining is thin.

In the beginning of menstrual cycle a Follicle Stimulating Hormone (Gonal-F, Puregon) is administered to stimulate the growth of ovarian follicles. The hormone is injected subcutaneously once a day. The injection is painless and most women learn to inject themselves. The injection treatment usually takes 9–12 days, and 2 or 3 ultrasound examinations will be performed during the course of the treatment to monitor the growth of the ovarian follicles and the effect of the hormone dosage. After the first ultrasound another medication is added (Cetrotide, Orgalutran). This medication suppresses the patient's own hormonal activity and prevents the premature release of egg cells.

Once the ovarian follicles have grown sufficiently, Human Chorionic Gonadotropin (Pregnyl, Ovitrelle) is injected to release the egg cells into the follicular fluid and to cause the final maturation of the eggs. Approximately 36 hours after injection, the eggs are retrieved with a needle inserted through the vaginal wall under the guidance of ultrasound. Full anaesthesia will be given intravenously during the procedure. The procedure is fairly quick, and many describe the sensation after the procedure as similar to ordinary menstrual pain. After the procedure, the patient must rest for a while to allow the effect of the anaesthetica to wear off. The medication affects reaction speed, so driving is not advised on the day of the procedure

Treatment of the surrofate mother.

Once the period begins, an ultrasound examination is performed on the surrogate mother to check that the ovaries have no cysts and the uterine lining is thin. After this, the surrogate takes oestrogen medication orally to prepare the uterine lining for implantation (Progynova, Progynon, Estrafem). As the treatment progresses, the surrogate will also start taking progesterone intravaginally (Lugesteron, Crinone, Utrogestan). Ultrasound examinations are performed to monitor the growth of the uterine lining.

The semen sample of the husband is needed for the fertilisation. Before delivering the sperm sample the husband must be tested for HIV and hepatitis (HIV-Ab, HBs-Ag and HCV-Ab). The tests can be done at a local laboratory. The sperm may be fresh or frozen. Sperm cryopreservation (freezing) may take place during the first visit of the couple to the clinic.

The cells are cultivated and cleavage is monitored for 3-5 days, after which a maximum of two high-quality embryos will be transferred into the surrogate's uterus. Embryos are transferred through the cervical canal using a soft plastic catheter. The procedure is usually quick and painless. If there are several high-quality embryos, they can be cryopreserved for later use.

After the embryo transfer, the oestrogen and progesterone therapy continues. A pregnancy test will be taken two weeks after the embryo transfer. If the test is positive, hormone medication will continue until the 12th week of pregnancy. Two weeks from the pregnancy test, an ultrasound examination will be performed to confirm the pregnancy. If the test is negative, the hormone medication can be discontinued.

As with all pregnancies, assisted pregnancies involve a small risk of miscarriage, ectopic pregnancy, foetal development defects, and later complications during pregnancy and delivery.

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