Pregnancy may be an ordinary occurrence to some people. We see women with bulging bellies, hardly able to walk straight, almost everywhere, on a daily basis. Most often, pregnancy is viewed as a consequence rather than a gift.

Few people realize what a miracle transpires once a woman becomes pregnant. Science can explain what the mechanics are, but if fully grasped, no amount of scientific explanation can entirely illuminate the real marvel of this experience.

As the girl’s body matures, her reproductive organ initiates a process called ovulation. This is when her ovaries start to release egg that is waiting to be fertilized. On most women, this happens on a monthly basis. During sexual intercourse and upon ejaculation by a man, millions of spermatozoa are released through the penis and finally to the female’s vagina where the egg sit silently, waiting to be fertilized.

Once these sperms are released, only the strongest and the fastest will be able to reach the egg; the first to reach the egg becomes the sole survivor. This sperm will enter an opening and penetrates the egg. Once it enters the egg, the sperm will lose its tail and its head will enlarge, the egg will start to enlarge as well. As this meeting happens, conception begins. The egg is now ready. It will implant itself to the uterus and if all goes well–a new being is going to happen.

As tedious as it may seem, this process roughly takes only 5-10 minutes—that is when it becomes a wonder. A most complex being, humans that is—only takes 10 minutes to generate. Cooking rice and washing dishes seems to take longer. And the best part is, as it happens, it never really occurred to anyone that it is happening. The process is so muted that even the bodies involved are not aware that a creation is about to begin or is already happening. Only when symptoms and pregnancy signs begins (usually after a month or so), that they realized they have finally conceived.

Although a contentious issue, commercial surrogacy is a legal process of bearing a child in various countries in the world. In fact, it is safe to say that the demand is reaching such gigantic proportions that it is now being termed as an industry in itself. It is however banned in several countries such as Japan, Netherlands, and Saudi Arabia which does not allow any form of surrogacy.

The first step that the doctors follow is to synchronize the menstrual cycles of the donor and the recipient. For this process, both the women are administered medication, delivered both through injections and pills. The doctors analyze the donor’s functioning of the ovaries on the first day of menses. This is done by conduction blood tests and vaginal ultrasounds. After this, the donor is prescribed birth control medication.

In the second step, the doctors work to suppress the process of ovulation in the donor’s body. For this, the donor is usually prescribed daily injections of gonadotropin (GnRH) agonists that stop the hormones secreted by the pituitary gland. This takes about four weeks, during which the donor continues to take birth control pills and the GnRH agonist injections. The doctors continue to conduct blood tests and vaginal ultrasound on the donor. The cycle ends when the donor stops taking birth control pills and her periods coincide with that of the recipient.

The next step is called the ovarian stimulation process, wherein hormones that stimulate the release of multiple mature eggs in the donor, are injected in her body. Doctors keep a track of the development of the egg follicles inside the donor’s body with the help of blood tests and ultrasounds. Once the follicles develop fully, the donor is given Chorionic Gonadotropin (hCG) that separates her egg from the follicle walls. Meanwhile, the doctors administer progesterone injections to the recipient in order to prepare her body for the transfer of the embryo.

The eggs are collected from the donor 34-36 hours after she has been administered the hCG injection. These eggs are then fertilized using the sperm. The sperm could either belong to the recipient’s partner or a sperm donor. Once the eggs incubate, embryos are placed inside the recipient’s uterus using the in vitro fertilization method. From here on, the recipient experiences a pregnancy like any other woman.

The donor is then compensated financially for her services rendered. According to the recommendations of the American Society for Reproductive Medicines (ASRM), donors should not be paid more than $ 50,000 for this process.

The doctors also test their semen for sperm count, its mobility as well as its morphology. They are tested for any genetic diseases and for infectious diseases such as HIV, Hepatitis B, and Hepatitis C. After the doctors decide that a particular candidate is fit to donate his sperm, the donation process begins.

Under the actual process of sperm donation, the man is led into a private room where he masturbates into a sterile container. The semen thus collected, is then put into cryopreservative solution, filled into vials and stored in liquid nitrogen. Men are usually paid $40-100 for a sperm donation. One man is allowed to sire about 10 children in the process.

i. Sperm donation
ii. Egg donation
iii. Gestational carrier

Sperm donation
In this case, a man donates his sperm which is used for insemination. Or the sperm can also be used to fertilize eggs, which are then implanted inside the mother for a child to be born.

Egg donation
In this case, a woman donates her eggs for fertilization. The eggs are fertilized mainly using the in vitro fertilization method of artificial reproduction. The egg is then placed in the womb of the mother-to-be.

Gestational carrier
Here, a woman carries the pregnancy and delivers the child for another couple, who are unable to do it on their own for some medical reasons.

The embryos that are transferred into the uterus may be of two kinds:

i. Fresh embryos
ii. Frozen embryos

Fresh embryos are fertilized egg cells from a fresh menstrual cycle, while frozen embryos refer to the embryos that were taken from a previous cycle than the present one. These embryos are then cryopreserved and are thawed just before they have to be transferred. Before an embryo can be transferred, doctors prepare the recipient’s uterine lining. The transfer is done during the luteal phase. The luteal phase means that the lining of the uterus, at the time of embryo transfer, is undeveloped.

In case the doctors are using frozen embryos for transfer, the woman is given estrogen preparations for about 2 weeks, after which she is put on a combination of oestrogen as well as progesterone. This is done to make the uterine lining receptive of the embryo. This time is known as the implantation window in medical parlance.

In the actual process of embryo transfer, the doctors place a speculum inside the vagina in order to see the cervix. The cervix is then cleaned with the help of a saline solution. The embryo is filled inside a catheter, which is then inserted inside the uterine canal. Once the embryos have been planted inside the uterine canal, the catheter is withdrawn. Doctors usually perform an abdominal ultrasound to ensure that the embryos have been placed correctly inside the uterus.

The process of invitro fertilization usually begins on the third day of menstruation. In this case, various forms of fertility medications are used to develop multiple follicles inside the ovaries. The eggs are retrieved from the woman’s body with the help of a transvaginal technique. In this technique, a needle guided by ultrasound pierces the vaginal wall in order to reach the ovaries. The eggs hence retrieved are then taken to an in vitro fertilisation laboratory.

For fertilization to take place, the sperm and the egg are incubated together. The embryo is then placed inside the woman’s uterus. After this, the woman goes through normal stages of pregnancy.

The success rate of the IVF technique depends on a series of factors. The most important ones of these are patient characteristics and the treatment approach. However, according to doctors, the success rate for women under the age of 35 is about 30-35%. Women between the ages of 35-37 have a success rate of about 25%. The rate of success further decreases with only 15-20% successful pregnancies for women in the ages of 38-40, and women over the age of 40 seeing a success rate as little as 6-10%.

In the United States, the average cost of one cycle of IVF is around $12,500. While it may be covered in some insurance plans, the patients have to pay the entire amount on their own if it is not covered in the insurance.

The method of artificial insemination is used primarily to treat infertility in both men and women. There are two ways in which doctors can perform this procedure:

i. Intracervical insemination
ii. Intrauterine insemination

Intracervical insemination is the process where the doctors place the sperm into the woman’s cervix. According to doctors, this is the easiest way of assisted reproduction. Medical practitioners inject the sperm into the cervix with the help of a needle-less syringe. Therefore, the intracervical process of insemination is also the most popular among couples wanting to conceive a child.

In the other case known as intrauterine insemination, the sperm is placed inside the woman’s uterus. Doctors are of the opinion that this process of insemination shows great results if the woman is under the age of 30.

Many factors determine the cost of this assisted reproductive technology (ART) such as:

i. Medical examination of the recipient and the drugs prescribed to her
ii. Cost of the artificial insemination process
iii. Cost of the stay in the hospital

In the United States, the government statistics put the average cost of artificial insemination at over $1000.

This transplant was a revolutionary step, and gave hope to millions of couples who were battling infertility. This process also started the trend of embryo donation, much on the lines of blood and organ donation.

A student of Stanford University, Dr Buster completed his medical degree at the University of California. His residency training in the field of obstetrics and gynecology were also completed at the Los Angeles School of Medicine, at the University of California, his alma mater.

i) they want to help a childless couple
ii) financial need

However, it is very important that young women looking to become surrogate mothers make themselves clear about their rights and duties. There are two ways in which a woman can become a surrogate mother. The first is by approaching an agency, and the second is becoming an independent surrogate. The foremost criterion for becoming a surrogate mother is having a healthy physical condition, whereby the woman can successfully carry a pregnancy to its full term, and deliver a healthy child.

The second important step in this process is to educate one’s self. In the United States, all the states have different laws regarding the practice of surrogacy. The woman needs to know all the rules of the arrangement, and know fully well what she will be expected to do. They also need to analyze the impact of such a decision on their personal lives. How will it affect their family and job? They also need to talk to the surrogacy agencies as well as independent surrogates to know which option will suit them the best.

In case the woman wants to proceed with the help of an agency, her first task is to select an agency for her. Selecting just the right kind of agency is also a crucial step. The woman has to make sure she is completely comfortable with the agency. The woman can also ask for references from the agencies. Once she has been enrolled in an agency as a surrogate mother, she needs to look for a family to which she can offer her services. Since the couple and the surrogate mother will be spending their next nine months together, it is crucial they get along well with each other. Once the couple has made their decision, the process of surrogacy will get underway after a contract has been duly signed by both the parties. The contract will mention all the details of the arrangement.

Being an independent surrogate mother is a slightly difficult task, as the carrier has to manage all the paperwork by herself. Therefore, she needs to be careful about the agreement she draws up. She has to make sure it takes care of the cost ensued in the process, the carrier’s fees, as well as her living expenses for the period.

Surrogate mother costs

While the cost of carrying a pregnancy to its full-term and delivering a child is not much, the surrogate mothers charge money owing to the emotional and physical service offered during this period. The cost depends on what has been included in the ‘fully inclusive medical quote’. These may include fee for carrying the baby, cost incurred on the residence, food, and traveling apart from costs incurred on aspects such as visit to the gynecologists and medicines.