When Do You Need a Surrogate?

When Do You Need a Surrogate?


– Dr. Mark Trolice with
Fertility Care The IVF Center. Nice to see you all again,
actually be with you all again. We’re sorry we’re just a
little bit late over here. We had some patients come in. It was a pregnancy ultrasound,
so it was a good thing. She had twins. But, I didn’t do the
transfer, we were monitoring. We try not to have twins, of course. Of course, it’s a complicated pregnancy. Need I digress. We’re gonna talk about today surrogacy, because I think there’s
a lot of misconceptions, if you’ll pardon the pun, about surrogacy. I see a lot of patients,
as you can imagine, and one question that they get from their friends and family and so on about when they’re learning, when the friends and family learn that you’re having
trouble getting pregnant, they say, “Well, can I carry for you?” That’s rarely needed. The indications for surrogacy are few. The problem that most of
the fertility patients have is conceiving, and then of course, with recurrent miscarriage,
that’s a special category. When would surrogacy be needed? Certain situations specifically. One is obvious, with an absent uterus. Either born with, called
Mullerian agenesis, and there’s also another situation that’s called androgen insensitivity. Both of those conditions,
you’re born without a uterus. The other with being without
a uterus is surgical. Some patients have their uterus removed. Without a uterus, a woman can still donate her eggs to the surrogate, so she’s still the
biologic mother of baby. She just doesn’t carry it. Another category of that is if the uterus is severely damaged. Now, this can happen through a condition called Asherman’s syndrome. Asherman’s syndrome is where the inside of the uterus has
lots and lots of scarring. It’s a very unique situation. One that we see, of course, often because of our specialty. Asherman’s syndrome can occur from excessive uterine
manipulation, uterine surgery, like a lot of D and C procedures, particularly about two to four
weeks after delivery of baby, or even a miscarriage. If you develop an infection or something that requires a D and C a few weeks later, that is a high risk
for scarring afterward. Uterine surgery from the outside, like a myomectomy, removing fibroids. If you make an incision in the uterus and then go through the muscle, and enter the uterine cavity, unless that uterine cavity is
reapproximated very carefully, it’s not something that’s going to, it will increase the risk of
scarring inside the uterus. Another category of that
is medical complications. If a woman has a condition that would, that pregnancy increases her risk of harm, then we recommend surgery. Pulmonary hypotension comes to mind. Certainly, if they are
with a disease situation, with obviously active cancer, of course. Situations that, heart disease, and any unstable medical condition where we feel the pregnancy
itself is excessive risk to mom, or if she had a significantly
difficult prior pregnancy for reasons that are unique, such as she develops antibodies to baby. That can result in severe harm to baby. Another condition that
is a contraindication to pregnancy, or at least a
relative contraindication, is Turner’s syndrome. We’ve seen two patients now
in these past two weeks. Turner’s syndrome is where
you’re lacking an X chromosome. Instead of being 46 XX, you’re 46 X. That causes a constellation of signs and symptoms that
are classic appearing. Turner’s syndrome, they’re
usually short stature. They have a wide, a webbed neck, a wide carrying angle, and
no egg ovarian function. These women are often where we have what we call primary
amenorrhea, no periods. They actually don’t go into
puberty without hormones. There could be some variations called mosaic Turner’s that some patients can actually have periods
and even have pregnancy before their ovaries fail. Pure gonadal dysgenesis
is Turner’s syndrome. The problem with Turner’s syndrome is that the risk of the aorta,
which is the major vessels leaving the heart, of that causing a dissection or rupture, is very high, even if the MRI of the heart looks normal. We look at what’s called
the aortic size index. Not to get too technical. The risk of death of a mom, in any pregnancy, is about one in 10,000. Really, really low. Turner’s syndrome is 2%. We’ve talked to our patients
these last two weeks. They’re going to be getting
an MRI of their heart, seeing a cardiologist, seeing
a high risk obstetrician, and then thinking seriously about whether they’re going
to carry the pregnancy and take on that risk, unfortunately, of morbidity and mortality, or go on to a surrogacy with a donation. Those are significant issues with the reasons for surrogacy. There’s many, many surrogacy agencies that we can connect you. We’re looking forward
to working with you all. Have a wonderful week. Hope that was helpful. We will see you in a week. (light music)

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