Dr. Vishali Joshi

Gestational Surrogacy

We will help you evaluate the benefits of gestational surrogacy and provide you with information about cost, legal issues, and treatment protocols.

In traditional surrogacy, the surrogate is pregnant with her own biological child, but this child will be raised by others. In gestational surrogacy, the surrogate becomes pregnant via embryo transfer with a child that is not biologically her own. The surrogate mother may be called the gestational carrier.

Once a suitable surrogate has been identified, and the screening process is complete, the cycle can begin. Timing depends on the surrogate’s and intended parents/donors menstrual cycle .

Surrogacy Cycle Overview

Evaluation Cycle

The surrogate needs to prepare her uterus for implantation with natural estrogen and progesterone. Because each woman is a little different, the dose, duration, and method of administering these hormones may need to be individualized. This can be determined ahead of time by conducting an evaluation cycle. This is a “dry run” in which we duplicate each part of the cycle except the actual transfer of embryos in order to determine how to maximize the chances of success. The evaluation cycle can be completed anytime before the actual procedure. In some circumstances, the evaluation cycle can be waived when the response of the uterus to hormonal stimulation is well known. This is fairly common for women who have undergone many treatment cycles in the past.

Cycle Synchronization

It is necessary to synchronize the menstrual cycles of the surrogate and the intended parent in order to obtain mature eggs and embryos and transfer these back into a perfectly prepared endometrium (uterine lining) to maximize the chances of pregnancy success. This is done using a variety of hormonal manipulations .We will determine which technique will work best for each circumstance. Once both women’s (surrogate and intended parent) ovarian function is suppressed and their cycles synchronized, they can begin the process of preparing for pregnancy.

Hormonal Therapy

On about the same day, the surrogate and intended parent will begin hormonal therapies to prepare the appropriate target for pregnancy success. The surrogate will begin taking estrogen to stimulate endometrial (uterine lining) growth and the intended parent will begin taking FSH to stimulate egg production. These treatments are monitored with ultrasound and blood estrogen levels until the eggs are ready to be retrieved and the uterus is ready to accept an embryo. Usually these treatments will take approximately two to three weeks and require five office visits for ultrasounds and blood tests.

Subsequently IVF and embryo transfer is done.

Pregnancy Success!

In successful cycles, the hormonal supplements are continued through the first trimester (12 weeks) of the pregnancy. Once the first trimester is completed and the placenta has matured to the point where it can provide for all the hormonal needs of the pregnancy, no further supplements are required. We will monitor blood levels of estrogen and progesterone at the end of the first trimester and taper off the hormone supplements gradually. Once the hormone supplements are stopped, the rest of the pregnancy is indistinguishable from any other pregnancy!

There is a reason behind this. Eating slow and having smaller bites help you eat less and chewing it properly help in absorption of nutrients and help in healthy digestion.

Eating fast leads to more calorie intake which leads to weight gain. When we are eating fast we tend to gulp more food and by this one can face digestion problems and nutritional inadequacies. 

Slowing the speed of eating help you in lowering down your energy intake and it also suppress your hunger pangs. Slowing eating helps you enjoy your meal and enjoy the taste and flavors of food.

How to eat at the right pace:

• Portion control: the portion size and obesity moves parallel. If you increase the portion size of your food simultaneously there will be inclination in your weight. Inclination in weight day by day leads to obesity. One of the biggest contributes to obesity is portion size. Don't sample everything on buffet table. The more you have the more you eat.
• Frequent meals: try to have small and frequent meals in a gap of 2 to 3 hours every day, instead of having a few big ones as this regulates your blood sugar level and your metabolism. This will also keep your hormones balance, keeps your energy level high, improve digestion. If you’re eating healthy whole foods during those small meals, you will be less likely to experience hunger cravings and binges. 
• Chew food: chewing food properly leads to proper absorption of nutrients.
• Focus on food: don't watch t. V, use cell phones, etc while eating food. Focus on food so that you eat your food properly, slowly and chew it properly. While watching tv you don't chew food properly and you tend to eat more and sometime you overeat also.
• Patience: if you have finished food, wait for some time till the body signals brain that it's enough for it. But at times we keep on eating when we are full and tends to overeat. Hence, overeating leads to weight gain.

It is a common notion that once a woman undergoes a Cesarean section, subsequent deliveries will have to be done by C-section too. This is not true and vaginal birth after cesarean is a very normal occurrence.
There are good chances that a woman can have normal vaginal delivery after a cesarean. However, this needs to be planned and the doctor and the mother would need to be prepared for it. There is also a good chance that the vaginal delivery may eventually be converted to a Cesarean, and so the doctor should be prepared for it too, parallely. This is known as TOLAC (trial of labor after Cesarean). The doctor will attempt for a vaginal delivery, but if it does not succeed, then Cesarean will be undertaken. This is an extremely safe procedure, though chances of success vary from one person to the other.

If you are keen on a vaginal delivery after a C-section, talk to your doctor to understand the risks and what to expect, both before, during, and after VBAC.

Benefits:

1. Both the baby and the mother have great benefits to see, if opting for a VBAC. Some of them include:
2. Reduced risk of maternal mortality with VBAC as compared to repeat Cesarean
3. Less pain after delivery
4. No uterine incision (The more number of deliveries, the more incisions)
5. Less chance of infection as another incision means another chances of infection, hemorrhage, sepsis, etc.
6. Reduced anesthetic complications and need for blood transfusion
7. Reduced chances of internal organ damage, bladder injury, uterine perforation, etc.
8. Reduced hospital stay and faster recovery from vaginal birth
9. Reduced scar management
10. Reduced chances of maternal morbidity
11. Better immune response and protection against diseases like asthma, obesity, etc. for the child

Risks of TOLAC/VBAC:

1. Good chance that an attempted vaginal delivery could get converted to a cesarean section
2. Possibility of the previous Cesarean incision tearing open, which would immediately call for conversion to a Cesarean section

The trend for most doctors is to advise for a Cesarean section, if the previous delivery was through Cesarean. However, this need not be the case. Mothers are advised to look for hospitals, which have a low rate of C-sections and encourage vaginal delivery. The success rate of VBAC is about 60% to 80%, and should be encouraged. It is completely safe and preferable to have vaginal delivery, unless totally contraindicated. A prior cesarean alone should not be the reason to opt for a C-section. Have a detailed discussion with the doctor and go for a TOLAC. If it does not succeed, for whatever reasons, it can always be converted to a Cesarean section.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Your brain is strongly influenced by hydration status.

Studies show that even mild dehydration (1-3% of body weight) can impair many aspects of brain function.

In a study of young women, a fluid loss of 1.36% after exercise impaired both mood and concentration and increased the frequency of headaches .

Another similar study, this time in young men, showed that fluid loss of 1.59% was detrimental to working memory and increased feelings of anxiety and fatigue .

A 1-3% fluid loss equals about 1.5-4.5 lbs (0.5-2 kg) of body weight loss for a 150 lbs (68 kg) person. This can easily occur through normal daily activities, let alone during exercise or high heat.

Many other studies, ranging from children to the elderly, have shown that mild dehydration can impair mood, memory and brain performance .

Bottom Line: Mild dehydration (fluid loss of 1-3%) can impair energy levels and mood, and lead to major reductions in memory and brain performance.