American Medical Association Family Medical Guide - American Medical Association [272]
The process is similar to the final step of IVF, in which embryos are introduced into the woman’s uterus to produce a pregnancy. Before undergoing the procedure, the woman who is receiving the donated embryos will have a thorough physical examination and tests to make sure that a pregnancy would not compromise her health. She will be given hormones, including estrogen and progesterone, to prepare the lining of her uterus to accept an embryo. In some cases, the timing of implantation is based on the woman’s own menstrual cycle. When the uterus is ready, the frozen embryos are thawed and transferred to the uterus. If pregnancy results, the woman continues to take the estrogen and progesterone for 8 weeks.
If you are considering embryo donation (either as a donor or as a recipient), talk to a mental health professional and a lawyer about the ethical and legal issues concerning the procedure. For example, you will need to consider issues such as disclosure—whether the donor wants to be named, whether you want the donor to know you, and what you will tell your prospective child. Each state has different laws that apply to embryo donation.
Gestational carrier
Some women cannot carry a pregnancy because they have had a hysterectomy (see page 870), were born without a uterus, or have had multiple miscarriages. In these cases, some infertile couples ask another woman to serve as a gestational carrier—also known as a surrogate mother. This agreement is a legal contract in which the woman consents to have a fertilized egg from the couple implanted into her uterus and to carry the pregnancy to term. The woman further agrees to turn the baby over to the couple upon delivery.
Having a baby with a gestational carrier has a number of medical and legal consequences, so be sure to discuss the topic thoroughly with both your doctor and an attorney before going ahead with it.
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Pregnancy and Childbirth
A healthy pregnancy starts before a woman gets pregnant. If you are planning to get pregnant, make an appointment with your doctor. He or she will perform a thorough examination to evaluate your health and determine if you have any medical conditions or inherited disorders that could complicate a pregnancy or make it inadvisable for you to get pregnant. In addition, if you have a chronic disorder—such as a heart disorder (see page 520), epilepsy (see page 686), diabetes (see page 889), kidney disease, or an autoimmune disease such as lupus (see page 920) or rheumatoid arthritis (see page 918)—your condition must be carefully monitored throughout your pregnancy.
Pregnancy
The healthier you are during your pregnancy, the more likely your child will be born healthy. If you are trying to become pregnant, take steps now to help ensure a healthy pregnancy. Stop smoking cigarettes and drinking alcohol, avoid potentially harmful drugs or chemicals, eat healthfully (lots of vegetables, fruits, whole grains, and legumes), and exercise regularly. Taking 400 micrograms (0.4 milligram) of folic acid every day in a supplement will reduce your risk of having a child with abnormal development of the spine or brain (neural tube defect; see page 398). Depending on your health history, higher doses of folic acid may be recommended.
Conception
Conception begins with the fertilization of one of a woman’s eggs. Fertilization can occur shortly after a mature egg is released from an ovary, which usually occurs about halfway through the menstrual cycle. If a woman has sexual intercourse during this time, she can get pregnant as sperm ejaculated from her male partner travel through her vagina and uterus up to the fallopian tubes. Fertilization occurs if a sperm penetrates the cell wall of an egg inside one of the fallopian