What is surrogacy?
Surrogacy is the process of transferring the embryos belonging to the expectant mother to another woman, which is preferred in cases where the uterus of the expectant mother is not available for any reason, or where it is not possible to conceive due to the structure of the uterus and her health is not suitable for giving birth, and thus the woman who carries and gives birth to these embryos, which are genetically unrelated to her, is called a surrogate mother. In cases where the expectant parents cannot use their own reproductive cells in this process, they can add egg or sperm donation to their treatment.
The surrogacy process builds a strong bridge between carefully selected surrogate mothers and families, and every step is carried out within legal and ethical frameworks. Our program provides comprehensive and holistic support that takes into account the needs of families and surrogate mothers.
Thanks to the rapidly advancing reproductive technologies in medicine, becoming a mother or father is no longer impossible. Until recently, some of the desperate prospective parents found a solution by adoption, while those who did not have the chance to adopt suffered great frustration.
Babies/infants born carry the genetic characteristics of their biological parents and have no connection with the surrogate mother. The baby born by the surrogate mother is delivered to the biological or intended parents after birth according to the contract prepared in accordance with the surrogacy law. According to this official contract, the surrogate mother does not have any legal rights over the baby.
Who Can Receive Surrogacy Treatment?
Expectant mothers who have these indications determined by TRNC laws can benefit from this treatment service. For this treatment method, reports on the existing health problem and application petitions are evaluated by the authorized committee in the Ministry of Health and it is decided whether or not to use a surrogate mother. The process of obtaining permission from the Ministry of Health usually takes 3-6 months even if the conditions are appropriate.
Women without a congenital uterus.
Those whose uterus has been removed for any reason (fibroids, tumors, bleeding, etc.)
Those with recurrent miscarriages
The uterus and its lining (endometrium) have been irreparably damaged by operations or illnesses.
Repeated unsuccessful IVF attempts
Having health problems where delivery is risky (serious heart disease, clotting disorder, kidney failure, HELP Syndrome in a previous pregnancy, etc.)
Those with uterine problems that prevent conception and birth (uterine deformity, small size of the uterus, adhesions in the uterus, Ashermann’s Syndrome, etc.)
Same-sex couples
How to Identify a Surrogate Mother?
Even if the surrogate mother candidate is medically evaluated and suitable, there are hesitations mostly due to the sociological aspect. For this reason, some families may want to make their own acquaintances or a family member a surrogate mother. After the treatment is completed with the surrogate mother candidate determined by the family, pregnancy follow-up and delivery are the responsibility of the family in the country of their choice. We do not recommend this choice, which is thought to be more economical, as social problems may occur in the future.
For prospective parents who benefit from our center’s surrogacy packages, the process is more controlled and safe and the whole process is under the control and responsibility of our center. In this process, which is carried out with the support of our legal advisors, we have also prevented concerns that come to mind and do not reflect the truth.
Do not use harmful substances such as alcohol, cigarettes and drugs
Psychologically and socially suitable to be a surrogate mother
Those of ideal weight (not obese or too thin)
Those who have already had a healthy live birth and experienced motherhood
Who had an uneventful previous pregnancy
Does not have any infectious disease
between the ages of 21-40
Those without chronic diseases (diabetes, hypertension, etc.)
There are no problems in the uterus and tubes that prevent pregnancy
Anyone who meets all of the above criteria can become a surrogate mother.
Tests Required for Surrogate Mother Treatment
Tests Requested from the Expectant Mother:
FSH, LH, E2, Progesterone
AMH (In expectant mothers with a value below 0.5, an insufficient number of eggs may not develop and this may prevent successful completion of the treatment. If pregnancy occurs, there is a risk of miscarriage)
TSH, T3, T4, prolactin (morning on an empty stomach)
Complete Blood Count, blood type
Fasting Blood Glucose (morning on an empty stomach)
Urea, SGOT, SGPT
PTT, INR, APTT
Vit B12 and Vit D
HBsAg, Anti-HCV, HIV, VDRL (Infectious diseases test)
Karyotype (according to condition)
Information Requested from the Expectant Mother:
If there are any diseases and medications that may adversely affect the treatment or pose a risk to health, they must be reported to us in order for us to take the necessary precautions. In particular, blood thinners, diabetes medications, blood pressure and heart medications, as well as the use of harmful substances such as smoking and alcohol are also important information for us.
The tests requested from the prospective father:
Spermiogram (3-5 days of sexual abstinence)
HBsAg, Anti-HCV, HIV, VDRL (Infectious diseases test)
FSH, LH, Testosterone hormone analyzes (on a case-by-case basis)
Karyotype (according to condition)
Information Requested from the Prospective Father:
We should be informed if he has a disease that prevents him from giving sperm (such as diabetes) or if he is unable to give sperm due to stress. In such cases, supportive medication may be given or it may be necessary to remove the sperm from the testicles with a small operation. The presence of heart disease may pose a risk due to complications of the medication. Blood thinners may also pose a risk for the operation. Again, the information about whether the sperm has undergone treatment or operation (Tese, Tesa, varicocele, etc.) and whether harmful substances such as smoking and alcohol are used should be made to us fully as it will shed light on the course of treatment.
Tests Requested from the Surrogate Mother Candidate:
E2, LH, Progesterone (to be done on the 2nd or 3rd day of menstrual bleeding)
TSH, T3, T4, prolactin (morning on an empty stomach)
Complete Blood Count, blood type
Fasting Blood Glucose (morning on an empty stomach)
Urea, SGOT, SGPT
Vit B12 and Vit D
HBsAg, Anti-HCV, HIV, VDRL (Infectious diseases test)
USG (Vaginal Ultrasonography) is preferred to be between 14-20th days of the menstrual period. The appearance of the intrauterine lining, fluid accumulation, adenomyosis (the structure that looks like a black hole in the endometrium), fibroids, polyps are detected more accurately by ultrasound. The thickness of the intrauterine lining (endometrium) is particularly important and is preferably 8 mm or more. Fluid accumulation in the endometrium is usually due to intrauterine operations such as cesarean section and suggests adhesions. In addition, fluid accumulation may also develop due to enlargement of the tubes called hydrosalpenx. The ovaries (ovaries) are also evaluated with USG. It is checked whether the egg reserve is suitable for this procedure. In order to have a high chance of success, a target of 10-15 mature eggs is desired. In cases where the egg reserve is low, the pool method is applied. In the pool method, egg collection is usually performed 2-3 times. This method can be time-consuming as well as a bit costly and tedious. In such cases, egg donation may sometimes be preferred.
HSG (Hysterosalpingography) is the most important and indispensable test in investigating the causes of infertility. It is a kind of x-ray that allows the uterus and tubes to be visualized, a special device is inserted into the uterine entrance and a contrast fluid is given and taken. Another name is uterine film. Since it can be painful due to the pressure, we recommend that it is performed under anesthesia. Although it is performed with X-rays, the radiation dose is very low. With this X-ray, conditions such as swelling in the tubes (fallopian tubes), polyps, fibroids, adhesions in the uterus, which are known to adversely affect pregnancy and cause ectopic pregnancy, especially due to the fluid in the fluid touching the embryo, are detected. In principle, HSG is performed within 2-3 days following the end of menstruation. In cases where it is certain that there is no pregnancy, there may be flexibility on the day of the filming. In the presence of infection, the filming is postponed.
The uterine film is valid for 2 years and if surgical intervention has been performed, it is recommended to repeat the film in terms of adhesions etc.
Documents Required for Surrogacy
In order to ensure that these documents, which must be prepared for submission to the Coordination Board of the Ministry of Health, do not create any suspicion and can be audited when necessary, all examinations, except for the surgery report, must be performed in institutions within the TRNC borders.
Expectant Mother :
Passport
Serological Tests
A report showing the health condition of the expectant mother that requires the use of a surrogate mother
Surgery report if operated on
Radiology report that there is no uterus
Gynecologist’s report stating that it is not possible for her to give birth
A notarized letter of consent signed by a notary public indicating acceptance of the designated surrogate mother candidate
Consent form signed at a notary public
Notarization of the mother-to-be’s signature
Father-to-be :
Passport
Serological Tests
A notarized letter of consent signed by a notary public indicating acceptance of the designated surrogate mother candidate
Consent form signed at a notary public
Notarization of the father-to-be’s signature
Intended Surrogate Mother :
Passport
Serological Tests
Gynecologist’s report stating that it is possible for her to give birth
Signed notary letter indicating that she agrees to be a surrogate mother to the identified family requesting her
Notarization of the signature of the surrogate mother-to-be
Consent form signed at a notary public
Surrogate Mother Treatment
IVF with a surrogate is no different from a normal IVF treatment. Only the embryos are transferred to the surrogate mother. The treatment process starts after approval from the Ministry of Health.
Synchronized (Mother-to-be and Surrogate at the same time) Treatment: If the expectant mother is menstruating, the eggs are enlarged with egg stimulating hormones starting on the 2nd or 3rd day of menstruation and lasting 10-14 days. The eggs collected at the appropriate time are combined with the sperm cells of the father-to-be, turned into embryos and transferred to the surrogate mother on the 5th day (blastocyst).
If the expectant mother is not menstruating (in those without a uterus), hormone tests are used to determine the time to start treatment. The surrogate mother’s menstrual cycle is adjusted accordingly and simultaneous treatment begins and then the process is completed with egg collection and transfer.
Sometimes it can be difficult to synchronize both sides and start treatment at the same time. Matching menstrual cycles, matching the development of the eggs with the development of the surrogate mother’s uterus can make the treatment difficult. In this case, embryos are created and frozen in advance to make the treatment easier and to perform the procedure at the right time. The surrogate mother’s treatment is then planned and the chance of pregnancy is increased by avoiding the risks associated with synchronization. This type of treatment is highly preferred even in the absence of any problems due to its advantages.
If there are no conditions such as asynchronous egg development, cysts, etc. as a result of the examination, treatment is preferably started by performing hormone tests such as Estradiol-Lh-Progesterone. A treatment protocol is determined according to the age, weight and egg reserve of the expectant mother. The most preferred of these protocols is the antagonist protocol known as the short protocol. In this protocol, egg enlarging and multiplying hormone injections are started at the dose deemed appropriate. This treatment, which lasts approximately 9-14 days, is completed by performing ultrasound every 2-3 days and checking hormones according to the situation.
In this treatment, it is also possible to have examinations in your country. If you have one, you can be under the control of your own doctor or a doctor we will recommend.
When the eggs reach a sufficient number and size (18-20 mm), the egg collection process is planned after 34-36 hours by giving a hatching needle.
The last needle of the treatment is the hcg needle, known as the hatching needle. The day and time of the injection is very important and affects the success of the treatment. The time difference between countries should also be taken into consideration when determining the time of the injection. In cases where more than 20 follicles develop in the ovaries and the E2 (estrogen) hormone is 3000 or more, a special ligation needle is used to prevent the development of the complication known as OHSS. OHSS (Ovarian Hyperstimulation Syndrome) is a very serious complication in which the ovaries overgrow and fluid outflows out of the veins. In this case, embryos are frozen and transfer is planned in the following months.
Generally, the trip to Cyprus starts on the morning of the hatching injection, i.e. the day before the egg collection.
Treatment Process of Surrogacy in Cyprus
Day 0
Since it will be convenient for you to come to Cyprus 1 day before the egg collection process, your travel is planned with the organization carried out by our transportation team. At the end of your journey, which starts under the control of our team, you will be welcomed with our private vehicle when you land at Cyprus Ercan Airport. After your transfer to the hotel of your choice in Kyrenia or Nicosia, you can spend your day resting. During your journey in Cyprus, you will notice that the traffic is on the left lane and the steering wheel is on the right side. For this reason, crossing rules are also different and you need to be careful when crossing the road. Our team will call you or send you an information message to remind you about the points you need to pay attention to before the transaction. In particular, it is the most important issue that you should be hungry and thirsty 8 hours before your transaction time so that your transaction is not delayed or canceled. It is usually requested to fast after 00.00 (you should not eat or drink anything, just like fasting). After egg collection, you can return to your country of residence if you wish. The rest of the procedures and organization will be done by our team in the best way and you will be informed.
Day 1
You will be transported from the hotel to our clinic with our private vehicle at the time we tell you. Due to the importance we attach to information security, all transactions are carried out with great care and confidentiality. After the interview with our doctor, you will be examined according to the situation. After the preliminary preparation (insertion of an IV drip, wearing a gown, signing information and consent forms), your egg collection (OPU- oocyte pick up) takes place in 10-15 minutes under anesthesia. The sperm sample taken from the father-to-be and the eggs are combined with the microinjection (ICSI) method by our expert embryologists in our laboratory.
Day 2
The egg and sperm cells are combined in the laboratory by microinjection and it is checked whether they are fertilized or not, or if so, how many of them are fertilized. We call the cell formed from this combination an “embryo”. Your phone should be on during the day as you will be informed by our embryologists after the controls.
Day 3
Day 2 of your embryos. While you enjoy your vacation in the unique nature and beautiful sea of Cyprus, your embryos will be safely monitored by our expert embryologists.
Day 4
Your embryos will be transferred on the 3rd day and their quality and number will be evaluated. In some special cases, transfer can be planned on the 3rd day of embryos. If you do not have a transfer, you do not need to come to the hospital, you can enjoy your vacation or rest. Again, you will be informed by our embryologists.
Day 5
It is the 4th day of your embryos and you do not need to come to the clinic again. Our nurses will inform you about the transfer time of your surrogate mother and the issues to be considered before the transfer.
Day 6
Transfer day To achieve high success and reduce the risk of multiple pregnancy or increase the chance of multiple pregnancy, embryo transfer is usually done on day 5. We call this blastocyst embryo transfer. On the day of transfer, your emotions such as excitement and anxiety may peak. Our team is always with you in this process. In order for the embryo transfer to take place more easily, your surrogate mother-to-be needs to urinate more frequently and for this reason, she is asked to drink about 1 liter of water 1 hour before the transfer. After the pre-transfer preparations are completed, you will be informed about your embryos and the transfer will be completed. The embryo transfer process will take 10 minutes in total, and after 30 minutes of bed rest, the surrogate mother is informed about the continuation of the treatment and the issues to be considered after the transfer.
If you have remaining embryos, freezing is applied after the information. In this way, if there is any negative situation, you will have the chance to try again at a lower cost.
Day 7
Now it’s time to return, hoping that your transaction went well. Our private car will pick you up from your hotel and transfer you to the airport in comfort.
The Process After Surrogacy Treatment
We hear so often that 12 days is worth 12 years. We are as excited as you are and we sincerely hope that this process will be successful. If your surrogate mother’s pregnancy test is positive, we recommend that you make an ultrasound appointment 10 days later. Depending on the result, a repeat pregnancy test may sometimes be requested after 2 days. If the pregnancy test is negative, the medication will be discontinued and a repeat test may sometimes be requested.
When your surrogate mother becomes pregnant:
First of all, we congratulate you for your struggle and patience in this difficult process. We are honored that you are getting closer to your dream step by step and that we are a part of this success.
If you have benefited from our surrogacy packages, our legal advisors will always be in touch with you. You will be informed by our medical team about your surrogate’s treatment, examinations and your baby’s development.
After the birth, our legal advisors will provide information about the registration of the baby, birth report and passport.
