Because I live a distance from the office, can my preliminary testing be done at my doctors office?

We prefer that you have your preliminary testing done in the office the day you have the initial IVF consult and mock transfer, but other arrangements can be made if necessary.

Is the male partner required to freeze a semen specimen and if so, can he do it with the initial semen analysis and cultures?
It is strongly suggested that a semen specimen be frozen prior to the egg retrieval. If the male partner is ill on the day of the retrieval, the frozen specimen will be used to inseminate the eggs. A separate specimen of semen is needed to freeze and the appointment should be scheduled after the culture results have come back with a negative result. You must schedule an appointment with the Andrology Lab for a semen freeze.

If I had the Hysterosalpingogram (the X-Ray of the uterus and tubes) done before, do I need to repeat it?
No, not unless the test was done three years prior or you had a surgical procedure since your last hysterosalpingogram. We must review the HSPG films if they were done at an outside facility.

How do I know which doctor will be doing my retrieval and transfer?
Dr. Zarmakoupis-Zavos will be the IVF physician performing all the oocyte retrievals and embryo transfers.

How do I know what medication I will be taking and when to take it?
During the IVF consult with the Dr. Zarmakoupis-Zavos, she will discuss with you the best medication stimulation protocol that you should be using. An instruction sheet and prescriptions will be given to you.

What should I do if I get my period, (cycle day 1), at night or on a weekend?
You should leave your name, date and phone number on our answering machine at
(859) 254-8108, (859) 226-7263, (859) 226-7264.. If you need instructions or have questions, please ask us to return your call. We will call you back the next working day. If there is an emergency and you would need immediate instructions, then you should call (859)254-8108 and leave a message with our answering service to have the doctor return your call.

I do not know how to take the injectable medication, what should I do?
You need to schedule a consult with our IVF nurse. The person that will be giving you the medication should be present at the time of consult. Generally, the best times to schedule this consult is about one week prior to starting your medications. You may schedule injection instructions in any of our offices. You should call the office most convenient to you and schedule the appointment. There is an office fee for this consultation. If your insurance company requires a referral you must get one prior to the consultation.

How long does the egg retrieval take?
Depending on the number of follicles that are present, but an approximate time is one hour. You should plan on being at the IVF suite for a minimum of three hours.

How will I feel after the egg retrieval?
Usually patients complain of feeling sleepy. Occasionally you may experience abdominal discomfort. The day after the egg retrieval you may decide to return to work, which is fine if you feel well enough. If you can afford the time off from work, we would encourage you to stay at home because you may not feel quite up to par.

When is my male partner required to produce the semen specimen?
On the day of egg retrieval, the Embryologist will inform you when the time is proper for you to produce. We have private rooms available for your use. If you have a specific problem, i.e., time constraints or difficulty producing, you should discuss this with an embryologist in advance of the egg retrieval.

Does every follicle contain an egg?
No. In fact, sometimes if the estradiol is very high it is difficult to see every follicle, so we may get many more eggs at time of retrieval than number of follicles seen on ultrasound. Unfortunately, when the estradiol is low and only one or two follicles are present on ultrasound, there may not be an egg in the follicle. We will do a pre-ultrasound prior to the egg retrieval if we suspect that you could prematurely release the egg(s).

Will every egg fertilize?
Our normal fertilization rate is approximately 65% of all of the eggs retrieved from each patient. Some patients have a much higher rate of fertilization and occasionally a few patients will unfortunately have no fertilization. If you do not get 100% fertilization with the first day insemination. The eggs will be reinseminated or injected using ICSI with sperm in an attempt to increase fertilization. This may require a second specimen from the male partner on the day after the embryo retrieval.

When are the embryos frozen?
They can either be frozen the day after the egg retrieval, called the 2 pro-nuclear stage, or at any day after the oocyte egg retrieval. They will be at multiple cell stages.

How long can the embryos stay in frozen storage before being used?
No one knows the exact answer to this question. In our program, several women have delivered healthy normal babies when the embryos were stored for 5 years or more in our laboratory.

After my transfer, will all of my remaining embryos be frozen?
Not all embryos go through normal cell division. If the embryos do not appear normal, they will be discarded in the lab. The Embryologist will call you 2-3 days after your transfer to tell you the total number of embryos that were frozen. ALL EMBRYOS THAT LOOK NORMAL WILL BE FROZEN.

When can I resume normal activities, i.e., driving, walking steps, going to work, etc.?
48 hours after the transfer you may resume normal activity, unless you have a very strenuous job. If your job is strenuous, you should discuss this with the doctor.

When can I have sexual relations?

You should not have sexual intercourse until after your pregnancy test.

What is the best position to stay in after the transfer?
Lying flat in a bed or couch or reclining in a chair is best. You may lie on your side or back, whichever is more comfortable for you. You should stay reclining except for using the bathroom and showering for 48 hours after the embryo transfer.

On the drive home, must I lie flat?
Because of the hazards of driving without a seat belt, we advise that you recline in the front seat, if possible, and put your seat belt on.

When can I resume strenuous exercise?

You may resume strenuous exercise only with the consent of a physician and after you have had your pregnancy test.

Does the program maintain a referral listing of previous client couples?
No. This is an intensely personal matter, and we do not ever give out phone numbers to strangers randomly. We will, upon request, contact former clients for their permission to release their phone number or ask them to contact you directly.

Does the program recruit its own surrogates (host uterus program candidate)? Through what means?
We do not recruit any surrogates (host uterus program candidates) but we receive a large number of referrals from a number of "host uterus programs" from all over the country. All of these referral programs advertise across the country for surrogate mothers in local weekly publications. They also receive many applicants who have seen TV shows on the subject or through the "word of mouth".

How do clients select a candidate?
Each couple that these referral programs represent, select their own surrogate with guidance from their staff. Sometimes clients are looking for someone who resembles the wife and sometimes they just want someone who is educated and healthy. When your signed agreement is received, those programs immediately begin the matching process with you. They will send you copies of surrogate applications complete with pictures of the surrogate and her children. They will arrange a telephone interview between you and your selected applicant. If you are not content with your original choice, you can continue the interviewing process until you have found a suitable helper.

Does any of the referral programs offer psychological screening and counseling to host uterus program candidates? To what extent?
Yes! An initial psychological evaluation is done prior to commencement of any medical procedure. This is usually an hour and a half in length. IQ testing can be done upon request. In most programs, the Surrogate Parenting Agreement also allows for six months of psychological counseling for the surrogate upon request, as long as, the representing program is within 6 weeks of the birth. The reality is that very few opt for this counseling. In most cases, they simply prefer to talk to another surrogate who has been through what they are experiencing.

Do we offer medical screening of the host uterus program candidate? To what extent?
Complete medical screening is done by the physician who is monitoring the case. It includes a gynecological exam and pap smear, venereal cultures and extensive blood testing including HIV. An extensive medical history is also taken at the same time.

Does medical screening include an AIDS test of the host uterus program candidate and her partner?
Yes, of course.

What other screening procedures are in place?
All programs that refer patients to us use a detailed application form that provides a variety of information about the surrogate and her familial history through 3 generations. It provides personal, educational, obstetrical/medical and legal information about the applicant. The application is reviewed by the medical, legal and psychological workers of the program. Once the helper has passed the initial review, she will undergo a telephone/personal interview with their staff. Information is verified and her intentions are discussed. The medical procedures and requirements of the program are discussed with her in detail. Upon selection, medical and psychological testing is completed immediately.

To what extent is contact between the host uterus program candidate and couple encouraged? (By letter, meeting fact-to-face, on-going?
All referring programs encourage all couples to personally interview their surrogate choice before proceeding. They also encourage couples to maintain contact at least monthly by phone or letter up to the time of birth. Whether or not contact continues after the time of birth is up to the parties involved. What is customary and usual is for there to be an annual exchange of letters and photos for the first couple of years following the birth.

What type of legal counsel is offered to the host uterus program candidate and couple? Does this include the drawing up of contracts?
Legal counsel is offered at the option of the surrogate for the purpose of reviewing the Surrogate Parenting Agreement or Contract. The Surrogate Parenting Agreement is prepared by the referring program. Any couple who wishes to retain outside counsel is welcome to do this. We will be happy to work with their attorney of choice. We highly recommend the existence of a contract between the parties before we begin to accept the parties to our program and begin to offer our medical and laboratory services.

Do we offer adoption finalization services?
We don't! However, the referring programs do. They will arrange for step-parent adoption finalization services (AI cases), court orders for maternity-paternity (IVF cases), paternity orders with termination of parental right when they are representing an unmarried man, and adoption finalization service when they are representing an unmarried woman.

Do the referring programs charge a fee for informational meetings or interviews?
These charges and others vary from program to program, but most of the time you only pay them a fee when you retain their services.

In the event that a uterus host program candidate has a pregnancy loss, what are the financial obligations for the couple?
In the event of a miscarriage, abortion or stillbirth, the surrogate is paid a pro-rated portion of the total fee based on total number of days pregnant. Most surrogates are expecting to be paid $20-30,000.00 for a live birth. To our understanding they simply divide that by 266 (the average number of days a pregnancy lasts). That figure is $75-112.00 multiplied by whatever number of days she was pregnant.

In the event that the contract is not honored, what are the financial obligations for the couple?
The various programs offer a variety of options but, in the very unlikely event that this would occur, the surrogate would not receive her fee, and the fee already paid to these programs is good until the couple goes home with a baby regardless of how long that takes. The fee normally entitles the couple to unlimited access to surrogate profiles until their goal is achieved but again this may vary from program to program. Those restrictions and regulations could vary among the various programs. General Comments It is highly recommended that each couple seeking to participate in a host uterus program should get acquainted with the program's rules and regulations. Each program offers a variety of options that you need to examine carefully and understand all the specifics.

310 South Limestone Street, Lexington, KY 40503 USA
P.O. Box 23777 " Lexington, KY 40523 USA
Phone: (859) 254-8108, (859) 226-7263, (859) 226-7264

Fax: (859) 226-0026