S1 Ep11: Surrogate screening – all you need to know

[Music] Hello everyone and welcome to our Mexico City edition of my surrogacy journey, the podcast. I'm your host, Wes. I'm one of the founders of my surrogacy journey and today I am joined by all of our MSJ teams. It's a really special edition. We're going to talk to you all about the surrogate screening process. So all the way from surrogate starting, making contact with us, all the way through to them being signed off and matching with a set of intending parents. And I think for those of you who are either watching on our YouTube channel or those of you listening at home, we're coming to you today from our Mexico City office. Now let me introduce you to our guests. So we have our regular and our podcasts, Debbie Evans. She's our clinical and compliance director at my surrogacy journey. Hi Debbie. Hi Wes. And then we've got Fernanda but we call her Fer. Fer is our surrogate membership manager. So she manages everything to do with surrogates here in Mexico City. Hi Wes. And then we've got Dr Alex. Hi Alex. Hello. Tell us a little bit about what you do. I take care of our patients and the clinical leader in my surrogacy journey. And look, let's just be really clear here like English is not fair analysis first language and they speak English really well and they speak far far better English than I speak Spanish. So let's dive right in because I think those of you listening are interested in how we screen our surrogates and just the basic process that we go through to get our surrogates to a point of being able to match with intending parents. And let me just also put this into context. Now we are probably the only organization in Mexico City that follow this protocol and we have this protocol because we think this has the best outcome for both surrogates and intending parents. What a lot of other organizations do in Mexico City is they will do some very basic medical assessments of surrogates when they come on board. They will then match them with the surrogate and then they will start a full screening process. Now the challenges with that is that the intending parents often have to pay for all of that screening and they are invested once they match with that surrogate. And if the surrogate doesn't meet any medical criteria at any point throughout that screening and then the surrogate is not a suitable candidate, then they have to be rematch which takes time. They then have to start the whole process of screening you get in which costs more money because they have to start the process again. But it also more importantly takes a lot of time. So you might have got forms down the process of being matched with the surrogate and going through the screening process where she's deemed then as not a good candidate for medical reasons and then you have to start the whole process again. So you've essentially lost another form. So at my surrogacy journey, we don't believe that's the right protocol, that's the right way to do it. It's important that when we match intending parents with a surrogate, they've been through a whole range of screening and on this episode we're going to talk you through what that screening process is. So you fully understand it and you fully understand why we're doing it. So often you're the first person that comes into contact with the surrogates, they come through social media, they message direct for the website. How do you approach them when they're where they first? And what's their first interaction like with you? It will be a video call or a phone call so I can explain a little bit about what we do and what we are because a lot of benefits that they can have with us. And the next step, it's an interview in the MSJ office in and Surre Spolanco. In that interview, I talk with them and I explain every step that will be taken to give us an embryo transfer and all the benefits that we had and all the doubts that they have. So it's really kind of giving them another view of our membership benefits. What benefits they can get as being a member, surrogate member. I've also been there to answer any questions if they have any, just about the process because sometimes people have never done this before. They have a lot of questions and I think to give them reassurance about, you know, potential medical treatment, the IVF process, the screening, there's a lot of components involved, right? Yeah, yeah, yeah. It's important to see the expectations that they have of us. Yeah, but it's about making sure they meet the criteria, right? And then it's being transparent about the processes because we really want to make sure that anyone that embarks on their journey with us, we're fully transparent about what's involved and everyone starts the journey knowing all of that. And then I think it's fair to say Alex that they then move over to you for a bit of a medical assessment. Yeah, so we care about our patients, our surrogates and our IPs. So we need to see that the surrogate is in good conditions of health to continue the process. So they come with me and we do our first medical appointment where I asked them a lot of things about their health. Their family, if they have some disease or how they feeling, so we know what we're going to treat. So we look at the upstairs, we're looking for general health and well-being, all of the typical things. And I think that's really important because there are a few organisations have a doctor in house and it is about making sure that they are fit and well and healthy and a good candidate, anything to add there, Debbie. It's really important to make sure that we cover everything because we're doing a medical assessment that needs to sort of lean out if there are any issues that we need to be concerned about. If there's anything that we can help them with, etc. So we need to do quite a detailed history. We need to make sure that they are eligible as much as fur as past them as being eligible. We need to back that up from a medical perspective. Is there be a my correct? Have they got high blood pressure? Have they got diabetes? Have they got a high thyroid function? Have they got lack of vitamin D? All of those things we need to start thinking about, do they know that already? Before we've even started to screening, it may well be that there's something they already know. So we need to tackle some of those things head on before we can say, yeah, they're good candidates and they're ready to take the next step because when we start thinking about processing screening and doing scans, etc, we need to know that they're prepared and ready for that. I think that's our commitment as an agency to make sure that we are very thorough in our clinical screening because, you know, and I know, Alex, I know that you spend a lot of time with our surrogates giving them reassurance, being a support network from a clinical point of view, so that if they do have anything that they're concerned about, if they're unsure about the treatment, so anything from a clinical point of view, you're there to support them. And I know that's something that the surrogates really appreciate. Yeah, here in Mexico or I don't know, maybe in a lot of parks, we don't know about the process, we don't know what's happening. So all the patients, they have a lot of questions, they have a lot of stuff. So also my work with them is to inform and to tell them what's going on. So they can feel more safe with us and they ready to continue the process. Yeah. And some of the diseases we have in this first appointment, they are really easy to treat. So we try to treat them. So they can continue and have everything good. And they can have them in a good health to continue the process. Yeah. And I think, you know, once we've kind of got that initials process with fair, they've passed the medical thing, we then start looking at potentially, you know, a legal assessment from an agency point of view, we want to make sure that any surrogate that comes through has all of the legal elements to be a good candidate and to meet the criteria. We want to make sure that, you know, if she says she's married, we've checked that she's married, and that, you know, she has that status or if she's divorced, we want to see that she's legally divorced because in some cases with intending parents, the status of the surrogate has an impact on the ability to apply for a passport for the baby. So we like to check that really early on, because it might be that, you know, if we have a surrogate that's married, we might not much here to a set of British intending parents where that has an impact on the exit, whereas there are other nationalities where it doesn't. So it is a real, a bit of a jigsaw puzzle really with our surrogate experts to make sure that we match them with the best suited set of intending parents. But once that legal assessment has been done and the surrogate has had a chat with the surrogate lawyers, and again, it's about making sure that they have some support and someone who's going to represent them, who can make sure that, you know, they're there if they need to. We're going to ask them, is there any legal elements pending within their life, you know, do they have any criminal convictions? Is there anything that's going to impact the journey? That's what that legal assessment is designed to do is kind of make sure that from like we are doing from a clinical point of view, making sure that the best candidate from a legal point of view, is there anything that's going to prohibit them from moving forward? And that's that's kind of the process we've from there. And then I think from from that point, once they've passed that legal process, we then start the more clinical screening, right? Debbie talked to us about what those three elements are. Okay, so Alex and I worked quite closely together on developing medical checklist so that when Alex does his initial clinical consultation with our surrogates, we know that everything is being asked and covered. So, you know, we talked about the medical history, etc. Obstetric history is really important if they had multiple caesarean sections. You know, what is their birth journey's been like? Have there been any complications? All of those triggers that start to think, okay, this is somebody that we need to have a little bit more awareness about and then we then need to start thinking about if they passed everything to that point, screening them and getting we've alluded to that where it's quite nicely in there that we want to MSJ, screen our surrogates before we consider matching them. Because that's really important to us. Sometimes we can get a screening result that comes back as a negative and that's not to say that a surrogate can't continue on a journey as a surrogate but we need to work with that clinically. So rather than matching with an IP, they've then get the negative test and then we have to work at which delays everything. So we're doing it the right way around in our concept. So when we talk about screening, we're looking at various different things. We need to screen out for virology, HIV, hepatitis B and C and we need to look at some of the more common STDs, sexually transmitted diseases such as gonorrhea, syphilis and chlamydia. And they're really important to know the status if they are present or if they're not because they could have an impact on the surrogacy moving forward. So that's really important to know and Alex will arrange all of those tests locally in-country with a really good provider that can do those tests quite swiftly. We get those results back swiftly and we can act on them. I'm going to get Alex to talk a little bit more about the general cultures that we do because that's also very important when we're looking at sexually transmitted diseases and the importance of the relevance on a potential pregnancy could be quite significant. So we need to make sure. And from a general health perspective, we need to make sure that she is fit and healthy to carry a pregnancy. Pregnancy is not an easy thing to do and we know that people procreate all around the world and naturally normally, etc. And that's fine if you're doing that for yourself. But when you're doing it or intend to parents who have pressure embryos, we need to make sure that that that arseurrogates are in the best clinical healthy position that they can be. So basic tests like vitamin D. And I do get very surprised that it makes a cosy city that a number of our surrogates do have very low levels of vitamin D and it's a beautiful sunshine city that we have low levels but it's quite common place. And so for me coming from the UK, that's been a real eye opener but with Alex, it's helped. We quickly swiftly get them on some calcium supplements to make sure that they are building up the vitamin D. We all need vitamin D to live healthily to help our kidneys and our livers to function naturally normally. And if they're lacking, then they could have an impact on that, which the internal impacts on their pregnancy. And I think one of the reasons we kind of assess vitamin D very early on is so that we can then take measures to increase that. And then everything that we're doing here from a screening point of view is to maximise efficiency. And I don't like using that way, but I do because it is going to impact the ability and the time frame of when we can get to embryo transfer. So I don't like talking about efficiencies because we are talking about our human process but the process is designed to be as efficient as possible because surrogates want to move efficiently, intending parents want to move efficiently. And I think it's in everyone's best interest to do that. So it is really tailored for us to be picking stuff up very, very early and for us to give us the ability to ever say, this is not a suitable candidate, unfortunately, and give them the support to move forward with any condition they have. Or if there is the irisuitable candidate, but we just need to give them some medication or they need some kind of a treatment that enables them to move forward, then we can pick it up nice and early and it's not impeding on the time frames to get to the point of embryo transfer. The process that we're talking about vitamin D is one of the most easily convertible thing that you can turn around very quickly, very easily with a simple addition. Yes, we want them to go out and be in the sunshine, but that takes several months for them to build up enough store to increase their vitamin D levels. And we're also looking at the thyroid function because that has quite a negative impact. If you do have another normal thyroid function on potential early miscarriage and potential harm to the pregnancies. And I'm not going to go into thyroid function today because it's going to be quite complex, but you need to make sure that that is managed correctly. And again, it's really simple to change the outcome of that. And everything we're doing in this whole on-bawling process to get into bite-bomba transphase is to maximise the chance of success. Vitamin D, thyroid, it's all about identifying these elements that we know have a negative impact on pregnancy and how can we rectify them or give the surrogate and the intente pose the best possible chance. Sometimes our surrogates have no idea that they're lacking in these, they come this way, "I've been so tired." But didn't recognise that there was something wrong and hadn't gone time to go to the doctors and find out or had the relevant screening. So we're finding these things out and they're fixable. So yeah, we can change it. So Alex talked to us about vaginal cultures. Yes. So as Devi says, we want to prevent everything we can. So a lot of women, they have like vaginal infections. Sometimes they don't even know that they have it because they are really common. We do the vaginal tests to see if there's some bacteria there. What happens when there's bacteria? Of course there is inflammation. Of course the uterus and the endometrium is not going to be in good conditions. That's why we do the vaginal tests. We see if we can find something and we give treatment to finish with that infection. So one of the most popular here in Mexico is called buria plasma. In my consultation there's maybe I have like 10 patients per day and like seven of them they have buria plasma. So it's really important to see if they have the infection treated and we finish with that. What's going to help us with that? We're going to have a better embryo fetus. It's going to be better for the woman to get pregnant and also about symptoms. She's going to be better. So it's really important to see if there's some bacteria or if they have something to have a very excess of the process. How long does that process for genocles? It's eight days. We have a really good laboratory who help us on that process. If something goes positive we also give the treatment and we try to be with them in all moments. Because maybe we treat that infection but also we give them recommendations to do and to prevent it. And then once once they've been given treatment we would then retest to make sure that they were clear. Correct. But also what's really important to remember as well is if the bacterial infection or the viral infection could affect their partners we need to make sure that their partners have been checked and tested and perhaps treated because there's no point treating our surrogates and we've got an infected partner at home that can then keep reinfecting. So we're very holistic. We want to make sure that we're looking after our surrogate but also if there's a partner and he's involved then that needs to be addressed to. And that's really important. Debbie let's put this into context as well. You know these types of infections are very common right? Very common. Some people at home listening might think well is the surrogate not a good person? Is the surrogate not looking after herself? Is this derogatory kind of view of people with infections? We all know infections are sometimes in our lives and we shouldn't judge people for. No, they're not judging. The giant vaginas can be quite dirty places and they can harbor bacteria very easily and most bacteria may cause no harm, may cause no symptoms to them. So these women have no idea that they're there until they're tested and then they get very upset and very shocked and oh my god what have I done and you know I haven't kept myself clean. Well no there's not those concepts at all but we just need to make sure that we get rid of that bacteria as far as we possibly can because again we don't want to have anything that could give potential harm to that pregnancy and the general infections can. Yeah and another element that we screen as part of that screening process is the saline infusion scan. So it's a uterine scan I'm talking like I'm a clinician here right? I'm showing off but Debbie tell us a little bit about why that's important. And when we talk about the screening we do the viralodil that we just talked about in the STDs. The next thing that we need to do is do some scans. So we do a scan that we want to make sure that the uterus is fit for purpose and the easiest way that we can do that is a commonplace examination that's done under ultrasound guidance with the vaginal probe and we insert warmish saline into the uterine cavity to look if there are any anomalies. What I mean by that is have we got anything that could prevent an embryo being implanted. We have the endometrium cavity which is the internal structure within the uterus that needs to develop time to nurture and hang on to that embryo when we implant it. And if we've got polyps, polyps, the easiest way to describe those is like a little skin tag. We can get them anywhere in our body but within the endometrial cavity they could be harmful because an embryo is not able to implant because there's a polyp in the way. These are quite simple structures that can be removed very easily but sometimes you might have several of them. You might have 10 plus and that again can happen and they may not cause any problems at all. Some women may complain of intermenstrual bleeding, subleading between their cycles and that could give you an alert that perhaps there's something that's disturbing that endometrium and making it bleed before it should do. So we have to do that investigation. The other thing that we're looking at for is are there any fibroids that could be encroaching on that endometrium cavity and therefore it's not able to expand and do what it needs to do as the pregnancy. pregnancy progresses. And there's another condition called adenomyosis, which is scarring of the endometriol and surrounding uterine moors. And that can cause cis-like structures that could give harm as well. So we need to roll out all of these things and it literally is making sure that the uterus is fit for purpose. Because there's no point doing all of that screening and then we've got a uterus that's not able to sustain an embryo in planting and a pregnancy. Continue not. And again, this is another part of planning for success because we look at every key stage of it and make sure that we have a process in place to check that it is. It is right. It's important that our surrogates have a really positive experience from a clinical point of view. And I know they get the support from Debbie and Alex, but we structure the way that we do the screening in a way that is designed to minimise the inconvenience of the surrogate. And I know that you attend all of the appointments with the surrogates to make sure that they are fully supported. And the medical team at the clinic we work with, which is probably one of the best in Mexico City as well, is an amazing facility in Debbie. I know you've been there today. Yeah, I've got it today. It's fabulous. Fair. It tells a little bit about what the surrogate can expect when she goes for that scan or for that level of screening. I will be with them all the time, all the first appointment and every appointment. So the expectation is being in the in the medical hospital. And the doctor that do the all the scanning is very patient and very kind doctor. He always treat them with all the respect and he explained every step. He's amazing. And that's particularly the sale and infusions. And the vagina culture is quite an invasive process isn't it? And I know a lot of the organisations, they'll do one thing and then the surrogate has to come back. And we've tried to set our process up in a way that does cater for the comfort of the surrogate. So that she's trying to get everything done in one appointment. So she's not having to come back with the forwards again, that's about time and efficiency as well. As it costs us more as an organisation to facilitate that, but it's the right thing to do. We care about the experience how surrogates get when they go for all of these screening. And we want to make sure that like all of our members, they get the most positive to experience. I know that we've had a significant amount of surrogates that have already gone through that process. What would you say the feedback from the miserable about that particular screening? They love the doctor. They love that he includes them in all the process and he explained everything. So they love that treatment. And the nurses are so gentle too. And they took the blood in the in the first try because sometimes it can find the veins. I think it's really important that the surrogates feel comfortable, that they feel at ease and that they feel cared for. That's really important to us. I know that both you and Alex have done a massive amount of work with that doctor and the hospital to create an environment for my surrogacy journey surrogate members that is a really positive one. So from the start, I've been involved with both of you and I know that the one thing that both of you have been really focused on is how do we best care for our members, our surrogates. And that really shines through with the kind of how it's been set up. And I know that Debbie, you see this from a far with you, you ever see everything that that the team do here from a clinical point of view, but I know that you see that. Yeah, and I had to rely on Alex and Fair to be my eyes and ears in Mexico City and to get the best service that we possibly could. And they've gone out and got an amazing hospital with an incredible compassionate doctor that cares about surrogates and cares about what we want to do for them. And you know, when they start the exam, they do the scan first to make sure that part is correct and that we've got a uterus that's fit for purpose before we do anything else. Because there's no point putting them through the procedure of all the bloods being taken and the scan is not correct. So, you know, they're doing it in the right way. And Alex has spent a lot of time negotiating with the doctor telling him how we want it done and this is what we're going to do and this is the test that we want and negotiated. You know, the price and the convenience and everything. And we want it all done together. And so he's, you know, we've made it the best possible. As you say, you know, these guys don't want to be going to several appointments all over the city. So we've, you know, only go centre to a really good way of making sure that the screening is correct at the right time. So, once they've then passed through that and Debbie and we, we as a team have a call every week and we talk about all of the surrogates coming through on board in what stages there are at the results back where we are with this and we as a team discuss that every week. Once, once you've got them to that point, Debbie, and you're happy then to sign them off from a clinical point of view, what are you looking for at that point to sign them off at what process do you go through? So I've got a clear checklist of the screening that we require. Have they got all of those? Are they negative? If they have been positive, have they now been treated and we've re-screened and it's now at a positive point, is the scan correct? Is she passed everything else that she's, that she's needed to within the whole clinical framework? And I won't sign off until we're at that point when we say, "Yeah, okay, and then everyone claps and says, "Yeah, we're in a good place." And then we say, "Yes, fair, Carly, we're ready to match." Because we're in there confident that we've got a really good surrogate that's met all of the screening targets. They're quite, I'll just, they're quite a lot to put them through, but it's important because, as I said earlier, our intended parents have got precious gametes and embryos that we need to look after in the best possible way we can. Yeah, now some intended parents might want to know a lot of the information about the surrogate and the screening process. They'll be, I'm going to ask you this question because I think it's really important and I really want to manage expectations of intended parents, you know, a surrogate, even if you're working on match with it, she has a right to privacy, right? Any of the information that the team are discussing is private confidential medical information. Correct. And, you know, we would not talk to any intended parents about any medical information that the surrogate has not consented to. Why is that so important that we. Because we have to protect her, absolutely, and she doesn't want me to discuss if she's got an STD with her intended parents because she's going to feel that that makes her feel bad, that makes me feel unclean, all of those things. And I feel really strongly about it actually because like everyone in this process, all of our members, surrogates and tenni parents, everyone has a right to privacy. And we work really hard as a team to ensure we safeguard everyone's privacy. Information is very tightly managed and I sometimes, you know, get the impression that some intended parents feel like because they're matched with a surrogate that they have a right to know some of this information and they absolutely do. And we will be asked direct questions and sometimes we're very transparent and we'll. I'll immediately, if I've got a hold up and I've been told that there is an infection and we need to treat them, we do let the intended parents know that we're waiting on screening, that there may be something that we need to look into further, but that's the level of detail. And if they come back and say, "Oh, can you tell us more?" And I say, "Well, now I'm protecting her medical history." Just like it is. Nobody's just like we protect. I mean, we get to know sensitive information about intended parents, clinical information. You do those consultations that we equally protect their privacy, don't we? You know, it's really, really, really important to us as an organization that everyone's information is protected and they have the right to privacy. If a surrogate doesn't pass all of those rigorous screening, all that we'll say to our intended parents is that she hasn't passed our medical screening. And then once we've got passed that point and Debbie's kind of greenlighted the surrogates and said that they're ready to be matched, we follow a couple more processes, don't we? So we're going to do a psychological evaluation to make sure that the surrogate is psychologically robust enough to manage her DNA and she's sheet that there's nothing that's going to prevent her from being a really good candidate. And then once that element is completed, we could then do a social and economic assessment and I know that fair you work really closely with some of our partners to enable those to happen. And from a social economic point of view, what we're looking for there is is does she meet the requirements? And let's just all be clear here, all of the requirements we're talking about today, they do form part of the eligibility criteria to get to the point of being able to match, but they also form a really big part of the legal process as well. We have to make sure that we're not only looking at the medical elements in the screen and we are making sure that we're ticking all of those boxes that the judges are going to be looking for. We need to make sure and to demonstrate that the surrogate has had all of that screening from a psychological point of view and they've done an assessment on a social economic environment. The social worker will visit her in her own home, make sure that the environment is conducive of a healthy pregnancy, does she meet the requirement of living in Mexico City? Do the people actually live with, know that she's doing surrogacy and are comfortable with it? Is she doing surrogacy because she needs to survive? If you know, that's not a conducive relationship for anyone. We learn to work with surrogate surrogate so we're financially independent and doing surrogacy to complement our enhanced their lives by supporting family creation with other people. So how do I surrogate react to that fair in terms of that? They know that, I mean, obviously, you're very transparent with them at the start about what the process is, but how do they how do they feel about some of those elements, the social economic and psychological? They're very very agree with all the onboarding process that we have because they know that it's for the best option, the best care for them, not for us. And for everyone, it's the best from them. So we need to protect them all the time. Yeah. So that will be the best for them. It is. And look, let's be really honest. The Intel parents have to go through a similar process. We do a non-bording and screening process of our Intel parents. And that's just to make sure that everyone is eligible and meets the criteria. I'm hoping that the podcast today is given everyone a really good understanding of the process that we go through. The diligence that we as an organization go through to ensure that our surrogates, members, are the best candidates they can be. But also that they have that level of support at every stage of this to make sure that they understand what's happening, but to enable someone to explain the process and make sure that they have-- particularly if I'm a clinical partner, because I think it's really important that they have that support network there. And I know, at least that you're checking on surrogates regularly, just independently of fair, so that you've got someone they can talk clinically to if they need to. And I think that's a really nice touch. And I know-- and fair, back me up here-- is that the surrogates really love our legs. She keeps talking to Halic, you know? But I think that's about the rapport. And that's what we are as an organization. And that's how we manage the process, right? I think pregnancy is really hard for a woman to be pregnant. So they need someone who can be with them in the whole process. And that's part of my job. So I enjoy, like, really to take care of them. So that's why I believe they're happy with me. And they love-- Yeah. And they love the idea to have someone look after them in case she has a flu or a stomach pain or something like that. She loved the idea. They loved the idea to have someone who is always taken. Yeah. And I think it's just a little bit more fair is that Halic is there to talk for the surrogate process. But also, if there's any other medical elements that they want to talk to me about, he's really happy to have those elements there. So I think we've really covered a lot today. Thank you all for your time. It's great to have just a podcast with the MSJ team on it. UK and Mexico City Surveillance. But thank you all for your work. You all make a massive difference to the support that our members get and to the outcome. So I thank you all. So if you like this episode, there are more episodes out. And if you want to hear more information about all of the other elements about our Mexico City Pathwood, then go to our website to look at them. Don't forget there are other episodes available. Whether you're listening to this via our app, via Spotify, Apple Podcasts or YouTube, there's still time to get another fix. If you want to know more information about our services, then you can head over to our website, which is my surrogacyjane.com. We'd love to help you figure out the best ways to create your family. So thank you all very much guests. I'm gonna say Astila Wago from Mexico City today. Thank you and goodbye. Thank you. - Bye. - Today's podcast was brought to you by Taluila and the Jude Productions. (upbeat music)