Attendees: Annie, prospective parents, Dr Moussa, and medical assistants.

The dialogues are summarized below.

Annie: Hello everyone, hello Dr Moussa。。。。。。。 The first is a mutual greeting, and the follow-up is recorded in Chinese for your convenience.

Annie: There are our Clients who have some questions and would like to consult with you.
The topic of our meeting today is:

When a surrogate mother’s first transplant fails, prospective parents would like to hear the doctor’s professional analysis; and whether the doctor recommends that the surrogate mother should continue with the transplant or change surrogate mothers in order to improve the success rate of the transplant, or whether there is any way to improve the success rate of the transplant. Is there anything else prospective parents would like to add?

Expectant parents: no more, want to hear the doctor’s analysis of the surrogate mother’s physical condition and our embryo match.

Annie: Okay, listen to Dr Moussa’s analysis of why surrogate mother transfers fail, and our embryo situation.

Dr Moussa: I’m very happy to have the opportunity to talk to prospective parents. From our embryo records, the first 5BB embryo is the one that develops into a blastocyst on day 5, usually a blastocyst on day 4 or 5 means that it’s developing at a good rate, the second letter B stands for whether or not the cell mass is tight enough to have any debris or something like that, and the third letter is the portion of it that will develop into the placenta later on. Generally, 4AA and 5AA are the best. According to the authoritative statistics in the United States, 4AA and 5AA have about 60-70% of the implantation rate, and 5BB embryos have about 50% of the implantation rate, and 42% of the live birth rate.

Regarding the surrogate mother’s condition, before the transfer, we did a thorough checkup on her and she was in good condition in all aspects. At the time of transfer, we put the embryo catheter into the uterus also smoothly, and the hormones such as lining and luteinizing copper of the surrogate mother were also checked and verified weekly before the transfer, and everything was fine, and the surrogate mother had 2 surrogate experiences, and the previous 2 surrogate pregnancies went well, and it was still very good from all circumstances.

If you want to continue the transplant next time, you can look at 3 things

1 is the level of the embryo, although the data show that there is a 50% rate of implantation, but this does not mean that it is absolute, there may be success, there may be failure, it is impossible to predict.

2 is that the surrogate mother uterus has a fibroid close to the endothelium, may top the endothelium to affect the success rate of transplantation

3 are unexplained failures in every transplant, and it is not uncommon for transplants to fail once.

So prospective parents should consider

Should I continue to use this surrogate mother for the transplant or should I do a hysteroscopy to take a closer look at the fibroids to rule out in this problem before transplanting.

It’s up to the prospective parents to consider whether to transplant with a different surrogate mother.

Mothers-to-be: no leiomyosarcoma found before transplant?

Father-to-be: there are findings and we were told about them. I would like to ask: does it mean that the second graft implantation rate is 75% or can we be sure that it is 75%.

Dr Moussa: I understand your algorithm, but there is no authoritative data that suggests a 75 percent placement rate, but there is data that suggests that three or more transplants is a 90 percent placement rate.

Expectant fathers: there is an 8% difference between %的着床率和42% 50 %的着床率和42% a %的着床率和42% live birth rate, what is the main reason for this difference?

Dr Moussa: The 8% most common is undetected fetal heartbeat, or miscarriage, or fetal arrest.

FATHER-TO-BE: So it happens with natural pregnancies, huh?

Dr Moussa: Yes, natural pregnancies can happen and 70 %～80% because of chromosomal abnormalities that lead to the discovery of a fetal heartbeat, or a miscarriage, or a fetal arrest, and although the embryo has been chromosomally screened, it doesn’t chromosomes aren’t everything, and there can be other tissues or cells that have abnormalities.

Mothers-to-be: were surrogate mothers’ first two surrogate pregnancies with leiomyosarcoma successful and live births in one transplant?

Dr Moussa: Yes, from the medical records, the first two surrogates also had leiomyomas. Normally, this leiomyosarcoma will not affect the pregnancy. Isn’t it time to analyze and improve the success rate of the transplant? We have listed all the possible reasons for this, for your information and choice.

Mother-to-be: The first two transplants were successful, and this time the myoma will grow like a polyp and affect the transplant.

Dr Moussa: Let’s first understand the uterus, the uterus is divided into a muscular layer and a lining layer inside, fibroids grow on the muscle of the uterus and polyps grow inside the lining, it’s not the same thing.

Here we show you the results of the surrogate mother’s saline ultrasound, which is what we check before every transplant (the doctor showed the black pepper photo of the saline ultrasound to the parents-to-be)

Here is the uterine cavity, from the picture, the uterine cavity is very clean, if the uterine cavity is not clean, the catheter at the time of transfer will stick or encounter obstruction, we can see that the uterine environment is still quite clean, at the time of transfer, we will follow the ultrasound guideline to place the embryo in this area.

The fibroid grows in this place (the doctor pointed to show you), which is in the upper left corner of the uterine cavity, there is a distance from the uterine cavity, the exact distance is xx (forget the value) mm, according to our experience judgment will not affect the transplantation, but if you are worried about it, you can give surrogate mothers to do the hysteroscopy will be a lens inside the uterine muscle, to see whether it will be squeezed to the uterus endothelium.

We know that we synchronize a lot of surrogate mothers’ medical reports to you, and I know that adds to your concerns, but it’s something you should do as a doctor, but don’t worry too much, it’s all fine.

Mother-to-be: I understand. So if you do a hysterosalpingogram, do you have to wait until your period is clean?

Dr Moussa: Yes, it is usually done on the 7th to 10th day of menstruation, when the surrogate mother’s period has come and gone, and you have the choice of whether to continue with the medication, or do the next cycle after the hysteroscopy, or switch to a different surrogate mother.

Mothers-to-be: don’t surrogate mothers need to rest before transplanting?

Dr Moussa: No, it’s not necessary, it’s fine to have one period.

MOTHER-TO-BE: Okay, so let’s discuss it. Give us a few minutes.

Dr Moussa: There’s no need to be in such a hurry, the next cycle is fine. Take it slow.

Mothers-to-be: Okay, thank you all. That’s the end of our meeting, huh?

All: Okay, thank you, thank you, thank you.

The meeting ended and 2 minutes later the prospective parents responded: continue with the medication for transplantation.

The speed of decision-making surprised Annie, who was worried before to the decisiveness now. Surprised, Annie rushed to the phone to ask the prospective parents to ascertain the outcome of the response.

We understand the worries and concerns that prospective parents have about every aspect of the process in a faraway land, but rest assured that we will do everything we can to help!