Prospective parents considering IVF and egg donor surrogacy are often overwhelmed and confused with a dizzying amount of information, unfamiliar terms and a multitude of options. In the USA, a frequent destination for prospective parents using egg donor surrogacy, there are hundreds of IVF clinics, surrogacy agencies and egg donation programs — each with differing offerings and costs. Knowing the right questions to ask and how to differentiate between the many options is essential for making the best choices for you personally.
Pride Life asked Dr Bankowski for his advice on some common questions.
What questions should prospective parents ask when choosing an IVF clinic?
First look at the live birth rates of clinics using a tool that has some oversight (not just clinic statistics or pregnancy rates). In the USA, this is through the Society of Assisted Reproductive Technology (SART) database (www.sart.org). Ask clinics to explain their success statistics. Accessibility to the physician and clinical team is also crucial. How does the clinic communicate? Are they responsive to questions? How large is the team and what expertise to they have on staff?
Ask about their embryology laboratory. Are they experts in genetic testing? How do they screen egg donors, surrogates and prospective parents? Do they have their own egg donor program? Ask about their egg donor surrogacy protocol as not every clinic does things the same way and this can impact your journey.
What is important to understand about IVF success statistics?
Using a validated database like SART is key. Other sources, like Men Having Babies, provide datapoints but only compare a very small number of self-reported outcomes and don’t show the whole picture. The number of cycles performed and the number of embryos transferred help identify if the clinics data are statistically significant and if the embryology laboratory is top notch.
Most clinics report pregnancy rates because they appear higher, not live birth rates, which is what matters. Success rates vary year-on-year depending on many factors including the composition of patients being treated in a given year. Look for consistency and high success rates over a multi-year period in both fresh and frozen embryo transfer data.
Twin vs single embryo transfer: what are the pros and cons?
Often prospective parents are hoping for twins through one surrogacy journey, including many gay male couples who each hope to be a genetic parent. Transferring one embryo has the lowest risk for the surrogate and baby for a healthy pregnancy and normal delivery. Transferring two embryos does increase the chance of at least one implanting and often results in twins. Many twin pregnancies are normal, but they carry a greater risk of complications for the surrogate, the most common of which is pre-term labor. This may mean bed-rest for the surrogate, early delivery, and premature birth complications for the babies. Caesarian delivery is also more common for twins. Twin embryo transfers also carry a small but increased risk of triplet pregnancy and selective reduction, but this is very rare. Because of the risk of complications for the surrogate and babies in a twin pregnancy, prospective parents should consider the impact on medical costs and insurance.
Fresh vs frozen embryo transfer: is one better than the other?
Historically fresh cycles have experienced higher success rates than frozen cycles. This differential has been eliminated with our improved freezing technology (vitrification). Often chromosomal testing of embryos, Comprehensive Chromosome Screening (CCS) is only possible to do with a frozen cycle. Because not all clinics offer chromosomal testing it can be difficult to get a clear comparison on fresh vs frozen cycle success statistics, especially as this aspect is not captured on databases like SART. In the best clinics, there is a small risk that a thawed embryo won’t be viable, so ask a clinic about their thaw success rates. Frozen cycles are also logistically simpler for the donor, surrogate and prospective parents and offer flexibility that is not possible in a fresh cycle. Together this can help manage costs and minimise stress.
What are the benefits of genetic and chromosomal testing?
At ORM, we automatically test everyone that is contributing egg and sperm (in the case of a gay male couple, one or both of the couple and the egg donor) for over 100 recessive carrier diseases. The person may not suffer from the disease being tested, but they may carry the gene. Approximately 35% of the men and women we test carry one of these genes. If both people contributing the egg and sperm are recessive carriers for a disease, then the baby may develop that disease. We counsel prospective parents beforehand on the results of this testing and where necessary this allows them to make choices, for example choosing another egg donor, so that risk of their baby having a genetic disease is ameliorated. Not all clinics test everyone that is contributing egg and sperm in this manner.
Not every embryo will carry the correct number of chromosomes — 23 pairs. Even in the case of a donor egg from a young woman, at least 25% of embryos will be chromosomally abnormal. An embryo with an abnormal number of chromosomes will either not develop if transferred, or may result in a baby with one of many conditions — most are incompatible with life but also include Down’s Syndrome. It is only possible to test an embryo for the correct number of chromosomes prior to transfer using CCS, which is typically done with a precise procedure prior to freezing. Then an embryo tested for the correct number of chromosomes can be transferred increasing the chance of success and minimising the risk of abnormalities.
What’s important to ask when looking at egg donor programs?
First, what level of screening have donors been through before being included in a program? Many programs only do a cursory screening before prospective parents can select a donor, with further medical and genetic testing done at their expense. Prospective parents may go through several donors before they pass medical testing. Many programs do not do genetic screening or testing at all, and unless your clinic asks for it you won’t have that information. At ORM our donors are fully medically and genetically screened beforehand by us and we only accept about 7% of those that apply.
Second, what level of information is available on the donor and does the program know her? Egg donor programs in-house to a clinic generally know their donors extremely well and if they have donated before they have the records of their prior donations, which increases the chances for success.
Third, what is the cost? Programs approach this in different ways and the cost of screening needs to be considered if not already done. Also important to understand is that success rates are generally higher with egg donation IVF than egg bank frozen eggs.
How can prospective parents improve their chances of success and a smooth process?
Creating a family is one of the most important endeavors you’ll do in your lifetime. Do your homework first. Surround yourself with a team of service providers — IVF clinic, egg donor program, surrogacy agency, lawyers, etc. — that meet your individual needs, have the relevant expertise and that you trust. Select a clinic that is going to give you the best chance of success the first time. If the clinic has a representative in your area or past patients that you can talk with, I think that is very helpful. Stay connected through the process. It will be an amazing journey!