Choosing a Fertility Clinic for Surrogacy
When choosing a fertility clinic for surrogacy arrangements, or even for fertility services for treatment for IVF and other procedures, there are a number of factors Intended Parents should consider when making their decision. The choices and issues may seem overwhelming at first but a full service surrogacy agency will help Intended Parents navigate these waters and make the best decision.
The major factors include the following:
- Success Rates
- Financial Assistance Programs
- Guarantee and Multiple Package Programs
- Egg Donor Options Offered by the Clinic or Practice
- Personal Preferences Regarding the Type and Size of Clinic or Practice
Types of Clinics
Internet Health Resources (IHR), a web-based resource for all things related to infertility, surrogacy and egg donation breaks down clinics into six different types:
- Sole practitioners
- Small practices with 2 – 8 member physicians
- Large, full-service practices
- Fertility networks
- University-based clinics
- Hospital-based clinics
The large practices, university-based and hospital-based clinics may have full resources and laboratories in-house; however, the experience may be more impersonal than sole practitioners and small practices provide. Which type of practice will be a best fit is going to be based on many factors. The following are some of the main factors that Intended Parents will consider when making their final decision:
Federal law mandates that all fertility clinics must present their success rate statistics to the Center for Disease Control. The CDC’s latest report on clinic success rates is from 2013. The Center for Disease Control website contains a plethora for information and statistics from the 440 clinics in the United States providing Assisted Reproductive Technology medical services.
Financial Assistance Programs
There are a variety of loan programs available through fertility clinic networks and direct loan programs through financial institutions.
Guarantee and Multiple Package Programs
The costs involved in surrogacy are high and for some Intended Parents guarantee programs or multiple package programs, which typically offer refunds if the IVF/FET process does not result in a live birth, provide some predictability to overall cost and financial risk. offer some SART, duh duh duh dut cut published an article regarding the ethics of these programs.
Egg Donor Options Offered By the Fertility Clinic
For Intended Parents in need of egg donation, consideration of the clinic and physician’s position on “fresh” versus “frozen” cycles, and whether the clinic has in-house egg donation programs can be an important decision-making factor.
For those not familiar with the terms “fresh” versus “frozen” cycle, a fresh cycle is accomplished by synchronizing the menstrual cycles of the egg donor and the surrogate carrier. The egg donor begins medications that stimulate her ovaries in preparation for extraction of eggs and the surrogate at or around the same time begins medications to prepare her uterine lining for the embryo transfer. In a fresh cycle, the transfer of the fertilized eggs or embryos occurs from the same menstrual cycle. In the case of a frozen embryo transfer, the fertilized eggs or embryos have been cryopreserved or frozen from a previous cycle rather than immediately transferred to a surrogate carrier.
- In-house egg donor program offered by the clinic
- Outside egg donor agency
- Frozen egg bank program
- Parent identified egg donor
- Embryo donation
If a clinic recommends a fresh cycle then the Intended Parents will identify an egg donor via an agency, independently (perhaps a family member or friend), or through the clinic’s in-house egg donor program, if available. If a clinic recommends a frozen cycle, or is comfortable with both fresh and frozen cycles, then Intended Parents can consider using an egg bank or perhaps even consider embyro donation, aka embyro adoption. Each of the donor methods have pros and cons. Let’s explore each in more detail:
In-house Egg Donor Program
Some clinics and practices work directly with egg donors. Typically, in-house egg donor programs offer the advantage that the egg donor may be prescreened medically which is not always the case with outside egg donor agencies. The egg donors may have already worked with the clinic on a prior donation which eases the process and predictability of success. The clinic may charge administrative fees but they are typically significantly less than the fees charged by an egg donor agency. Typically, a clinic’s in-house donor program is more limited in the number of donors available than many egg donor agencies. Also, clinic in-house programs may not have as robust an intake questionnaire as some agencies may have when it comes to non-medical information such as academic record, interests, personality, social history. Also, the clinic typically does not provide full coordination services such as any legal coordination or psychological assessment coordination; however a full service surrogacy agency can provide these services.
Outside Egg Donor Agency
If the fertility clinic recommends a “fresh cycle” as described earlier, and the clinic does not have an in-house program or does not offer enough available egg donors to meet the preferences of Intended Parents, then an outside egg donor agency is another option. There are hundreds of egg donor agencies that match Intended Parents with egg donors. These agencies often have egg donors who are available throughout the United States. The advantage of working with a reputable egg donor agency is that the agency will will assist in coordinating the medical and psychological screening and the legal representation of Intended Parents and the Egg Donor. Additionally, the egg donor agency will coordinate the cycle with the fertility clinic as well as coordinate any genetic testing that Intended Parents require.
The larger egg donor agencies have many candidates from whom to choose as well. The agency will have each egg donor complete a detailed questionnaire in which the egg donor will provide information about her and her family’s health history, her educational history, social history, and biographical history which explores her likes, dislikes, personality, aspirations, any special interests or accomplishments.
The vast majority of egg donors will be anonymous in that neither the Intended Parents nor the Egg Donor will have identifying information on the other party. There are a growing number of agency’s who offer the option of open egg donation in which the Intended Parents and Egg Donor are able to communicate directly, perhaps meet, and/or exchange contact information. The level of openness is also often discretionary.
There are pros and cons to engaging with an egg donor for a fresh cycle. CNN did a report on this which is worth a read. Agency fees range from $4,000-$7,000.
Frozen Egg Banks
For several decades, egg donation has been performed almost exclusively by fresh cycles. Recent advances in technology have led to the option of using frozen eggs. The advantages of using frozen donor eggs is that the eggs are already available so one does not have to wait for the egg donor to be ready to cycle. With egg donors, there is uncertainty in that one does not know if she is going to respond to the medication and produce healthy eggs or how many or whether she will be compliant in taking the medications. The cycle can be scheduled much easier and with less complications than with fresh cycles requiring coordination of cycles.
Frozen egg banks are typically significantly less costly (by as much as half) than using fresh donor eggs particularly when working through an egg donor agency.
The Journal of American Medical Association issued results of a study on success rates for fresh cycles versus frozen cycles in it’s report, Outcomes of Fresh and Cryopreserved Oocyte Donation dated August 11, 2015. The report was based on analysis of success outcomes published by the Society for Assisted Reproductive Technology in its 2013 annual report of US in vitro fertilization center outcomes comparing live birth and cycle cancellation rates using either fresh or cryopreserved donor oocytes. The study found that there were fewer live births when using frozen eggs versus fresh eggs – approximately 43% versus 50% respectively.
Parent-Identified Egg Donors
In some instances, Intended Parents match independently with egg donors through online matching sites or possibly with friends or family members. While using certain family members or friends as egg donors is certainly possible, there are ethical considerations that are particularly important when using family members. The American Soceity of Reproductive Medicine published an article on family donation. There are complexities that arise when family members or friends donate eggs including parenting relations between the donor and the child that require careful consideration and therefore counseling and discussion.
When couples or individuals form embryos for use in assisted reproductive technology, they usually cryopreserve them for future use. Once they have completed their family, they may decide to donate them to medical science, destroy them or in some cases, they may donate their remaining embryos to another couple or individual. There are many agencies who assist the embryo donors and recipients with the process. As with egg donation, the process can be completely anonymous or have varying degrees of openness. Some organizations consider this process to be “embryo adoption” and some consider it to be “embryo donation”.
The cost savings for embryo donation are significant with savings of tens of thousands of dollars.
The Personal Experience – One Size Does Not Fit All
Deciding which clinic or practice to choose is not always a simple process and will involve complex and sometimes competing interests. A full service agency can guide Intended Parents through the maze of issues and help greatly in the decision making process.
Each practice, clinic and doctor have different styles and organizational structures. What works for one person may not work for another. The best way of gauging whether a particular practice or clinic is the best fit for you is to set up a consultation either in person or via phone or Skype.
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