How to Choose a Surrogacy Clinic?

In addition to offering fertility treatments, such as in vitro fertilization, many fertility clinics also provide surrogacy services to intended parents struggling with fertility problems. These medical professionals work closely with their patients to diagnose the root cause of their fertility issues and develop a personalized treatment plan to improve their chances of conceiving a child.

However, if the fertility treatments are unsuccessful, intended parents may opt for surrogacy, which involves a woman carrying a baby to term for them. Fertility clinics offering surrogacy services can help intended parents navigate the complex process of finding a surrogate mother, assessing their suitability, and coordinating the legal and medical aspects of the surrogacy arrangement.

By providing both fertility treatments and surrogacy services, these clinics offer a comprehensive approach to family building for singles and couples struggling with infertility. They can offer hope to those who have been trying to conceive for a long time and provide support and guidance throughout the surrogacy process.

What Is a Surrogacy Clinic? 

A surrogacy clinic is a specialized fertility clinic that provides reproductive services for singles and couples who wish to use a surrogate mother to have a child. Surrogacy clinics work with intended parents and surrogate mothers to coordinate and manage the medical aspects of the surrogacy process, which typically involves in vitro fertilization (IVF) treatments and other fertility procedures. These clinics employ experienced fertility specialists and staff who are knowledgeable about the unique medical needs of surrogacy, and they may also have relationships with surrogacy agencies and other professionals to provide a comprehensive range of services. By providing expert medical care and guidance, surrogacy clinics play a critical role in helping intended parents and surrogate mothers achieve their dreams of creating a family.

What Services Does a Surrogacy Clinic Offer? 

While most surrogacy clinics work with gestational surrogacy cases and power up the IVF cycles, some surrogacy clinics also work with traditional surrogacy cases and perform IUI procedures. And just a few surrogacy clinics work only with traditional surrogacy cases (in states or countries where gestational surrogacy is outlawed). Depending on the surrogacy type — traditional or gestational, and early medical screening results, a surrogacy clinic will start either IUI or IVF therapy. 

It is essential to note that IUI treatment will be started only if the intended father’s sperm analysis shows a ‘normal semen quality,’ meaning that there is enough viable sperm, there is no severe sperm DNA fragmentation, the sperm has normal morphology, is motile and may penetrate the oocyte during the gamete fusion.

If minimal criteria of sperm quality for intrauterine insemination is not met, fertilization and pregnancy can be achieved by ICSI even with immotile spermatozoa, a high sperm DNA fragmentation index, cryopreserved spermatozoa, spermatozoa that have not undergone the acrosome reaction, spermatozoa without tails, and morphologically aberrant and/or immature spermatozoa. It means that instead of starting an IUI, a surrogacy clinic will start an IVF.

If the intended father is a carrier of a genetic disease, it may be necessary to undergo in vitro fertilization (IVF) with preimplantation genetic testing (PGT) to ensure that only healthy embryos are selected for transfer. This involves fertilizing eggs in a lab with the intended father’s sperm and then testing the embryos for genetic abnormalities before implanting them in the surrogate mother’s uterus. The process can increase the chances of a successful pregnancy and the birth of a healthy baby. However, it is essential to note that not all genetic diseases can be screened for, and in some cases, genetic counseling may be recommended to assess the risks and options available to the intended parents.

Intended parents who have vitrified embryos and want to use them instead of generating new embryos may apply for cryogenic shipping and frozen embryo transfer. The same thing is for intended parents who have cryopreserved sperm and vitrified oocytes — they may ship their gametes to the surrogacy clinic and use them to create embryos.

Traditional surrogacy via IUI treatment 

For most traditional surrogacies where the surrogate mother becomes pregnant via IUI, the surrogacy medical process includes the following: 

Medical screening

A surrogate mother undergoes comprehensive medical assessment, including an ultrasound examination of the female pelvis and pelvic exam, tubal patency test and hysteroscopy (hysteroscopy if needed), uterine check, the Pap Smear test, STD testing (sexually transmitted diseases), urine sample, Prolactin AMH, viral screening (Anti–HIV type 1 & 2 antibodies, HBs Ag, Total anti–HBc (Hepatitis B antibodies anti–core IgM – IgG), Anti–HCV antibodies, Syphilis, Rubella IgG, IgM, CMV IgG, IgM, Toxoplasmosis IgG, IgM), blood count, blood group, biochemical profile, biochemistry Glycaemia (Glucose Blood Level test), Urea Creatinine, immunological tests, hormonal profiling, genetic testing (karyotyping), drug screen and more.

An intended father undergoes male fertility screening, including blood group, blood count, infectious disease screen, complete sperm analysis including Sperm DNA Fragmentation Index, male hormones test (FSH, estradiol, testosterone), immunological tests, and chromosome karyotyping. Some surrogacy clinics also offer male fertility genetic test enabling the professionals to identify the genetic cause of the alterations detected in the sperm analysis, analyzing 420+ genes involved in sperm development.

Monitoring of the stimulation cycle

The surrogate mother will start taking fertility drugs or/and administering injectable hormones to stimulate her ovaries to produce more than one egg in the cycle. Over a period of nearly two weeks of stimulation, she will likely have one to three ultrasound scans to determine the number of follicles developing in the ovary (ovaries), blood tests to monitor the development of the egg–producing follicles, and, if necessary, an extra appointment with a fertility specialist to consult on the medication dosage or change of medication. Monitoring of the cycle is usually performed from day nine or ten of the cycle.

Once the leading follicle is at least 18 mm in diameter and the lining of the womb (endometrium) is suitably thickened, an injection of human chorionic gonadotrophin (hCG) is administered to trigger ovulation. Single IUI is usually performed 24–36 hours after the injection (Trigger shot). In the case of Double IUI, the first IUI is performed 12–18 hours after injection of hCG, followed by a second IUI 34–60 hours later.

Semen processing 

Standardly, semen samples are prepared for intrauterine insemination within 1 hour of collection. Semen processing includes washing and centrifugation. The ejaculate is mixed with a sperm wash solution containing antibiotics and protein supplements and then undergoes repeated centrifugation. Through this process, the seminal fluid is removed from the sample, and the sperm cells are concentrated for insemination. This procedure typically lasts for 20 to 40 minutes. Before drawing into an IUI catheter, some sperm (50–60 μl) is used to determine the concentration and motility.

IUI procedure

Depending on the IUI protocol, the surrogate mother will be given an hCG injection to trigger ovulation and undergo an insemination procedure. An IUI will be performed from 12 to 60 h after the hCG injection. Single IUI is routinely done 24–36 hours after the trigger shot to time insemination with ovulation. Double IUI (one IUI on two consecutive days to increase the amount of available sperm for fertilization by increasing the frequency of insemination) is performed two times: the first IUI 12–18 hours after injection of human chorionic gonadotropin, followed by a second IUI 34–60 hours later.

Pregnancy testing

After a two–week waiting, the surrogate mother will have her first pregnancy test done to confirm a pregnancy. It can be a urine or blood pregnancy test. Sometimes, both tests will be performed. She will continue visiting a surrogacy clinic to monitor the pregnancy process, and starting from week 6 to week 8 of pregnancy, she will have the first pregnancy ultrasound scan to image the pregnancy (normal early intrauterine pregnancy, ectopic pregnancy, pregnancy of unknown location, or early pregnancy loss), image the embryo (fetal pole) and embryonic cardiac activity (a fetal heartbeat), and measure the length of the fetus from “crown to rump.

Once the initial stage of artificial insemination is completed, the traditional surrogate mother will carry the baby to a term like any other pregnancy until the birth. Following delivery, the surrogate mother will relinquish her parental rights to the intended parents, who will then be required to initiate the formal adoption process for the newborn. This process can be legally complex and may require the assistance of an experienced attorney to ensure all legal obligations and requirements are properly fulfilled.

Gestational and traditional surrogacy via IVF 

Although most traditional surrogacies involve an IUI procedure, in some cases, an IVF cycle should be performed instead of simple insemination. In such cases, the traditional surrogate mother also acts as an Egg Donor and undergoes a more intensive stimulation cycle, egg retrieval procedure, and endometrium preparation. Unlike traditional surrogate mother’s IVF therapy, the gestational surrogate mother doesn’t have to undergo controlled ovarian stimulation and egg retrieval as she doesn’t donate her eggs to create an embryo. Instead, in gestational surrogacy, an intended mother’s or donor’s eggs will be used.

For most gestational (and sometimes, traditional) surrogacies where the surrogate mother becomes pregnant via IVF treatment, the surrogacy medical process includes: 

Medical screening

A surrogate mother undergoes extensive medical and psychological screening to ensure she is healthy enough to carry a surrogate pregnancy. The screening is similar to the one described above (traditional surrogate mother screening for the IUI procedure).

Depending on the eggs used to generate an embryo, either the intended mother or an egg donor will also undergo medical screening, including a pelvic exam, ultrasound scan including antral follicle count done at the beginning of the menstrual cycle, blood count, blood group, hormonal profile (FSH, LH, Progesterone, Estradiol, Prolactin), AMH level, coagulation test, a blood test with TSH and FT4, FT3, anti–TPO levels, and viral screening (antiHBc, TPHA, HbsAg, anti–HCV, RRR, and HIV 1,2), and more tests depending on the protocol.

In the case of using donor eggs, male fertility testing will most likely also include screening for recessive genetic conditions to select a genetically compatible egg donor.

Monitoring of the stimulation cycle

Depending on IVF protocol, an intended mother or egg donor will undergo one or a Double ovarian stimulation cycle (DuoStim). While a single stimulation cycle includes one egg retrieval (routinely performed on day 14), DuoStim involves two egg retrievals done on day 14 and day 28.

An intended mother or egg donor will start administering injectable hormones to stimulate her ovaries to produce more than one egg in the cycle. Usually, stimulation lasts between 10 and 14 days, but sometimes it may take longer. An intended mother or egg donor will attend a surrogacy clinic for routine ultrasound scans and blood tests during this stage. As soon as scans and tests confirm that follicles in the ovary (ovaries) are ready for scheduling an egg retrieval, the intended mother/egg donor will have an injection of hCG. Egg retrieval will be performed 36 hours after the hCG injection.

While the intended mother or egg donor undergoes the stimulation cycle, a surrogate mother starts the endometrial preparation cycle. She will also attend the surrogacy clinic for endometrial lining scans and blood tests to ensure her endometrium lining is ready for embryo transfer. And before transferring an IVF embryo, the surrogate mother may undergo an Endometrial Receptivity Array Test (ERA) to assess when the lining of the uterus is most receptive to the embryo.

Egg retrieval

The intended mother or egg donor will undergo an egg retrieval procedure. During this procedure, the oocytes are collected together with follicular fluid, which is easily available during oocyte pick–up and represents an optimal source on non–invasive biochemical predictors of oocyte quality. Then, all collected biological material will be transferred to an IVF laboratory, where the embryologist will select the best oocytes for ICSI (IMSI or PICSI) among all oocytes retrieved ones.

Creating IVF embryos

Using the oocytes from the intended mother or donor and the intended father’s sperm (prepared like for IUI or using more sophisticated sperm preparation techniques), the embryologist will create embryos either without micromanipulation (eggs and sperm will be left in the Petri dish for fusion) or “ICSI’ed”/”IMSI’ed”/”PICSI’ed.” 

Performing mock embryo transfer 

Some surrogacy clinics perform a mock embryo transfer which is a “trial transfer” of the upcoming embryo transfer. Mock embryo transfer enables the professionals to prepare for the actual procedure and “blueprint” the map of the surrogate mother’s uterus. 

An endometrial biopsy can be taken in a mock embryo transfer cycle to analyze endometrial receptivity and find out when it is the best time to transfer an embryo, increasing the chances of successful implantation. 

Transferring an embryo 

One or more embryos will be transferred to the surrogate mother’s uterus. 

Pregnancy testing

Two weeks after an embryo has been transferred to the surrogate mother’s uterus, the surrogacy clinic will test her urine sample and blood sample to confirm a pregnancy. If pregnancy is detected, in a few weeks, a surrogacy clinic will make an early pregnancy ultrasound scan to confirm a viable pregnancy. 

Once a viable pregnancy is confirmed through medical testing, the gestational surrogate mother will be responsible for carrying the baby to term, just like any other pregnancy. This means that the surrogate mother will go through the typical prenatal care and checkups, including regular visits to the obstetrician, ultrasounds, and other medical tests to ensure the health of both the surrogate mother and the developing fetus. Throughout the pregnancy, the intended parents may be involved in the process and may attend appointments and ultrasounds with the surrogate mother. Once the baby is born, the intended parents will take legal custody of the child, and the surrogate mother’s role in the process is complete. It is important to note that the process of surrogacy involves legal agreements and contracts between all parties involved to ensure the best outcome for the baby and everyone involved.

Surrogacy using frozen embryos

If the intended parents would like to use their cryopreserved embryo in the surrogacy process, the first step (medical screening) is the same as for IVF surrogacy. All parties involved in surrogacy (the surrogate mother, the intended mother, and the intended father) undergo a thorough medical and psychological assessment. The second step is the cryogenic transfer of the embryo from the fertility clinic, where it is banked, to the surrogacy clinic, where the process will take place.

After that, the surrogacy clinic starts the endometrium preparation cycle of the surrogate mother and regular tracking of its progress. Finally, when it is an optimal time for transferring an embryo, the embryo is thawed and transferred to the surrogate mother’s womb. After embryo transfer, the surrogacy clinic will perform pregnancy testing and ultrasound scans to confirm a viable pregnancy.

Using vitrified oocytes and frozen sperm in surrogacy 

Some intended parents have deposited oocytes and sperm, cryopreserved for later use, and want to use their gametes in IVF surrogacy. For such cases, a surrogacy clinic offers the following services: CryoShipping of the eggs and sperm from a fertility clinic or gamete bank to a surrogacy clinic, medical screening of the couple and surrogate mother, monitoring of the surrogate mother’s endometrial preparation cycle, generating embryos in the IVF lab via ICSI (IMSI/PICSI), performing preimplantation genetic testing (if necessary), performing mock and actual embryo transfer, and doing pregnancy tests.

How to Choose a Surrogacy Clinic?

There are two options for finding a surrogacy clinic. Option 1 is to use references provided by your surrogacy agency. If you are working with a surrogacy agency, your specialist can refer you to surrogacy attorneys and clinics that the organization trusts and often collaborates with. You can discuss your surrogacy goals and preferences with your surrogacy specialist to help them find surrogate clinics that meet your expectations. They may even offer a discount on services due to their existing relationship. 

Option 2 is to find a surrogacy clinic through your own research. If you are completing an independent surrogacy and you don’t have an existing relationship with a fertility specialist, you will need to locate a surrogacy clinic on your own. You can research different professionals with your intended parents to determine whether they can offer the services you require, and take the time to interview them to get to know them better before committing. As intended parents, it’s important to keep in mind that the choice of a surrogacy clinic will largely depend on your location. In most cases, you will need to use a local clinic to complete the gamete harvesting and IVF process. However, if you need more help finding a surrogacy clinic, consider reaching out to a local surrogacy agency for guidance and referrals. They may be able to offer valuable insight into the best options available to you in your area.

Wrapping Things Up 

In conclusion, choosing a surrogacy clinic is a crucial decision that the intended parents need to make carefully. Surrogacy clinics provide specialized reproductive services for singles and couples who wish to use a surrogate mother to have a child. They offer a range of services, including medical screening, IVF, IUI, PGT, and cryogenic shipping. Surrogacy clinics work with intended parents and surrogate mothers to manage the medical aspects of the surrogacy process. Intended parents should choose a surrogacy clinic that is experienced and knowledgeable about the unique medical needs of surrogacy, has a good success rate, and offers comprehensive services. By making the right choice, intended parents can increase their chances of a successful surrogacy journey and the birth of a healthy baby.