How does surrogacy and IVF differ from general IVF?
As a form of Assisted Reproductive Technology (ART), In vitro fertilization (IVF) is used to help people conceive a child when natural conception hasn’t worked previously or is unavailable for biological or medical reasons. The IVF process involves taking eggs and sperm and combining them in a laboratory setting outside of the body to create an embryo. The embryo is then implanted into a uterus. The technicality behind IVF has existed since 1978 with increasing success rates as techniques have improved. At least 8 million babies have been born via IVF since the technology arrived.
In surrogacy, an embryo is transferred to the uterus of a gestational carrier instead of to the child’s mother.
In surrogacy, the mother or egg donor will undergo a cycle of ovarian stimulation. She will take hormone medications such as FSH, LH, and GnRH-antagonists to increase the number of eggs that reach maturity in her ovaries. These hormones will stimulate the growth of multiple egg-containing follicles in the ovaries. During the stimulation cycle, the mother or egg donor will be closely monitored to check the size and number of follicles. She will also be monitored for ovarian hyperstimulation syndrome (OHSS), a potential side effect of the egg creation and retrieval process.
When follicles reach the desired size (generally 18-22mm), they are ready for egg retrieval. A “trigger shot” containing Human chorionic gonadotropin (hCG) will be administered with the egg retrieval typically scheduled for 36 hours following the hCG injection.
During the egg retrieval process, an ultrasound-guided needle is inserted into the mother or egg donor to remove mature eggs from their follicles. The eggs are then examined to determine quality. Any eggs deemed viable will be fertilized to create embryos. The sperm used in the fertilization process is either collected from a male spouse/partner or from a donor.
To create an embryo, the eggs and sperm are either mixed together in a culture dish or combined using an advanced technique called intracytoplasmic sperm injection (ICSI). ICSI is a process by which an individual sperm is directly injected into an egg. ICSI is most commonly used when sperm quality is less than desired and when male infertility is a factor.
The embryos will develop over the next several days to reach their blastocyst stage when they will be reexamined. Embryos may be tested via biopsy where a small number of cells are removed and analyzed by a lab technician. Preimplantation genetic screening (PGS) involves checking embryos for the potential of chromosomal abnormalities, while Preimplantation Genetic Diagnosis (PGD) involves screening for hereditary genetic disorders. PGS and PGD testing is not without controversy. On one hand, pre-tested embryos may lower the risk of miscarriage by weeding out embryos of lesser quality. There is a small risk that these screening tests can damage a viable embryo, however, as a hole must be pierced in the outer wall of the embryo to gather the cells for testing. Reproductive Endocrinologists weigh the pros and cons of these procedures with prospective parents.
Although “fresh” transfers (from a current IVF cycle) can be done, most embryos used in surrogacy will be frozen and thawed before implantation. The FDA requires that all materials including eggs, sperm, and embryos be tested for communicable diseases (e.g. HIV) before they can be implanted into a surrogate.
When embryos are frozen, they will be rapidly cooled via a cryopreservation process called vitrification instead of a slower cooling process to prevent ice crystal formations. Embryos are then placed into a liquid nitrogen tank for short or long-term storage. Because of the ultra-cold temperatures (around -320°F), embryos can be stored indefinitely. The current record for embryo age is 30, with twins born in 2022 using 30-year-old embryos. It is unknown how long stored embryos remain viable, but we now have scientific proof the answer is at least decades!
When an embryo transfer is scheduled, frozen embryos are brought up to room temperature through a careful thawing process. The number of embryos transferred will depend on the quality of embryos though most Reproduction Endocrinologists will only transfer single embryos (SET) to avoid the increased risks of twins and multiples. Most surrogates will refuse more than one embryo because of the increased risk to their health in the event of twins or multiples.
Before an embryo is transferred, the surrogate will have already gone through a rigorous screening process to make sure she is physically and mentally able to carry a surrogacy pregnancy safely. This includes an in-person medical exam by a Reproductive Endocrinologist and a psychological evaluation done by a licensed professional. Take a look at our list of surrogacy requirements.
To prepare for embryo transfer, a surrogate will take a hormonal and medical regimen of estrogen, Lupron, progesterone, and pre-natal vitamins. These are taken orally or by injection. If a surrogate has a fear of needles, she must overcome her trepidation to participate in gestational surrogacy. The embryo transfer procedure itself is fairly simple and done in an outpatient clinic setting without the need for anesthesia. Some clinics recommend a short period of bed rest following embryo implantation.
After embryo transfer, a surrogate who is confirmed to be pregnant will be monitored by her own OB-GYN. The pregnancy will be handled in a medically identical way to her own children. If she carries a baby to term, she will give that child to very grateful Intended Parent(s) immediately at birth.
In summary, the medical process for gestational surrogacy IVF is very similar to the traditional IVF process with the notable exception that the eggs are created by one person (a mother or donor) and carried by a different person (the gestational surrogate).
Costs of surrogacy and IVF:
The cost of IVF varies widely and depends on needs including number of cycles, location of clinic, and desired additional procedures and screenings (e.g. ICSI, PGS/PGD testing). In the US, a single IVF cycle can run around $15,000-$20,000+. Some insurance companies will cover IVF treatments for infertility, though the majority do not.
The overall cost of surrogacy, however, is far greater and includes legal costs, surrogacy base compensation and reimbursements, escrow fees, and maternity medical insurance/expenses. Surrogacy is significantly cheaper when not using a surrogacy agency and doing an independent journey e.g. using a self-matching platform like SurrogacyPlace.com. To review typical surrogacy expenses, please see our “How Much Does Surrogacy Cost?” blog entry.