Q & A: Your IVF and Surrogacy Questions Answered
Our British American Household Staffing team had the pleasure of sitting down with London’s leading provider of high-success fertility treatments, Harley Street Fertility Clinic.
Here, we join them as they take our questions regarding fertility treatments and share their advice on how to perfectly balance the first steps of fertility treatment, from IVF to surrogacy, with their personable and private services designed by their impeccable team of specialists for you to begin your wonderful journey.
Q: What is involved in the surrogacy process?
A: Surrogacy refers to an arrangement when one woman carries a baby or babies for another woman/couple and hands over the baby after birth. The couple, or single person, who wish to have the baby are called the intended parents. The woman who carries the baby is called the surrogate. There is provision within the Human Fertilisation & Embryology Act 1990 as amended for the granting of parental orders for situations involving surrogacy as long as particular criteria are met. We strongly advise that you seek your own independent legal advice prior to embarking upon surrogacy treatment.
Q: Who are the people involved in a surrogacy journey?
A: We will look after the medical side of treatment. In order to help you find a surrogate we work with two agencies: Extraordinary Conceptions and Brilliant Beginnings.
The next question to answer is who the gamete providers will be, i.e. whose eggs and sperm will we use?
The options are:
- Eggs from intended mother
- Eggs from anonymous or known donor
- Eggs from surrogate
We typically do not recommend using eggs from the surrogate owing to the genetic relationship between the surrogate and the baby.
- Sperm from intended father
- Sperm from anonymous or known donor
In any surrogacy arrangement the gamete providers will be considered an egg or sperm donor. They will be screened accordingly.
Surrogacy essentially involves IVF, with the created embryo(s) being transferred into the surrogate.
The gamete providers, surrogate and intended parents will first be assessed for their suitability both medically and psychologically.
The egg provider will then undergo ovarian stimulation, followed by egg collection. The eggs will be fertilised using the chosen sperm. The fertilised eggs will grow into embryos and be cultured in the laboratory for 5 days before being frozen. The embryos will then be quarantined for 3 months. At the end of the quarantine period the gamete providers will be screened again for infectious diseases.
The surrogate will then be prepared for embryo transfer. When she is ready, the chosen embryo(s) will be thawed and transferred. The pregnancy will be confirmed by blood test and scan in due course.
Q: How are surrogates and egg donors screened?
A: Egg donors initially have a consultation with a doctor who will take a detailed medical history and perform a physical examination. The doctor will explain the procedure involved in egg donation treatment. The donor will then see a nurse to fill out some basic information about herself. She will then be provided with a letter, containing a medical history form that she must complete and have confirmed by her GP.
Once we receive the completed medical history form (provided everything is clear), the donor will be offered a session implications counselling, with an accredited fertility counsellor, to discuss the social and ethical issues pertaining to egg donation.
The donor will also be asked to attend the clinic for a vaginal ultrasound scan and hormone blood tests between days 2 and 5 of her period. These tests are performed to assess the current fertility of the donor.
All donors are then screened for the following:
- Full blood count
- Blood group and Rhesus type
- HIV and HTLV
- Hepatitis B and C
- Syphilis (VDRL)
- Cytomegalovirus virus (CMV) antibodies screening
- Chromosomal analysis – normal karyotype
- Cystic fibrosis screening
- High vaginal swab
- Chlamydia and gonorrhoea (urine test)
In some instances, additional screening tests are carried out.
Donors must inform the clinic of any medical information that may come to light after donation that may have health implications for any woman who receives treatment with their eggs or for any child born as a result of such treatment.
The screening process may reveal previously unknown conditions or infections, some of which may be treatable. Donors’ chromosomes are screened and therefore previously unsuspected genetic disorders may be brought to light. We will arrange referral to Genetics Counselling and provide support. In some situations genetic disorders may affect other members of a donor’s direct family and we will discuss the relevant issues with the donor should these come to light.
Immediately prior to starting her stimulation the donor will be screened once more for infectious diseases (HIV, Hepatitis B and Hepatitis C, Chlamydia, Gonorrhoea) by a new method called the nucleic acid amplification technique (NAT). In addition to providing a repeat set of results, this technique allows early detection of viral infections that may have a incubation period during which they cannot be detected by traditional methods (e.g. HIV can be dormant for up to 180 days).
Q: What type of Screening and Support do you provide for Surrogates?
A: Surrogates are screened in the same way as donors, except for normal karyotype and cystic fibrosis carrier status since they are not providing gametes.
Q: How are parents and surrogates matched?
A: Once the intended parents register on Extraordinary Conceptions' database, they will have immediate access to the online database and available surrogates, they can see pictures, some personal info like hobbies, diet, and history of past pregnancies, and deliveries and this way they can see if they may be interested in the profile. Once they find a profile they like, the agency will send over the surrogate's medical records for review and pre-approval to the clinic. With the clinic’s approval, the agency will send over a questionnaire with the IPs general info to the surrogate for review and if she likes the profile the agency will coordinate a video call to introduce all parties and see if they may want to move forward.
Q: What legal and custody issues might same-sex couples and singles face?
A: Surrogacy treatment is a complex treatment, emotionally, psychologically and clinically. There are numerous complications that can arise, including:
- The surrogate may fail to handover the baby at the end and keep the baby.
- The commissioning couple may reject the baby if the baby is abnormal.
- In view of the above problems, it is better to have an agreement drawn between the relevant parties with the aid of a specialised solicitor.
Please note that commercial surrogacy is not allowed in the UK and hence no outright payment should be made to a surrogate at any point.
A question commonly asked by couples is whether the intended mother can breastfeed the baby after it is handed over by the host. The answer is: yes, it is possible and the intended mother can be prepared for this with medications.
Q: What laws apply? Whose name goes on the birth certificate?
A: English law
Under English law the person who gives birth is automatically the legal mother in common law. If she is unmarried, she may nominate the other legal parent, so this could be the intended father. If the surrogate is married or in a registered civil partnership, her legal partner will the second parent.
A parental order will then be sought by the intended parents for them to become the legal parents of the child.
We know there is a large shortage of surrogates in the UK and it can take years to find a surrogate. Further, the law is rather cumbersome in requiring the approval of a parental order, as detailed above.
Hence, we developed our Hybrid Surrogacy Program in partnership with Extraordinary Conceptions. Our Hybrid program allows our international clients to undergo surrogacy IVF, closer to home, with no waiting time to find a surrogate.
All our surrogates in the Hybrid program reside in the USA. Your surrogate will be screened as per our protocols and undergo embryo transfer at Harley Street Fertility Clinic. Afterwards, she will return home to continue her pregnancy and to give birth in the US state where she resides.
Surrogacy is a legally recognised form of parenthood in certain states in the USA and as such, the intended parents can be the legal parents at birth. Thus, removing the need for a parental order.
Q: How much does surrogacy cost? Does insurance cover it?
A: The medical treatment up to pregnancy will cost approximately £15,000 - £20,000.
Surrogacy costs: there are several programs for the different budgets. Please view our Extraordinary Conceptions’ info brochure, which also contains info about the insurance for the surrogate.
Q: How long does the surrogacy process take?
A: The medical treatment will take approximately 3-4 months:
1-2 months for screening and assessment
1 month for creating embryos
1 month for embryo transfer
Q: What are the initial stages of IVF?
A: 1. Preparation. At Harley Street Fertility Clinic, we perform a thorough assessment prior to beginning an IVF treatment cycle and depending on the results, advise patients on pre-treatment preparation as indicated.
2. Ovarian stimulation involves a course of daily injections of a stimulating hormone over a period of seven to ten days. During this period the ovarian response will be closely monitored using ultrasound scans and blood tests.
3. Egg collection & sperm sample. The egg collection is a minor procedure typically lasting less than 30 minutes. The procedure is performed under mild sedation. On the same morning the male partner produces a semen sample (alternatively frozen or donor sperm can be prepared).
4. Fertilisation & embryo culture. In conventional IVF, the prepared eggs and sperm are placed together in a culture dish to allow fertilisation to occur. The development of the embryos is monitored either daily, or continuously if time-lapse microscopy (Embryoscope™) is performed, for the next 5 days.
5. Embryo transfer. Depending on the development of the embryos and the patient’s history, embryos are transferred into the patient’s uterus on day 5 or 6
Before considering any form of treatment, the doctor will perform a thorough assessment of your fertility. This will include ultrasound scans and hormone blood tests for you, as well as a semen analysis and possible further testing for the man. Without accurate information, a doctor cannot suggest the best treatment, nor can they optimise that treatment for your unique situation. Once a treatment plan has been devised, the doctor will advise on preparing the body for the treatment. This may include further assessment and treatment of your immunological response, nutrition and lifestyle. One of the key factors involved in having successful treatment is embryo implantation, which is a complex process. In order to increase the probability of implantation a relatively new process called endometrial scratch and saline hysterogram is offered to our patients undergoing IVF or ICSI treatment.
Q: What is the advised age limit for IVF treatment?
A: There is no advised age limit for IVF treatment.
Q: How long is the IVF process from start to finish?
A: It can take as little as 2 months (from consultation to completing embryo transfer).
Q: Is IVF painful?
A: IVF is not painful. The only operation involved is the egg collection and this is short procedure performed under intravenous sedation. You will be discharged within a couple of hours and fine to return to work the next day.
Q: What is the success rate of IVF?
A: The success rate of IVF depends on a variety of factors (mother’s age, fertility profile, general health, BMI, lifestyle and so on). Our clinical pregnancy rates for women of all ages is 50% and this rises to 64% in women under 35. We are a non-selective clinic and so we don’t turn patients away if they have a poor prognosis.
Q: Where are eggs/sperm/embryos stored?
A: On site at our Harley Street clinic.
Q: Are there side effects from the IVF treatments?
A: The only material risk from IVF is the possibility of multiple pregnancy and this can be minimised by transferring only a single embryo.
Q: Why is Harley Street so successful in their patient cases?
A: Harley Street Fertility Clinic has been helping families to grow for over twenty years. Led by renowned fertility specialist Dr Geetha Venkat, our highly experienced team provides a personalised service that is safe, supportive and successful, in the state-of-the-art surroundings of our newly-equipped clinic.
Tailor-Made Fertility Treatment Plans
Our personalised fertility treatment plans are tailor made to suit you. We use the latest genetic testing techniques, advanced analysis and cutting edge technology to determine the approach that will maximise your chances of success.
Safe, Successful Treatment
Harley Street Fertility Clinic is proud to have one of the highest success rates in the country for IVF and IUI fertility treatments. We offer safe, proven techniques to enhance your chances of conception, and advanced analysis of the issues that could be preventing you from conceiving.
Friendly, Family-Run Environment
We’re proud to be a family-run clinic, staffed by experts who are passionate about helping you to become the parents you’ve longed to be. Patients often comment on how approachable, warm and caring our team are - we truly have your best interests at heart.
If you’d like to learn more about Harley Street Fertility Clinic, and how we can help you, request an initial consultation by calling 020 7436 6838 or contacting us through our website: www.hsfc.org.uk