Chapter 4: Choosing Your Fertility Clinic

There are many fertility clinics to choose from, but you’ll want to ensure you’re picking one with extensive experience working with surrogates and with a good track record with the LGBTQ community.

While there are more than 400 IVF fertility centers in the US you’ll want to ensure you’re picking one with extensive experience working with dads to be and familiar with the intricacies of an egg donor gestational surrogacy journey surrogates and with a proven track record with the LGBTQ community.  Most fertility clinics do not have extensive experience in this form or family building.

“I’ve been a fertility doctor for more than twenty years,” said Dr. Mark Leondires, Founder and Medical Director of RMA of Connecticut and Gay Parents To Be. “Our bread and butter is to help women who are having infertility problems have a baby.” Some IVF Centers such as RMACT have developed a speciality in surrogacy as well. They have applied the extensive learning from treating infertile couples to help gay, bi and trans men become fathers through surrogacy.

Here are the services provided by most fertility clinics:

Sperm analysis

Your fertility clinic will conduct a semen analysis for you — and your partner if you both plan to create embryos — to ensure the samples are in the best condition possible. Your fertility clinic will work with you to improve your sperm quality where needed, including suggesting certain lifestyle changes, such as quitting smoking, alcohol consumption, the usage of certain medications, and steps to help you maintain a healthy weight. Though roughly 98% of men will have viable sperm following these changes, the remaining 2% may need to seek the aid of a urologist for further analysis. Your fertility clinic will help connect you to a reproductive urologist if necessary.

Recessive gene testing

Within our human family there are 100’s of broken genes, in fact you have a 50-70% chance of being a carrier of a recessive disease related gene.  Your fertility clinic will conduct testing for you and your partner if applicable for these genetic issues to reduce the risk of your child having a recessive genetic disease such as cystic fibrosis by screening both you and your egg donor to make sure there is not a match that increases the risk of disease to 1 out of 4 (25%)

Egg donor screening

Testing and screening of egg donors: Fertility clinics will conduct extensive screenings on your egg donor per Federal FDA regulation and guideline from the American Society for Reproductive Medicine (ASRM). “That includes infectious disease screening, drugs and alcohol screening, and assessing her overall health,” said Dr. Leondires of RMA of Connecticut. The clinic will also look at an egg donor’s ovarian reserve, to determine that she will be able to produce a sizable number of eggs — typically at least between 15 to 30 — in order to produce the largest number of healthy embryos possible.  Egg donors will also have recessive carrier screening to help dramatically minimize the risk of recessive diseases in your child.

Egg donors will also complete mental health testing at the clinic and psychosocial counseling and testing to assess their motivations for donating, to rule out any potential mental health issues, and to assess their willingness to be known. “In the past 20 years, we’ve been moving more towards known donors,” said Dr. Leondires. If this is something you want, as the intended parent, the fertility clinic can help facilitate a meeting, phone call, or video session between you and your donor.

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Ovarian hyperstimulation and embryo creation

After completion of your egg donor match the IVF center will give your donor fertility medication to induce her to develop 15-25 eggs which she will donate to you.  Egg yield is essential to your success as there is a significant attrition rate from eggs retrieved to high quality normal embryos that results in a successful pregnancy. Your fertility center will fertilize the eggs from your donor with your sperm and your partners (if applicable),to lead to the creation of new human embryos. They IVF laboratory observes them as they grow into a healthy embryo, called a blastocyst. Most of the time, clinics will freeze, or cryopreserve, these embryos for use once your gestational carrier is ready for transfer. Once your surrogate has been properly screened, and is ready for transfer, your clinic will oversee the process of thawing the embryo(s) and placing it into the uterus of the gestational carrier.

Preimplantation genetic testing

Your clinic can conduct preimplantation genetic testing (PGT) to help determine which of the embryos you have created have a higher chance to result in a successful pregnancy. The PGT process involves taking a biopsy of the blastocyst and sending the sample to a specialized laboratory.  The PGT process will help your clinic identify embryos with any chromosomal abnormalities that can lead to conditions such as Down’s Syndrome. In some unique situations PGT can be used to screen out embryos with single gene disorders and even genes that may predispose your child to breast cancer. Testing can also help reveal which embryos contain abnormalities that may increase the likelihood of miscarriage or difficulty conceiving.

Gestational carrier (GC)/ surrogate screening

The IVF center is responsible for medical screening of your GC.  This is per FDA and ASRM guidelines similar as to an egg donor.  Importantly it is the IVF center that is responsible for your success from the biological side and complete medical screening including: pre pregnancy blood work, vaccination updates, prenatal vitamin usage, drugs and alcohol screening, uterine cavity assessment, and review of previous pregnancy.  This screening is essential to clear any GC for pregnancy

Embryo transfer and early pregnancy monitoring

Monitoring of your donor and surrogate: The fertility clinic will oversee the monitoring of your surrogate once pregnant for up to 10 weeks — a process which may occur locally or nationally, depending on their location. “We often have surrogates and egg donors located in other states, and they are monitored in clinics in other states who send their results to us,” said Dr. Jerald S. Goldstein, Founder and Medical Director of Fertility Specialists of Texas. “This allows us to help make decisions to help optimize the outcome of the pregnancy.”

Gamete storage

IVF Centers  also provide storage of gametes — including unused eggs, sperm, and embryos. “Our goal is to produce between three and ten normal embryos,” said Dr. Guy Ringler, Partner at California Fertility Partners. “Often, several of these will be remaining after you’ve achieved a successful pregnancy.” Some clinics will cryopreserve your remaining specimens, and store them, in case you hope to use them for a future journey.

Tips for choosing a fertility clinic

To help make a decision, here are some considerations to keep in mind:

Track record: Though there are hundreds of fertility clinics to choose from, not all of these clinics have extensive history working within the field of surrogacy. “Surrogacy cases are complex with a lot of players,” said Dr. Guy Ringler of California Fertility Partners. “We have one or two sperm providers, an egg donor, the surrogate, the surrogate’s partner — everyone needs to be kept in the loop and screened.” Clinics with extensive surrogacy histories will be familiar with all of these moving pieces, so ask how many surrogacy cycles they do each year.

You will also want to research your clinic’s pregnancy and live birth rates, which you can find on the Society for Assisted Reproductive Technology or SART. “The live birth rate is the most valuable measure of success of a clinic,” said Dr. Goldstein of Fertility Specialists of Texas.

Connection with staff: You will want to make sure you are comfortable with the clinic’s support staff when making a decision. “How comfortable are you with the physician and third party coordinator? You will be spending a lot of time, particularly with your third party coordinator, helping walk you through the process of creating and transferring embryos.” Also make sure you know who will be your main point of contact throughout the process.

LGBTQ inclusivity: You will want to make sure your clinic has a long track record of helping gay, bi and trans men become fathers through surrogacy. Ask for evidence of this history by seeing how many of clinic’s previous clients have been gay, bi or trans men. You can also look for inclusive language and imagery on their websites, such as photos of same-sex parents, and content targeting the LGBTQ. Ask if you can specifically speak with previous LGBTQ clients of the fertility clinic.

Get Answers.  Surrogacy FAQs

CONGRATULATIONS!  You've completed Chapter 4: Choosing Your Fertility Clinic.  

NEXT UP:  Chapter 5 - Chapter 5: Overview of the IVF Process

Or, contact one of the experts interviewed for this article:

Dr. Mark Leondires of Reproductive Medicine Associates of Connecticut

Dr. Guy Ringler of California Fertility Partners

Dr. Jerald S. Goldstein of Fertility Specialists of Texas

Dr. Daniel Skora of Fertility Specialists of Texas

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