What Is IVF Surrogacy? – Process, Success Rates & Cost

By Babygest Staff
Last Update: 07/05/2019

Surrogacy, commonly referred to as surrogate motherhood, is a procedure that has been around since the 1980s. Although at the beginning, traditional surrogates were the option of choice, today gestational surrogacy is the preferred type of surrogacy, as it allows for the surrogate to have no genetic link with the child. The difference lies in the techniques used as well:

Surrogacy with IUI
If the surrogate is inseminated artificially, she is a traditional surrogate, i.e. has a genetic link to the child.
Surrogacy with IVF
If the surrogate pregnancy is achieved through IVF, she is a gestational surrogate or carrier, i.e. she has no genetic link to the baby.

So, in short, IVF surrogacy is a variant of classical in vitro fertilization whereby a third party, that is, a gestational carrier is responsible for carrying the resulting pregnancy after embryo transfer. The embryo is created using the eggs and sperm of the intended parents as we shall see below.

Provided below is an index with the 9 points we are going to expand on in this article.

What is IVF surrogacy?

In vitro fertilization (IVF) is a well-known infertility treatment used to treat a wide range of fertility issues in couples around the world. There exist two types of IVF: classical IVF and Intracytoplasmic Sperm Injection (ICSI).

Basically, it allows for the creation of an embryo at the laboratory, simulating the conditions at which natural conception would occur inside the female reproductive system. The fusion between the egg and the sperm leads to the creation of embryos.

For fertilization to take place in a laboratory, the eggs and sperm have to be collected from the intended parents previously.

In classical IVF, the resulting embryos are cultured for a timeframe that ranges between 3 and 5 days. Afterwards, the resulting embryos are transferred back to the womb of the intended mother. In IVF surrogacy, the resulting embryos are transferred to the womb of the gestational surrogate. And that's the main difference between classical IVF and IVF surrogacy.

Whether a surrogate is used or not, the steps to follow are the same in both IVF and ICSI procedures. Depending on the quality of the gametes used, the specialist will recommend one option or the other. Continue reading to learn what part of the process corresponds to the intended mother (IM) and which one to the gestational carrier (GC).

Intended mother process

The steps that are included in this first part of the process correspond to the intended mother.

In case she is unable to use her own eggs, this part would be assigned to an egg donor, and the steps followed would be exactly the same.

Ovarian stimulation

To promote the production and maturation of multiple egg cells, ovulation is induced in the intended mother by means of hormone replacement therapy (HRT).

The goal of this phase is that all the eggs that start growing in this cycle are able to complete the maturation process. In a natural cycle (without using fertility drugs), only one egg accomplishes this goal.

By doing this, we increase the chances for success of IVF. As a general rule, the higher the number of good quality eggs, the greater the chances for fertilization to result in viable embryos, able to implant and lead to an ongoing pregnancy.

The duration of this stage may vary on a case-by-case basis, with an estimated timeframe of 6-10 days. Throughout this stage, it is necessary for the patient to attend regular gynecological examinations in order to monitor follicle development and schedule a day for collecting the mature eggs from the ovary.

Oocyte retrieval

This procedure is known as follicle puncture, transvaginal oocyte retrieval, or ovum pick-up (OPU), and it involves the collection of mature eggs from the ovary in order to fertilize them with the sperm of the intended father.

Semen samples are collected by masturbation after a sexual abstinence period of 3-5 days. In case the quality is insufficient, fertilization may be done using ICSI, or the specialist may suggest that you use donor sperm.

Oocyte retrieval involves the use of a needle to aspirate the fluid contained within the follicles. Mature oocytes will be found in this fluid, and the number of oocytes to be retrieved depends on each woman.

Although this step requires a surgical intervention, it is very simple and takes only 15-30 minutes. It is done using a mild anesthetic and does not require hospitalization.

Gestational carrier process

When the eggs and sperm from both intended parents, or gamete donors in case it is necessary, are fused together and fertilization occurs, the goal is to obtain viable embryos. It is at this point when the GC comes into the picture, but firstly she has to be prepared to receive the embryos. Let's see how this works in the following sections.

Endometrial preparation

In order for the embryos to be able to attach to the endometrial lining, it has to be prepared to receive them. In IVF procedures, it is achieved by means of fertility drugs that contain estrogen and progesterone.

The goal is to make the endometrium acquire a triple-line pattern and a thickness of about 7 to 10 mm. If the natural estrogen levels of the GC were high enough naturally, it is likely that she's prescribed only progesterone to support the luteal phase.

Embryo transfer

When the uterine lining of the gestational carrier has the appropriate conditions to receive the embryo(s), the embryo transfer is performed using only the embryos with the highest quality.

But firstly, it is important to determine the number of embryos to transfer. Specialists recommend Single Embryo Transfers (SETs) in order to reduce the risk of multiple births, especially in cases of surrogacy.

A multiple pregnancy has several risks associated, including preterm birth. Having premature babies in cases of surrogacy can add a considerable amount to the overall cost of surrogacy, especially if special care at a NICU is required.

Embryo transfers can be done either on day 3 or on day 5 (blastocyst stage). Choosing one over the other depends solely on one's preferences. High quality embryos that are not used can be frozen for later use.

Use of sperm and/or egg donors

Surrogacy is a third-party reproduction treatment due to the participation of a third party: the surrogate or gestational carrier.

Even though it is clear that the eggs used won't be hers, it may happen that the eggs of the intended mother and/or the sperm of the intended father cannot be used either. What is done in such cases?

The answer is donor conception, including egg donation and sperm donation, both considered third-party reproduction treatments as well. When conception is not possible using the gametes of the intended parents, surrogacy can be done using donor eggs and/or sperm.

Using an egg donor is quite common in gestational surrogacy arrangements, especially if you are a gay couple or a single man, who have no female partner to contribute the eggs.

As for sperm donation, it is often used when the semen sample of the commissioning father is altered, for example, due to azoospermia (zero sperm count), or when it contains a genetic disease that could be passed to offspring and cannot be detected through PGD/PGS.

IVF surrogacy for gay men

IVF surrogacy is an advantageous option for gay couples who want to share a genetic link with the baby-to-be. Indeed, they have several options to contribute the semen sample and therefore share their DNA with the resulting child.

On the one hand, they can decide that only one of them contributes the sperm, either because the other partner produces poor-quality sperm, or because they have agreed so. In this case, it is clear who is going to be the genetic parent.

On the other hand, another option is to mix sperm for a surrogate. Broadly speaking, we can say that fertilization occurs "randomly" in this case. Even though finally only one of them will be the genetic parent of the child, the element of surprise will always be there unless DNA testing is done.

Finally, they have the option to transfer two embryos to the surrogate, each one created using the sperms of a different parent. The chances are that the GC gets pregnant with multiples. This option has to be agreed upon due to the high number of risks involved.

How much does it cost?

The cost of a complete surrogacy arrangement typically ranges between $90,000 and $130,000. However, these figures can be split into various parts, each one adding a different sum to the overall price.

Particularly, gestational surrogacy IVF cost $12,400 on average, while classical or traditional IVF is often $8,000. Most surrogate agencies include an IVF embryo transfer fee of $1,000, as well as a fee for multiples ($5,000 for twin pregnancies and $10,000 for triplet pregnancies approximately).

Surrogacy is the most challenging of all fertility treatments. For this reason, it's crucial that you rely on well-versed professionals. Therefore, we recommend you to visit this article to read some tips before getting into this process.

It should be taken into account that the medications for the surrogate during the IVF process and pregnancy are typically not included in the overall cost. The costs may vary on a case-by-case basis, depending on the needs of each surrogate.

When donor eggs are used, the egg donor fee is typically $8,000-$10,000 plus another $5,000-$8,000 to be paid as egg donor agency fee.

Get more info by clicking the following link: Surrogacy Cost Breakdown – Agency & Gestational Carrier Fees.

FAQs from users

What are the pros and cons of ICSI over IVF?

By Dr. Joel G. Brasch (gynecologist).

ICSI, intracytoplasmic sperm injection was developed in 1988 as a treatment for male infertility, i.e., men with very poor sperm parameters, to treat failure of fertilization with IVF. ICSI is now used routinely in many IVF programs as the fertilization rate is higher than with standard fertilization techniques and the pregnancy rates are higher. There is inadequate information about a possible increase in congenital anomalies with ICSI. There appears to be an increased risk of identical twinning with ICSI, especially with transferring blastocysts. This may be as high as 2%.

Can I use a surrogate mother with my eggs?

By Andrea Rodrigo (embryologist).

Yes. In fact, that's what gestational surrogacy is all about: the surrogate is just a gestational carrier, that is, she just carries the pregnancy until birth. You can use your eggs as well as the sperm of the intended father thanks to IVF.

What are the success rates of IVF surrogacy?

By Andrea Rodrigo (embryologist).

The success rates of IVF surrogacy are quite high: about 75% on average. If we take into account the success rates of surrogacy abroad, they can be as high as 65% as well. Once the surrogate gets pregnant, the live birth rates reach 95%.

How does the surrogate mother get pregnant?

By Andrea Rodrigo (embryologist).

In gestational surrogacy, the gestational carrier gets pregnant as in any woman does through IVF. Once we have viable embryos to be placed into the GC's womb, an embryo transfer (ET) is carried out. An ET involves placing an embryo or embryos into the GC's uterus. The goal is that they are able to attach and lead to an ongoing pregnancy.

Is IVF the same as surrogacy?

By Andrea Rodrigo (embryologist).

No. Actually, IVF is an Assisted Reproductive Technology (ART) that is used in surrogacy arrangements. While surrogacy is a form of third-party reproduction, IVF is a technique that involves creating embryos at the laboratory and transferring them to the uterus of a woman. In this case, this woman is a surrogate.

Does a surrogate mother use her eggs?

By Andrea Rodrigo (embryologist).

If we were talking about traditional surrogacy, then the answer would be yes. In traditional surrogacy, as explained above, the surrogate gets pregnant by means of Intrauterine Insemination (IUI), and therefore fertilization occurs as it would through sexual intercourse: inside her reproductive tract.

However, traditional surrogacy is not used anymore nowadays due to the number of legal and emotional complications associated. So, technically, a more precise answer to this question—as long as we're talking about gestational surrogacy—is no, she doesn't.

Learn more: What Are the Different Types of Surrogacy? – Names & Definition.

Can an embryo be transferred from one woman to another?

By Andrea Rodrigo (embryologist).

Technically yes, it is possible thanks to IVF surrogacy. As explained throughout this post, an embryo can be created using the eggs from woman A (i.e. intended mother) and then transferred to the uterus of woman B (i.e. gestational carrier).

Do surrogate babies look like the parents?

By Andrea Rodrigo (embryologist).

Yes, as long as the embryo or embryos are created using their eggs and sperm. If donor eggs and/or sperm were needed, then the resulting child will not share his or her genes with them.

In any case, when matching a donor to a couple of intended parents, patient coordinators always choose a donor who resembles the intended mother and/or father as much as possible.

Does a baby get DNA from a surrogate mother?

By Andrea Rodrigo (embryologist).

No, this is only possible in traditional surrogacy arrangements, as she uses her eggs to get pregnant. But, as we mentioned above, a surrogate cannot be the same person as the egg donor in IVF surrogacy arrangements.

Suggested for you

The IVF procedure is a key part of every surrogacy process: it is the step that causes the surrogate to get pregnant using the gametes of the intended parents. What other steps are involved? Click here to find them out: Guide to the Surrogacy Process – The 7 Steps of Surrogacy.

In case you wish to get an overall idea of the entire surrogacy process and the many factors that are involved, you might also like: What Is Surrogacy & How Does It Work? – Everything You Should Know.

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