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Surrogacy and Egg Donation IVF in the
USA
November 2018FTS Australian Seminar Series
Craig Reisser
Craig Reisser, Global Programs Director
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• Dad through donor egg surrogacy
• 2 journeys – 3 years minus 3 weeks
• ORM Patient• Same surrogate for both
journeys• One egg donation, ORM Donor• Writer for Fertility Road on
surrogacy and egg donation• London-based
Surrogacy in the USAGestational Surrogacy vs Traditional Surrogacy; compensated model
+30 years of experience – tens of thousands of US and international families created
Full medical, professional, legal infrastructure in place for safe and ethical surrogacy journeys
Legally enforceable surrogacy arrangements, but a patchwork of state-level laws
Strong focus on relationship between surrogates and intended parents
Not-regulated (ASRM, SEEDs guidelines)
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Egg Donation in the USA
Compensated model
Intended parents can potentially receive full profile information
Intended parents choose the donor who is right for them
Intended parents choose whether they want an anonymous, semi-open, or fully open donation
Multitude of egg donor programs (both clinic and non-clinic)
Intended parents are legally protected (donor does not have parental rights)
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Putting Things in Context
140,000Transfers
IVF2,000 Transfers
Patient Eggs + Surrogate
Heterosexual CouplesSingle Women
Female Couples
2,000 TransfersDonor Eggs + Surrogate
4,000Transfers
IVF with a Surrogate
3% of IVFHeterosexual Couples
Male CouplesSingle Men, Single Women
Female Couples18% of IVF involves egg donation
The Key Parties in the Process
The top 10 IVF clinics in the
US do 35-40% of these
procedures
Doctor
Friend or Family
IVF Clinic Donor
Agency Donor
Donor
Own surrogate
Agency surrogate
Surrogate
+135 surrogacy agencies in the USA – the top 10 mange about 35% of casesCan be a cheaper, faster, more certain option – fully screened and medically approved – donors typically reflect the local demographics
May provide a different diversity of donors – agencies charge a fee, less likely to be local to your clinic, not fully screened – you pay for medical screening
Role of the IVF Clinic
Medical screening and approval of egg provider (yourself or donor) and surrogate
Sperm provider medical screening
Medical treatment of your egg provider (yourself or donor) and surrogate through the IVF process
Embryology
Genetic screening
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Choosing an IVF Clinic
Experience with the type of procedure you require –surrogacy, egg donation, genetics, international patients
Live birth success rates – public databasesin the USA
In-house egg donor program
Team that you trust
Cost
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Role of the Surrogacy Agency
Recruiting and non-medical screening of surrogates
Matching intended parents with a surrogate – helping to facilitate that relationship
Helping manage US legal elements of the process
Helping manage US medical insurance elements of the process
Looking after the interests of both the surrogate and the intended parents
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Choosing a Surrogacy Agency
Experience, reputation and service level
Screening protocols for surrogates
Which states the agency recruits surrogates in
Team that you trust – 18 months or more working together
Waiting time for a surrogate match and twins policy
Cost
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Physical location of your surrogacy agency may be less important
Surrogate Matching• State of residence• Marital status• Twins• Personality match• Relationship expectations during journey• Views on selective reduction• Surrogate medical screening
Surrogate Medical Screening is Key for Safe Pregnancies
‒ BMI, number of prior pregnancies, number of caesarian deliveries, location to hospital, non-smoker, non drinker, no drug history, no psychiatric issues or medications, no obstetrical or medical history concerns, infectious disease clear, immune to varicella and rubella
Donor Selection Personal Information- Education and interests- Reasons for donating- Photos (adult and childhood)- Physical and ethnic characteristics- Personal and family medical history- Genetic screeningOvarian Reserve / Donation Success- Donor medical – Age, BMI,AMH, BAF- Prior donation outcomesRelationship- Anonymous v. openCosts
Donor Medical Screening / Ovarian Reserve is Key for Success
Eggs(Stimulation +
Retrieval)
Embryology(Insemination + Development)
SelectingEmbryos(Grading +
Testing)
Uterus(Stimulation +
Transfer)
Basic Steps in Every IVF Cycle
Uterus(Stimulation +
Transfer)
Sperm Provider(s)
Egg Provider
Patient
Commonly the woman providing the egg and carrying the pregnancy are the same
Patient / Donor Surrogate
IVF in surrogacy adds some complexity and requires many choices
Reproductive Genomics is Revolutionising IVF
Carrier Screening Embryo Testing (PGS/PGD)Fresh Embryo TransferFrozen Embryo Transfer
Creation of Embryos, Grading and Testing Selection and Transfer
Average IVF Results – Woman of 25 Years Age26 Follicles produce 25 Eggs
20 Mature Eggs
15 Fertilized Eggs = “Embryos”
11 Embryos growing on Day 3
8 top quality Blastocysts (day 5 Embryos)
5 chromosomally Normal Blastocysts
50%+ implantation rate
PGS Screening
• Detects embryos with abnormal number of chromosomes
– Increase implantation rates/transfer
– Decrease miscarriage rates
– Identify abnormal fetus (e.g. Down Syndrome)
Can minimize surrogate cycles
Egg Donor <35 35-37 38-40 41-42Normal
Embryo Rate* 61% 51% 43% 30% 18%
* Combined data from Reprogenetics and Genesis Genetics up to March 2016 – 33,236 embryos tested
Rate of Chromosomally Normal Embryos
Impact of PGS Screening
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donor egg <35 35-37 38-40 41-42
Implantation Rates in PGS Screened vs Unscreened Frozen Embryo Transfers (FETs) Over 7 Years
CCS tested FET Untested FETPGS Screened FET Unscreened FET
Thank you!