Ask THE DOCTOR

LEADING IVF PHYSICIAN, DR BRANDON J. BANKOWSKI, OF WORLD-RENOWNED OREGON REPRODUCTIVE MEDICINE, PROVIDES ANSWERS TO SOME OFTEN ASKED QUESTIONS TO HELP PRIDE LIFE READERS MAKE MORE INFORMED CHOICES ABOUT IVF AND EGG DONOR SURROGACY

Prospective parents considering IVF and egg donor surrogacy are often overwhelmed and confused with a dizzying amount of information, unfamiliar terms and a multitude of options. In the USA, a frequent destination for prospective parents using egg donor surrogacy, there are hundreds of IVF clinics, surrogacy agencies and egg donation programs — each with differing offerings and costs. Knowing the right questions to ask and how to differentiate between the many options is essential for making the best choices for you personally.

Pride Life asked Dr Bankowski for his advice on some common questions. What questions should prospective parents ask when choosing an IVF clinic? First look at the live birth rates of clinics using a tool that has some oversight (not just clinic statistics or pregnancy rates). In the USA, this is through the Society of Assisted Reproductive Technology (SART) database (www.sart.org). Ask clinics to explain their success statistics. Accessibility to the physician and clinical team is also crucial. How does the clinic communicate? Are they responsive to questions? How large is the team and what expertise do they have on staff?

Ask about their embryology laboratory. Are they experts in genetic testing? How do they screen egg donors, surrogates and prospective parents? Do they have their own egg donor program? Ask about their egg donor surrogacy protocol as not every clinic does things the same way and this can impact your journey. What is important to understand about IVF success statistics? Using a validated database like SART is key. Other sources, like Men Having Babies, provide datapoints but only compare a very small number of self-reported outcomes and don’t show the whole picture. The number of cycles performed and the number of embryos transferred help identify if the clinic’s data are statistically significant and if the embryology laboratory is top notch.

Most clinics report pregnancy rates because they appear higher, not live birth rates, which is what matters. Success rates vary year-on-year depending on many factors including the composition of patients being treated in a given year. Look for consistency and high success rates over a multi-year period in both fresh and frozen embryo transfer data. Twin vs single embryo transfer: what are the pros and cons? Often prospective parents are hoping for twins through one surrogacy journey, including many gay male couples who each hope to be a genetic parent. Transferring one embryo has the lowest risk for the surrogate and baby for a healthy pregnancy and normal delivery. Transferring two embryos does increase the chance of at least one implanting and often results in twins. Many twin pregnancies are normal, but they carry a greater risk of complications for the surrogate, the most common of which is pre-term labour. This may mean bed-rest for the surrogate, early delivery, and premature birth complications for the babies. Caesarian delivery is also more common for twins. Twin embryo transfers also carry a small but increased risk of triplet pregnancy and selective reduction, but this is very rare. Because of the risk of complications for the surrogate and babies in a twin pregnancy, prospective parents should consider the impact on medical costs and insurance. Fresh vs frozen embryo transfer: is one better than the other? Historically fresh cycles have experienced higher success rates than frozen cycles. This differential has been eliminated with our improved freezing technology (vitrification). Often chromosomal testing of embryos, Comprehensive Chromosome Screening (CCS) is only possible to do with a frozen cycle. Because not all clinics offer chromosomal testing it can be difficult to get a clear comparison on fresh vs frozen cycle success statistics, especially as this aspect is not captured on databases like SART. In the best