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

Pride Life Magazine - - SPONSORED FEATURE -

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

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