By Mark Leondires, M.D.
There are a specific set of hopes and challenges surrounding the LGBTQ surrogacy journey. If you’re like most hopeful parents-to-be, perhaps you’ve already researched local fertility clinics in your area, or the best clinic for LGBTQ singles and couples. Ideally, your chosen clinic has experience in this area. Certifications that indicate a level of LGBTQ inclusivity such as the Healthcare Equality Index or the Open Door training offered by Family Equality, a leading nonprofit that works to advance family building rights and equity for LGBTQ+ persons, are other great markers to look for.
There is a separate organization that over 90% of fertility clinics in the U.S. choose to report to, called SART (or, the Society for Assisted Reproductive Technology). SART data is freely available online, and the success rates posted reflect data from only a few years prior. How is “success” determined in the world of fertility clinics? Luckily, in the United States, it is federally required that all fertility clinics report to the CDC – this ensures that safe and successful laboratory and clinical practices are being followed, for your health and the health of your surrogate and future child. You should be aware that fertility clinics are inspected by the FDA every two years specifically in regard to how cycles including egg donors and surrogates are managed.
For hopeful parents-to-be, SART can be an amazing resource – a way to access clinic specific data. However, understanding how to read the data can also be confusing! There are a lot of numbers and different terms listed – singleton births, pre-term and very pre-term, and implantation rate, to name a few. Here are some key things to help intended parents demystify SART data, as well as surrogacy statistics, when selecting their future fertility clinic:
Where Do I Go To Find Data on My Fertility Clinic?
In order to look at an individual fertility clinic’s rates on the SART website, click on the “Find a Clinic” tab. You will then be able to select between a few years of data results that a clinic has reported. For gay men, the surrogacy process involves creating embryos using donor eggs, freezing them, THEN thawing them and placing them in a gestational carrier. So you will primarily be looking at the “Donor Egg” tab and the subsection “Thawed Embryos”.
Why Are Surrogacy Success Rates Different?
You may be wondering, “why are the rates listed in the thawed Donor Egg section different from the overall success rate?” Typically, gay men seeking to build their families, biologically, have a higher chance of success compared to many opposite-sex couples who need the help of a fertility clinic. The reason for this is that your family plan will leverage the help of a young, healthy, egg donor, and a gestational carrier who has successfully carried and delivered a pregnancy. While it is a good idea to look at a clinic’s overall success rates, remember that those numbers are a composite of all the practice’s patients, not just the donor egg surrogacy group.
When you look at the data, you will see rates listed in a number of different categories. The top two statistics that parents should look at are live birth rate, which is a report of how many embryo transfers resulted in the birth of a child, and the rates of prematurity (pre-term – a child is born between 32-37 weeks; and very pre-term births – a child is born before 32 weeks). There are significantly more potential medical risks for babies that are pre-term and very pre-term than in babies delivered after 37 weeks. While all of the other numbers are important, and may demonstrate a clinic’s success, your main concern as an intended parent is that babies are born healthy and safe.
Why Is the Implantation Rate Different from the Live Birth Rate?
Implantation rate, another important number that measures the success of a clinic, is the proportion of embryos transferred that resulted in a fetal heartbeat observed by ultrasound. It is a separate measure of a program’s success as it measures the chance that an embryo will attach and implant into the uterine wall. Implantation rate differs from the live birth rate and is an independent indicator of embryo quality, which reflects IVF laboratory practices. Unfortunately, even under the best circumstances miscarriages can occur, so you may see that the implantation rate and the live birth rate are different.
What About Twins? Are More Embryos Better?
The rate of implantation is important because it speaks to the quality of embryos created, not just a high pregnancy rate based on the number of embryos transferred. Although the American Society for Reproductive Medicine recommends a single (one) embryo transfer for any patients using donor eggs, many clinics will transfer more than one embryo. An increased number of embryos transferred not only increases the chances for implantation, but also the chances of multiples. While adorable twins or triplets may sound like a dream come true, oftentimes a multiple pregnancy incurs greater risk for both the woman who is pregnant and the children. Multiples are frequently delivered pre- or very pre-term, and carry additional developmental risks.
June officially marks the start of Pride Month, and there are more hopeful gay parents to be out there now than ever. Thanks to modern medicine and advances in assisted reproductive technology, LGBTQ+ persons around the country are working with fertility clinics to build their families. Ultimately, the choice of a fertility clinic is a highly personal one. Surrogacy journeys can take upwards of 18-24 months, and it requires a lot of time, sharing experiences with fertility doctors, nurses, and administrative staff. This is a major life-decision, and choosing a fertility clinic is a major part of the surrogacy process. Personally, as a parent of two young children, I can say whole-heartedly that being a parent is the most rewarding and hardest job you’ll ever have. At times it may seem overwhelming, but we’re all working towards a common goal, and we can’t wait for you to bring home a healthy, happy baby.
Dr. Mark Leondires is the Founder, Medical Director and Partner in reproductive endocrinology at RMA of Connecticut and Gay Parents To Be (GPTB). He is board-certified in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility.