In the UK through an HFEA (Human Fertilisation and Embryology Authority) licensed fertility clinic, we offer two main surrogacy journeys. Straight (sometimes referred to as traditional) surrogacy and host/gestational surrogacy. The terms that healthcare professionals tend to use when explaining both pathways are Straight surrogacy or host surrogacy. The couple wishing to create their families are referred to as the IP’s (Intended parents). It is important to remember that not all fertility clinics are able to offer surrogacy treatments and to find out which ones do, you can visit the HFEA website. Some clinics will also have a dedicated team member who oversees the surrogacy programme and this will often be a senior fertility nurse who will be the designated surrogacy coordinator.
Clinics are now also seeing single people who wish to create embryos for future surrogacy arrangements in view of the law reform surrounding legal parenthood and single people being able to commission surrogacy arrangements. More information surrounding this can be found via the Law Commission website.
Prior to all surrogacy treatments, there are a number of investigations and tests that you will be required to complete before the treatment actually takes place. These include screening the intended parents (if they are providing their gametes or eggs and sperm) for sexually transmitted infections, blood borne viruses and blood karyotype (genetic screening) and of course, performing a semen analysis to assess the sperm of the male intended parent. The surrogate will also be required to complete some of the tests outlined above and in addition, a trans-vaginal ultrasound of the uterus to assess the uterine cavity to ensure that there are no problems that could potentially cause a problem for her to conceive or to maintain a healthy pregnancy and carry a child to full term.
In addition to investigations and tests, we will also require that all parties attend implications counselling with a competent specialist fertility counsellor, and we will recommend legal advice for both the IP’s and the surrogate. Your surrogacy coordinator will provide you with clear guidance on the required consents and documents prior to starting your treatment.
Straight (also known as genetic, full or traditional) surrogacy is when the surrogate provides her own eggs to achieve the pregnancy. One of the IP’s (or the male partner in a heterosexual relationship) provides a sperm sample for conception through IUI (intrauterine Insemination) at the clinic. The sperm is prepared and injected into the uterus of the surrogate at the time of the surrogate’s ovulation. This is a relatively straight forward procedure and can be carried out on a completely natural cycle for the surrogate, or with some medication that will stimulate the ovaries to grow and mature follicles (fluid filled sacs that may contain eggs). Ultrasound scans will be performed during the cycle to track the growth and once the follicles are at the right measurement for ovulation (usually around 18mm) then the clinic will either wait for the ovulation to occur naturally or trigger the ovulation with a medication known as HCG.
If either the surrogate or IP has fertility issues or prefers an alternative route, then embryos may also be created in vitro and transferred into the uterus of the surrogate as outlined below.
Host (also known as gestational or partial surrogacy) is when the surrogate doesn’t provide her own egg to achieve the pregnancy. In such pregnancies, embryos are created in vitro (IVF) (figure 2.) and transferred into the uterus of the surrogate using the gametes of at least one IP, plus the gametes of the other IP or a donor, if required. The egg donor or female Intended Parent will undergo a cycle of stimulation with some fertility medication to stimulate the ovaries to respond and produce a number of follicles. This cycle will be tracked by ultrasound scans to monitor the growth of the follicles and once the follicles are at the required size (approx. 18mm) the clinic will trigger the release of the eggs from those follicles and perform an egg collection (a surgical procedure which will extract the eggs from the ovaries in order to fertilise them in the lab). This is often the preferred method for Intended Parents who have not yet found their surrogate. The clinic will create embryos in vitro and vitrify (cryopreserve) them (usually at the blastocyst stage) and store them until they are ready to perform a frozen embryo transfer cycle for the surrogate. This can take place in a completely natural cycle or with the use of some stimulation medication that the fertility nurses will explain to you.
After the embryo transfer or the insemination has taken place, then further information about the next steps will be given and the surrogate will usually be given information about further medication (if applicable) and when to carry out a pregnancy test, which is usually 10-14 days after the embryo transfer or insemination. This is sometimes referred to as the ‘2 week wait’. Some clinics will offer an early pregnancy scan which will take place approximately at approximately 6-7 week gestation and then the surrogate and the IP’s will be discharged over to the GP to begin their ante-natal care.
Further information can be found via the links below:
Francesca Steyn is the Head of Nursing at the CRGH (Centre for Reproductive and Genetic Health) based in London and has a specialist interest in gamete donation and surrogacy. She is a steering committee member for the Royal College of Nursing (RCN) Fertility Nurses Forum and is also an active member of the Senior Infertility Nurses Group (SING). Francesca has co-authored national guidance and publications on surrogacy, fertility education and fertility preservation and has presented both nationally and internationally on Fertility nursing care and best practice.