Navigating the Fertility Journey: The 10 Phases From Clinic to Surrogacy

Brandy Lepold
Aug 20, 2024
6 min read

The path to parenthood isn’t always straightforward. For many, including us, it’s a journey filled with medical procedures, emotional highs and lows, and countless decisions. From the moment you step into a fertility clinic to the day you decide to pursue surrogacy, each step is a significant part of your journey. Here’s a summarized look at what that journey can entail.

1. Joining a Fertility Clinic

The first step in the fertility journey begins with joining a fertility clinic. This is where you’ll meet with fertility specialists who will guide you through the process. The initial consultation typically involves discussing your medical history, previous attempts to conceive, and any known fertility issues. This step is crucial as it sets the stage for the tests and treatments that will follow.

Side note - Blog coming on why we changed clinics

2. Screening and Testing

Once you’ve joined a fertility clinic, the next step is a comprehensive series of screenings and tests. These tests help identify any underlying issues that may be affecting your fertility. Common tests include:

Hormone Testing: Blood tests to measure hormone levels, which can provide insights into ovulation and egg quality.
Ultrasound: To check the ovaries and uterus for any abnormalities.
Semen Analysis: For male partners, a semen analysis is conducted to assess sperm count, motility, and morphology.
Hysterosalpingogram (HSG): A specialized X-ray to check the fallopian tubes for blockages.
Genetic Testing: Sometimes recommended to identify any genetic issues that could affect conception or pregnancy.

These tests are crucial in developing a personalized treatment plan.

3. Medications and Treatment Cycles

Once your fertility specialist has reviewed the results of your screenings and tests, the next step is usually to begin a treatment cycle. This often involves medications to stimulate the ovaries to produce multiple eggs . Common medications include:

Clomiphene Citrate (Clomid): Often used to stimulate ovulation in women who have irregular cycles.
Gonadotropins: Injectable hormones that stimulate the ovaries to produce multiple eggs.
GnRH Agonists/Antagonists: Medications used to control the timing of ovulation.

These medications are typically taken over the course of several days/weeks, with regular monitoring through blood tests and ultrasounds to track the response of the ovaries. This is a physically demanding part of the journey as there are a tremendous amount of injections taking place (stomach and glute - Refer to this blog for more detail - The Medical Protocol of a Retrieval and Transfer).

4. Egg Retrieval and Fertilization

Let's spend some time here…because we found this a very difficult part of an already difficult journey for us.

Egg Retrieval and Fertilization is the next step after the medication cycle. This is a surgical procedure where eggs are collected from the ovaries. Once the eggs are retrieved, they are fertilized in a lab to create embryos. Here’s a brief overview of what happens during the embryo fertilization process and the typical success rates at each stage:

Egg Retrieval: Eggs are retrieved from the ovaries after stimulating the ovaries with hormones. Not every retrieval yields eggs—approximately 70-80% of retrievals result in eggs, but the exact number can vary based on individual factors and the stimulation protocol used.
Fertilization: The retrieved eggs are fertilized with sperm in the lab. Not all eggs will be successfully fertilized. On average, about 70-80% of mature eggs fertilize successfully.
Embryo Culturing: Fertilized eggs (embryos) are cultured for several days to allow them to develop. The survival rate of embryos from fertilization to day 5, when they reach the blastocyst stage, is about 30-50%. This means that a significant number of embryos do not make it to this stage due to various factors, including chromosomal abnormalities or developmental issues.
Blastocyst Stage: By day 5, the embryos are assessed for their quality and potential for implantation. Out of the embryos that reach the blastocyst stage, only a portion will be suitable for transfer. Around 50-70% of blastocysts are considered of good quality and suitable for implantation.

For example, let’s say 10 eggs are successfully retrieved:

Egg Retrieval:
- Total Retrieved: 10 eggs
Fertilization:
- Percentage of Successful Fertilization: 70-80%
- Successful Fertilization: 10 eggs x 70% = 7 eggs (at the lower end)
- Successful Fertilization: 10 eggs x 80% = 8 eggs (at the higher end)
- Fertilized Eggs: Between 7 and 8 eggs
Embryo Culturing:
- Survival to Blastocyst Stage: 30-50%
- Embryos at Blastocyst Stage: For 7 fertilized eggs:
  - 7 eggs x 30% = 2.1 embryos (approximately 2 embryos)
  - 7 eggs x 50% = 3.5 embryos (approximately 4 embryos)
- For 8 fertilized eggs:
  - 8 eggs x 30% = 2.4 embryos (approximately 2-3 embryos)
  - 8 eggs x 50% = 4 embryos (all 4 embryos)
Blastocyst Quality:
- Percentage Suitable for Implantation: 50-70%
- Embryos Suitable for Transfer: For 2-4 blastocysts:
  - 2 blastocysts x 50% = 1 embryo
  - 2 blastocysts x 70% = 1.4 embryos (approximately 1-2 embryos)
  - 4 blastocysts x 50% = 2 embryos
  - 4 blastocysts x 70% = 2.8 embryos (approximately 2-3 embryos)

Summary:

If all 10 eggs are retrieved, you might end up 1 to 3 embryos of good quality for implantation.

From time of retrieval to results is 2-3 weeks. The updates and waiting with uncertainty consumes what seems to be every moment during that time.

We have done 3 of these. There were also several times we had to start over at step three as a result of hormone imbalance. However, we do consider ourselves fortunate because there are instances where people go through this process and end up with 0 viable embryos. Each retrieval costs ~$20k. We currently have 3 tested good quality embryos.

5. Embryo Transfer

Once the embryos have developed, the next step is the embryo transfer. During this procedure, one or more embryos are placed into the uterus with the hope that they will implant and result in a pregnancy.

Fresh vs. Frozen Embryo Transfer: Depending on your specific situation, your fertility specialist may recommend transferring a fresh embryo or freezing the embryos for a later transfer.
Luteal Phase Support: After the transfer, medications like progesterone may be prescribed to support the uterine lining and increase the chances of implantation.

After 1 miscarriage, 2 surgeries, 2 fertility clinics, 7 fertility doctors, one diagnosis requiring us to choose adoption or surrogacy, we decided to move to surrogacy - step 6.

6. Deciding to Pursue Surrogacy

Surrogacy is a process where another woman carries and delivers a baby for you.

Choosing an Agency: The first step in surrogacy is often choosing a reputable surrogacy agency. The agency will guide you through the process, from matching with a surrogate to navigating the legal aspects

Side note - Blog coming on why we changed agencies.

Legal Considerations: Surrogacy involves complex legal agreements to ensure that the rights of all parties—the intended parents, the surrogate, and the child—are protected. It’s crucial to work with a lawyer experienced in reproductive law.
Matching with a Surrogate: The agency will help you find a surrogate who meets your criteria and with whom you feel a connection. This step is about finding someone who shares your values and is committed to helping you achieve your dream of becoming parents.

*WE ARE HERE! We are getting closer and have just begun phase 7:)

7. Medical Screening for the Surrogate

Once a match is made, the surrogate will undergo extensive medical screening to ensure she is physically and mentally prepared for the surrogacy process. This screening typically includes:

Comprehensive Medical Exam: To check for any health issues that could affect the pregnancy.
Psychological Evaluation: To ensure the surrogate is emotionally prepared for the surrogacy journey.
Screening for Infectious Diseases: To ensure a healthy pregnancy for both the surrogate and the baby

Side note - We will post a blog once we get here.

9. Embryo Transfer and Pregnancy

The final step is the embryo transfer, which is similar to the process described earlier but involves the surrogate. If successful, the surrogate will become pregnant, and the intended parents will embark on the journey of monitoring the pregnancy and preparing for the arrival of their baby.

Pregnancy Monitoring: Regular prenatal care will be provided to ensure the health of both the surrogate and the baby.
Birth Plan: The intended parents and surrogate will work together to create a birth plan that reflects everyone’s wishes and ensures a smooth delivery.

10. The Post-Birth Process

After the baby is born, there are legal steps to ensure that the intended parents are recognized as the legal parents. This may involve a court process depending on your location and the specifics of your surrogacy agreement. Luckily in Ontario we likely won’t need to go through a court process and can more easily obtain birth rights and certificates.

Legal Parenthood: Finalizing legal parenthood is a critical step to ensure the intended parents have full rights and responsibilities for their child.

The transition to parenthood through surrogacy can and is emotionally complex.

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Support Our Journey

If you’d like to support us on our journey to parenthood, please visit our fundraiser here. Your support means everything to us as we continue to navigate this challenging yet hopeful path.

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The fertility journey is not a single step but a series of stages, each one requiring patience, resilience, hope and is an absolute rollercoaster of emotions. We hope this post sheds light on the complexity of this process and helps others who are on a similar path understand what lies ahead.

Thank you for being part of our journey.

SL/BL