According to the U.S. Centers for Disease Control and Prevention, surrogacy has the highest rate of success of any fertility treatment. The CDC reports in vitro fertilization (IVF) with a donor egg has a success rate of 52%. Higher still is the rate of success with a surrogate. Fertility centers in the US have a surrogacy success rate of about 75% and that number can increase as high as 95% for a birth once the gestational carrier is pregnant. And success is seen in the growth rate of surrogacy. The CDC reports that a gestational carrier was part of 5% of all embryo transfers in 2019, up from barely 1% a decade ago.
Medical pioneer Dr. Brian Kaplan with Fertility Centers of Illinois has been passionately leading the way in infertility for nearly three decades in IVF, egg donation, gestational surrogacy and more. Dr. Kaplan joined our All Things Conceivable: A Podcast with Nazca Fontes to explain what this statistic means, and the context behind what it means both now and going forward, for intended parents and surrogates embarking on a surrogacy journey.
Listen to the full podcast here, and you can hear firsthand what a honor it is to have Dr. Kaplan speaking with us.
And read on for a summary of the key points made by Dr. Kaplan.
“There are very different couples and people who need surrogates and the results will vary depending on what the underlying reason is for doing surrogacy. In infertility, we have to have realistic expectations and they have to be set based on each, specific individualized story.
The success rate of surrogacy is very dependent on what the reason for surrogacy is. Obviously, the uterus plays a role and the sperm, but the critical variable in getting pregnant is the egg. Women are born with all their eggs. They lose eggs and by the time they reach puberty, half their eggs are gone. By the time they reach menopause, all their eggs are gone. So as women age, they are losing eggs, both quantitatively, but also qualitatively. If an egg comes from a woman who's in her forties, the success rate with surrogacy will not be 70%. It will be determined by the quality and age of the egg and subsequently the embryo. If the intended mother is 38, the success rate will be lower because the miscarriage rate will be higher. If it is a donor egg, then the miscarriage rate is under 10% and the success rate may be 90 to 95%. It's very important to realize that each circumstance is unique and depends on many factors.”
“The success rate with a patient using donor eggs and a surrogate will be the highest of all, because that is the ideal situation. You have relatively young eggs and therefore young embryos, so the implantation rates are very high and the miscarriage rates will be very low. If you use a surrogate who has a proven uterus that has been tested, you have a combination of the best of all worlds. That success rate can be well into the seventies and once they are pregnant, a 90 or 95% success rate. You have a normal uterus and embryos that are young from young eggs. That's the ideal situation that provides the highest chance of a healthy baby.”
“The population of same sex male couples or gay men pursuing surrogacy to build their families is growing tremendously. The surrogacy process for gay men uses a donor egg together with a surrogate. In this case, the success rate of surrogacy goes up exponentially because now you have a young egg together with a proven uterus, or a proven surrogate. Now, your pregnancy success rates can be well into the seventies. So if it is a gay couple or male using surrogacy, the pregnancy rates are very high and can easily be around 70% for every embryo transfer. The success rates are the best of everything we do, but it is a commitment and I'm always humbled by that commitment.”
“Surrogates are women who are unique. Every time I meet one of these women, it is truly humbling that someone makes the decision to be a surrogate. They are contributing to giving life and that is really a very deep decision.
There are surrogate requirements that a woman has to meet physically and emotionally. For me, age is not as critical because the uterus ages very little, as long as she's proven to have had a healthy pregnancy. The surrogate will have to pass medical clearances and we do a whole battery of testing, both medically, genetically, and psychologically to make sure that she will have a safe and healthy surrogacy journey. I look at the surrogate's history from an obstetrical point of view. If she's had a strong history of pregnancy without complications, then she becomes ideal as a surrogate. It's not a simple process. There's a lot of education and there has to be a camaraderie and personal relationship between all of us, so everybody knows exactly what the expectation is. They have to trust who they are working with and that the legal system is all in place.”
“The surrogacy team is very important. If you have a surrogacy agency that is incompetent, everything's going to fall apart. If you're looking for a less expensive way out, because it's just cheap, that's the result you're going to get. This is life. You don't want to take a chance with anything, whether it's on the recruitment side, the legal side, or the medical side. You want those all optimized as much as science has available, even with its imperfections. And I think the collaboration between all of the parties is the key to a successful surrogacy journey. None of us can do this on our own. And I think why we get the success rates we do is a reflection of that collaboration.
All physicians have different approaches and there are plenty of people who do a good job with surrogacy. We will have different styles, just like in art and music and everything else. And as a patient, you have to see someone you're going to feel comfortable with in your heart, with your trust, and thinking you're getting the best care. The approach some physicians have is a purely scientific approach. You base it on algorithms and that's one approach to doing it. And it works very well and I respect that. I look at it a little differently. Of course what we do is science, but it's also humanities. This is all about people. You have to get inside each other's souls. You have to understand where they're coming from, what their desires are, and what their dreams are.”
“Choosing a surrogacy agency that has earned a stellar reputation plays such a big role in a successful surrogacy journey. It's not just the physician. Once the fertility physician gets patients to pregnancy, our care ends. We rely and we affiliate ourselves with the best agencies, like ConceiveAbilities, because we know that they are going to be taken care of all the way through their surrogacy journey. When you look at the complexity and enormity of a surrogacy journey, a patient should think about good standards of care, so that they don't cut corners and they don't take risks unnecessarily. It's the same when you choose an IVF clinic as well. It’s very important to find someone with experience, so they know how to deal with many situations. My advice for intended parents and surrogates is to look for a surrogacy agency and ask a few questions. What is their reputation? How long have they been doing this? What kind of volume do they do? What kind of patients do they take care of? Can they provide service? Not just locally, but nationally. I wouldn't look for the shortcut. I wouldn't look for something that's quick and easy because that's where the problems occur.”
“The genetic advances have exploded and we'll get more and more advanced in the ability to test for genetic disease before pregnancy. Artificial intelligence is the hot term that everybody's talking about. I'm still not sure what role it plays in the fertility field, but it's inevitable. At what pace and how we'll utilize it is still unknown.
Surrogacy is a growing part of our practice at fertility clinics. The population that needs a surrogate is growing as well. Today, surrogacy is broadly accepted. If you go to the schools today in all of the major metropolitan cities, a third of those children are born by working with surrogates, donor egg, donor sperm. There are single mothers, single fathers, gay parents. It's such a heterogeneous group of how children are conceived. And at the end of the day, if you have children that are born as healthy as possible, that's the bottom line. How we achieve that with technology is just a matter of individuals being comfortable. I think it will evolve where employers will realize how important it is and cover some of the expenses and costs with surrogacy. And I think all people should have an option to have children.”
And, are you a woman who enjoyed a healthy and successful pregnancy? Do you have friends or family who have suffered from infertility or need assistance from someone else to build their family? Have you ever considered the role you could play in helping someone else build their family - as a surrogate? Learn more about the process of helping someone else's dream of building a family come true. We would love to talk with you.