Overview of IVF

Egg donors

Egg donors can be proven or unproven. The former have donated eggs which led to a successful pregnancy.

The IVF process

Both egg-donor and surrogate mother require hormonal treatments for several weeks before the eggs are harvested. Usually 10-20 eggs are obtained, to be fertilised in vitro (hence the term "test tube baby"). The growing ball of cells is called a blastocyst once grown in culture for 3-5 days. The embryologist determines when they should be implanted into the surrogate mother. Usually two are implanted. Successful implementation is more likely with a 5 day blastocyst, although a proportion will die between the three and five day stage. About 25-50% of fertilised eggs should survive to become a 5-day blastocyst. Gender selection is possible, although will inevitably reduce the number of blastocysts that can be implanted.

IVF success rates

IVF clinics in the United States obtain a successful pregnancy in about 60 to 70% of cycles. See the Assisted Reproductive Technology (ART) Report from the Centers for Disease Control and Prevention for US fertility clinics success rates from 1997 to present.

Gay couples often choose to implant a blastocyst derived from each partner. Per cycle, the probability of twins is about 30% and that of a single pregnancy about 20% for each partner. These rates are much higher than most IVF cycles since the egg donor is young, usually aged between 20 and 25. Similar odds apply if subsequent cycles are required (despite the eggs being frozen), so that some clinics in the United States now refund fees if no pregnancy results after three cycles.

IVF clinics

Men Having Babies, a New-York based non-profit organization that supports gay dads and intended parents, has compiled ratings and reviews of fertility clinics. Browse their reviews below or share your story in the Men Having Babies survey of surrogacy parents.

CT Fertility, an IVF clinic 90 minutes north of New York, has the largest number of reviews and one of the highest ratings in the Men Having Babies survey. This clinic was used by both authors, as they are closely linked to several of the leading surrogacy agencies in the US. CT Fertility has a very good track record and now also offers a surrogacy service.

Other fertility clinics that have been recommended by our members include:

Optimising spermatogenesis

Gay males reading this website might ask how can they ensure that their sperm are as healthy as possible. Sperm take 75 days to develop. Here are dos and don'ts, drawn from medical sources:

DosDon'ts
  • Exercise
  • Take a multivitamin
  • Eat plenty of fruit and vegetables
  • Keep testicles cool: shower rather than bath; wear boxer shorts and loose trousers and avoid electric blankets and warm rooms at night
  • Ejaculate every 1-2 days
  • Avoid stress
  • Do not smoke or take illicit drugs
  • Drink minimal alcohol (1-2 small drinks per day)
  • Minimise bicycling

There is some, limited, evidence that antioxidant intake can help. Having reviewed this, one of the authors took daily: lycopene 10 mg, folic acid 800 ug, purified omega 3 fish oil 1 g, vitamin C 1 g, B-carotene 7 mg, zinc 15 mg, a multivitamin, vitamin E 200 iu, vitamin D 800 iu, and selenium 200 ug. Another, somewhat simpler option is to take ProXeed® Plus, an anti-oxidant supplement.

There are additional techniques that might be employed, such as ICSI (intracytoplasmic sperm injection); PICSI (a super-charged ICSI); and PGD (pre-implantation genetic diagnosis). If you are having difficulty becoming pregnant, particularly older fathers, then consider checking sperm DNA fragmentation and integrity (see www.lewisfertilitytesting.com)

Indicative IVF statistics

You may want to know whether you're on track whilst going though the IVF process. This can be a stressful time, and as most do OK, some don't. So here are the rough odds, assuming that you have a young egg donor (nearer 20 years old than 30) that are likely with gay surrogacy ventures.

  • If all goes well, you should expect 20 to 25 viable eggs to be retrieved. We'll assume that to be the case.
  • 70-90% of these should fertilise, providing roughly 18 embryos. This will be known one day post retrieval.
  • The majority of day 1 embryos will progress to the 6 cell stage by the third day. For example, you should expect to have at least 12 such embryos (as young, healthy eggs have robust repair mechanisms that can correct DNA abnormalities that occur more often in older (> 40 y) sperm donors).
  • Blastocysts develop between day 3 and day 5. This stage of development can be limited by abnormalities in the father's (sperm-derived) DNA as from here onwards new genetic instructions from the embryo are required for cell division. As a result there is about a 50% reduction in the number of day 3 embryos that become day 5 blastocysts.
  • Therefore about 1/3 of day 1 embryos should reach the day 5 blastocyst stage..i.e. 6 blastocysts if 20 viable eggs were originally obtained. There is considerable variation in these rates between couples.
  • Blastocysts contain about 100 cells. Usually the best two will be implanted, and any remaining viable blastocysts frozen for future IVF as needed.
  • The pregnancy rate following implantation is about 75 - 80%, half of whom are twin pregnancies. 90-95% of confirmed pregnancies result in a live born infant. About 1% of two-blastocyst transfers results in triplets.
  • Pregnancy is confirmed with a blood test two weeks after egg retrieval. The first ultrasound scan is usually performed five weeks later (called the seven week scan).