What’s the likelihood that I will (or won’t) get pregnant?

“Surrogacy in North America is such a big investment. What’s the likelihood that I’ll pay all of this money and won’t get pregnant?”
— Mark

Hello Mark.

I work with a lot of couples and they all have their own ideas about success rates. Some expect a long and drawn out series of procedures, each with a remote likelihood of success. Others plan to arrive to their journey with one egg, one embryo and an immediate pregnancy. I suppose your expectations depend on your previous history. But there is some data worth understanding.

According to data collected by CDC, the average US fertility clinic has a pregnancy rate of around 50% per embryo transfer. (The exact number varies depending on age and circumstance — but generally hovers around 50%.) That means that every time you put an embryo into your surrogate, there’s a 50/50 chance that nothing will happen.

That sounds brutal until you consider that the average US fertility clinic treats a diverse clientele with long-term unexplained infertility issues. In that context, a 50% success rate seems amazingly successful.

Meanwhile, clinics that specialize in surrogacy have a much better record. Many surrogacy clinics have success rates from 65% to 75% per transfer. The very best fertility clinics in the US have a success rate around 80% per transfer.

That 80% figure assumes the best possible medical scenario: The sperm donor has confirmed sperm quality above WHO standards. The egg donor is young, with strong hormone levels and verified ovarian reserve. The surrogate has passed an elaborate series of medical checks and has a history of successful pregnancies.

It’s hard to imagine a more perfect storm of positive fertility factors… and yet even the best clinics will fail to produce a pregnancy in 20% of these ideal attempts. More commonly, clinics will fail about 35% of the time, assuming everything works perfectly.
 

So will my surrogacy journey be successful?

Don’t confuse the success of one embryo transfer with the success of your entire surrogacy journey. The typical IVF cycle conceives 3 to 5 high-quality embryos, and each embryo means one attempt at a pregnancy. Each time you attempt an “embryo transfer” to your surrogate, there’s a 65% chance of getting pregnant. Assuming the same quality embryos and surrogate, second transfer has about an 80% chance of success. After three attempts, the pregnancy rate should surpass 90%.

So assuming there is no infertility issue, most surrogates in the US should get pregnant within the first three embryo transfers. When planning your budget, you should allow for this contingency.

If you have three transfer attempts and do not achieve a pregnancy, we would strongly suspect for some undetected cause. the likely reason would be:
• Embryos that haven’t developed well and are simply unhealthy or unstable (as graded on the Gardner Scale)

• Embryos with damaged/abnormal chromosomes. Sometimes a fertility issue can be passed to the embryos from the egg or sperm donor. In some cases, chromosome abnormalities can naturally, spotaneiolsy arise during the IVF procedure. These types of chromosome problems can be detected via PGS analysis)

• Undiagnosed fertility issues or incompatibility with your surrogate.

What if our surrogate does not get pregnant?

Each of the above possible risks can be mitigated through additional steps before the IVF cycle begins. Here are some suggestions:

• Reduce the possibility of quality issues with the embryos by choosing donors with successful previous donation cycles, including successful pregnancies.

• Ensure you have sufficient embryos for multiple attempts. That means find an egg donor with an ovarian scan that visibly confirms a lot of eggs to retrieve, and who has a history of large egg retrievals.

• You can run fragmentation test on the sperm donor to make sure there are no chromosomal issues that could result in a failed IVF.

• Test the embryos themselves with PGS analysis to ensure they are chromosomal normal.

• Of course, you should choose a surrogate with a history of excellent fertility and successful pregnancies.

In the end there is always a bit of luck that the embryo will “latch on” within the surrogate’s uterus — but if you’re able to repeat the transfer multiple times, the effect of “dumb luck” is greatly reduced.

That said… less expensive programs are possible in clinics overseas. In Kiev you should expect about the same outcome from the IVF, but pregnancy rate is only about 60%. So while the possible financial loss is smaller in Ukraine, the likelihood of realizing that loss is higher. (Fortunately, in a country like Ukraine the costs are low enough that you can repeat the entire program if it is unsuccessful and achieve the same overall success rate as in North America — but you will pay for the program twice and spend twice the time.)

I hope this helps.
— Bill