• In the UK, through the Human Fertilisation and Embryology Authority (HFEA), licensed fertility clinics can offer two main surrogacy journeys: straight surrogacy (sometimes-referred to as traditional) 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 intended parents (IPs).
• 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 find out if you visit the HFEA website choose a fertility clinic page.
• Some clinics have a dedicated team member who oversees the surrogacy programme, often a senior fertility nurse who will be the designated surrogacy coordinator.
• Single people may wish to create embryos for surrogacy arrangements using either egg or sperm donation. It is important to understand that the intended parent will need to have a genetic link to the child.
• It is important to understand that all intended parents that use their sperm or eggs (gametes) to create embryos for surrogacy through a licensed centre, will need to be registered and screened as a gamete donor with the HFEA. This means that clinics will follow the HFEA guidance and policies for consent, counselling and screening for egg and sperm donors, and you will be registered as an egg or sperm donor with the clinic and also with the HFEA.
• Prior to all surrogacy treatments, there are a number of investigations and tests you will be required to complete before the treatment takes place. These include; screening the intended parents (if they are providing their gametes) for sexually transmitted infections, blood borne viruses and blood karyotype (genetic screening) and performing a semen analysis to assess the sperm of the 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 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 counselling with a specialist fertility counsellor, and we will recommend legal advice for both the IPs and the surrogate. Your surrogacy coordinator will provide you with clear guidance on the required consents, documents, policies and procedures 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 IPs (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 straightforward procedure. It can be carried out during a natural cycle for the surrogate or with some medication. Medications 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 we 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) 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) we 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 IPs who have not yet found their surrogate. We will create embryos in vitro and vitrify (cryopreserve) them (usually at the blastocyst stage) and store them until we 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 ‘two week wait’. Some clinics will offer an early pregnancy scan which will take place approximately at approximately 6-7 weeks gestation and then the surrogate and the IPs will be discharged over to the GP to begin their ante-natal care.

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