This module provides a comprehensive overview of fertility treatment options commonly used in surrogacy or assisted reproduction. It describes each type of treatment, key considerations, logistics, and action items to help professionals, intended parents, and stakeholders understand how to plan and coordinate care.
By the end of this course, learners will be able to:
Distinguish among the major fertility treatment modalities (timed intercourse, IUI, IVF).
Understand indications, pros/cons, and key steps for each treatment type in a surrogacy or assisted reproduction context.
Recognize logistical, regulatory, and operational considerations for scheduling, coordination, and monitoring.
Translate concepts into actionable planning steps.
Identify additional resources and continuing education opportunities.
Below is a detailed treatment taxonomy, with clinical rationale, procedural workflow, advantages/limitations, and special considerations in a surrogacy / third-party reproduction setting.
Timed intercourse refers to planning sexual intercourse during a woman’s fertile window (around ovulation) to maximize chances of fertilization. This is often the least invasive (and lowest cost) initial intervention in fertility workups.
Indications
Couples with mild unexplained infertility or minimal risk factors
When semen parameters are normal
When ovulatory cycles are regular or can be induced
As a first-step approach before moving to more invasive treatments
Workflow & Key Steps
Cycle monitoring: Track ovulation via ultrasound, LH kits, basal body temperature, or hormonal assays.
Timing: Determine 1–2 days before ovulation and day of ovulation as the optimal window.
Frequency of intercourse: Recommend every 24–48 hours during the fertile window to optimize sperm availability.
Monitoring & adjustment: If no pregnancy after 3–6 cycles, reassess and escalate treatment.
Advantages & Limitations
| Pros | Cons / Risks |
|---|---|
| Least invasive; lowest cost; no surgical risk | Lower success rates in many infertility etiologies; relies on normal gamete function; limited in cases of tubal blockages or severe sperm issues |
Special Considerations in Surrogacy / Third-Party Reproduction
When the intended mother’s uterus will not carry the pregnancy (in gestational surrogacy), timed intercourse is not applicable.
When using donor egg, surrogate, or surrogacy arrangement, this method is rarely relevant except in preimplantation or fertility preservation contexts.
Intrauterine insemination involves directly placing washed sperm into the uterine cavity during the ovulation period, circumventing cervical barriers and improving sperm access to the fallopian tubes.
Indications
Mild male factor infertility (borderline sperm count or motility)
Unexplained infertility after initial workup
Donor sperm scenarios when cervix is suboptimal
Patients with cervical issues (e.g., hostile cervical mucus)
Workflow & Key Steps
Ovulation induction or control (if needed): Use medications (e.g., clomiphene citrate, letrozole, gonadotropins) to stimulate follicle development.
Monitoring: Serial ultrasound and hormonal assays to time ovulation.
Semen preparation: Sperm “wash” or gradient processing to concentrate motile sperm and remove debris.
Insemination procedure: A catheter is used to place sperm directly into the uterus, typically without anesthesia.
Luteal support & follow-up: Administer progesterone if indicated, plus pregnancy testing about 2 weeks later.
Cycle outcome & decision point: If unsuccessful after several cycles, consider escalation to IVF or alternative strategies.
Advantages & Limitations
Pros
Cons
Special Considerations in Surrogacy / Third-Party Reproduction
In surrogacy, IUI typically applies only in specific hybrid protocols (e.g., if surrogate is ovulating and uses her own eggs) — but more commonly, IVF is used.
If donor sperm is used, IUI can be used into intended mother’s uterus if she is carrying the pregnancy (traditional surrogacy), but this is seldom practiced in gestational surrogacy setups.
In vitro fertilization means retrieving oocytes (eggs) from ovaries, fertilizing them with sperm in the lab (in vitro), and then transferring resulting embryos into a uterus (typically that of a gestational carrier).
Indications
Tubal factor infertility (e.g., bilateral tubal blockage)
Severe male factor infertility (low sperm count, motility, or morphology)
Poor ovarian reserve (when every oocyte matters)
Failed previous IUI or timed intercourse cycles
Use of donor eggs or embryos
Need for genetic testing (PGT)
Gestational surrogacy / third-party reproduction (the predominant method)
Workflow & Key Steps
Ovarian stimulation / controlled ovarian hyperstimulation (COH)
Administer gonadotropins (FSH, LH) in a tailored protocol
Monitor follicle growth via ultrasound and hormone assays
Trigger ovulation (e.g., hCG or GnRH agonist) when follicles reach maturity
Oocyte retrieval
A minor surgical procedure (transvaginal ultrasound-guided aspiration under sedation)
Fertilization
Conventional insemination or Intracytoplasmic Sperm Injection (ICSI) depending on sperm quality
Embryo culture & assessment
Culture embryos to Day 3 (cleavage) or Day 5/6 (blastocyst)
Perform morphological grading and possibly preimplantation genetic testing (PGT)
Embryo transfer
Transfer one or more embryos into the uterus of the carrier under ultrasound guidance
Excess viable embryos may be cryopreserved (frozen)
Luteal support & monitoring
Provide progesterone support
Monitor hormone levels and perform pregnancy testing
Cryopreservation / frozen embryo transfer (FET)
Some cycles use freeze-all strategies and transfer in subsequent cycles to optimize endometrial receptivity
Advantages & Limitations
Pros
Highest success rates per cycle (especially with good ovarian reserve)
Ability to perform genetic testing, embryo selection, and cryopreservation
Flexibility in coordinating surrogate cycles separately from donor/egg cycles
Cons / Risks
Higher cost and more complexity
Ovarian hyperstimulation risk (OHSS)
Multiple pregnancy risk (if multiple embryos transferred)
Need for invasive procedures (retrieval, transfer)
Emotional, physical, and logistical burdens
Special Considerations in Surrogacy / Third-Party Reproduction
IVF is generally the standard approach in gestational surrogacy: intended mother or egg donor cycles are timed, and embryo is transferred to the gestational carrier.
Coordination is critical: donor stimulation, retrieval, and surrogate preparation must be synchronized (or separated with cryo).
Legal and regulatory oversight may affect embryo custody, transportation, storage, and contractual protocols.
Logistical coordination across states or countries may require shipping of eggs or embryos (subject to legal/transport constraints).
Initial assessment & decision tree
Protocol planning
Logistics & scheduling
Consent & legal oversight
Monitoring & contingency planning
Follow-up & quality review
Fertility treatment is constantly evolving. Staying informed about new medications, monitoring technologies, and work accommodation laws empowers patients to make confident, data-driven decisions.
At Surrogacy4All, we encourage ongoing education through webinars, expert Q&A sessions, and reading trusted medical resources. Understanding the science and logistics behind treatment not only reduces anxiety but also fosters a proactive mindset.
Continuous learning helps individuals feel more in control of their fertility journey—an essential factor in both emotional resilience and treatment success.
Our job is to listen, to connect the dots between your needs, and to determine how we can best help you have your baby. If you’re asking how much does it cost for a surrogate, we’ll walk you through every step of the process to ensure there are no surprises.
To make an appointment with one of our counselors or physicians, please call (212) 661-7673 or email info@surrogacy4all.com. We look forward to hearing from you.
Surrogacy4All is a unique international surrogacy service targeted at providing state of the art IVF and surrogacy services to Intended Parents irrespective of age, sex or color, at the lowest possible cost in the world.
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