The doctor is the hub of this process, working with you, the surrogate and the egg donor to make sure the journey is as seamless as possible and ends in success. What questions you ask doctors during your fact-finding phase are critical to making a good choice. Having worked with gay couples for over two decades, I’ve been asked every question imaginable. Now starting your journey, here are seven questions I think are critical to ask any doctor or clinic you’re considering. Their answers will go a long way to informing your decision. 

How many surrogacy cycles does your program do each year?

Gestational surrogacy involves a team of professionals working together to make these cycles run smoothly and successfully. You want to make sure the clinic you work is very familiar with all of the requirements for the government regulated screening – referred to as “FDA labs” of egg and sperm providers.   

If mistakes are made, embryos cannot be transferred into the surrogate, so you need to be certain the clinic has enough experience to know the protocols required, and has the staffing to correctly meet the requirements. In general, a clinic that manages about 50 treatment cycles per year for the past 5-10 years should have acquired enough experience to provide comprehensive care. 

How many gay patients do you have? 

Your family building process will be a major chapter in your lives.  It’s important to work with a center and staff who treat you with openness, kindness and caring. Ask the staff how many LGBT patients they see and treat. Get a sense of how comfortable you feel in your interactions with the staff and doctor. It’s important to feel cared-for and to know that you have an advocate for your family building. 

How will you manage the most important factors impacting my success rate? 

It’s very important for your doctor to be committed to maximizing your chance for success. Your physician should be your manager, engineer and artist for this project.  Having an attention to detail is very important in cycle management. It’s important to optimize each factor in this process. We want the best quality sperm for insemination of the eggs, the highest quality eggs to present to the IVF laboratory, a highly skilled team of embryologists to handle your reproductive tissues, and a proven high quality culture system to provide your embryos the best possible environment to their development.   

One or two of these high quality embryos will then be transferred into the optimal uterine environment provided by the surrogate. Each of these factors -- sperm, eggs, laboratory environment, skilled embryologists -- have an impact on the number and quality of embryos obtained.   

Who will be managing my case? 

It’s very important for all patients to feel involved and connected to their treatment cycles. Each doctor has a dedicated team of nurses, IVF coordinators and medical assistants to help guide you through the treatment process. It’s important to know who is making the decisions along the way. Will your doctor follow you along each step, or will other staff members be managing the treatment process? Ask who will make the important decisions regarding best protocols, timing of the egg retrieval, evaluation of the embryos, and selection of the best embryo for transfer into your surrogate.   

Since you may not live in the same city or country as the IVF clinic it’s important to receive frequent updates on the process in order to be involved and educated to make the decisions that will come your way. 

How do I communicate with my doctor? 

Access to your doctor either through email, phone, WhatsApp or Skype for questions that will arise along the way is critical to your peace of mind. Ask which method of communication he or she prefers if you should have questions during the prep and treatment stages of the process. Also, will they be available for you every day? I find that email is the most direct and efficient way to stay in contact with my patients, especially those who live in other countries. It’s important to have a back-up method as well.   

Which agencies do you work with and why? 

We are very fortunate in the United States to have some of the best surrogacy agencies in the world. These successful agencies are well respected by professionals in the industry for their high quality work and their commitment to helping people have children through surrogacy. 

As a patient it’s very important to have choices. You should talk with several agencies to gain an understanding of their screening process of surrogate candidates and how involved they are once your surrogate is pregnant. Ask which agencies the doctor works with and why. Do they have a financial arrangement with them, or do they refer for other reasons? Ask how the doctor and agencies communicate and how often. Ask who will be your communication manager with both clinic and agency. 

What happens if I don't get pregnant after two transfers? 

Our goal is to get you pregnant on the first embryo transfer. We are successful in achieving this goal for most patients. However, no clinic is successful every time. If you do not conceive on the first one or two transfers, it’s important to have a plan for the next steps.   

After a failed embryo transfer cycle it’s important to review each variable to see if there are any “clues” as to why it did not result in a pregnancy. Before proceeding with another transfer it’s important to improve any variable that was not optimal in the prior attempt.

After two failed transfers, it’s important to do additional testing that may shed some light on the reasons for failure, and to attempt to find ways to optimize conditions for implantation and pregnancy. 

Ask your physician how he or she approaches  the clinical challenge of failed cycles and what changes they typically consider in attempts to improve outcomes. 

In summary, it’s important to select a fertility doctor that makes you feel cared for and is willing and able to answer all of your questions before and during the treatment process. In addition, it’s best to work with a program that has abundant experience dealing with these complex cases involving multiple people and professionals. 

Be sure to ask a lot of questions and become an active participant on your team.