It is usually carried out in conjunction with medications [Clomid or
gonadotrophin] to increase the chances of ovulation occurring. In a few
cases, the client’s natural cycle is used and the IUI procedure is carried out
when natural ovulation occurs.
IUI aims to increase the number of motile sperm that reach the fallopian
tube and thus improve the chance of fertilization.

WOMEN WHO BENEFIT FROM IUI

IUI is recommended for couples with:
Mild male factor infertility
Couple with unexplained infertility
Women who have ovulation challenges
Teams who require sperm donation
Couples in a same-sex relationship

PREPARATION FOR IUI

IUI is an office procedure and couples are expected to be at the clinic 1
-2 hours before the scheduled time. The client would have had
ovulation induction before this and HCG injection.
While the procedure lasts a few minutes, sperm production and
preparation could last more than 1 hour. The semen is produced by the
male partner and handed over to the health personnel at the clinic for
sperm washing. In cases of male factor infertility where the male
semen is not suitable for use, donor sperm cells are used. The woman
should ensure she takes her HCG injection before coming to the clinic.
The IUI procedure occurs 34 – 36 hours after the HCG
injection.

PROCEDURE FOR IUI

A Cusco speculum is inserted into the vagina and the vagina is
cleaned with saline. The washed sperm is aspirated into a small plastic
IUI catheter is introduced through your cervix into your uterus. The
sperm is pushed and deposited gently into the uterus. The procedure
lasts only a few minutes.

COMPLICATIONS OF IUI TREATMENT

Ovarian hyperstimulation

Because drugs are used to stimulate the production of more follicles,
there is the risk of overstimulation of the ovaries by the gonadotropins
forming large cysts. Ovarian hyper-stimulation is very common in clients
with polycystic ovaries.
These cysts could rupture and leak out excessive fluid into the
peritoneal cavity of the abdomen resulting in weight gain, abdominal
pains and swelling, the passage of a small quantity of urine and
occasionally difficulty breathing. This problem usually occurs within one
week of HCG injection and in most cases resolves within 3 weeks.
This condition could be avoided by using a low dose of the medications
and monitoring the growth of the follicles in the ovaries during
stimulation with the transvaginal ultrasound scan. Despite this
precaution, some women still go ahead and develop ovarian
hyperstimulation.

Mild to moderate forms of the condition could be managed at home with
your doctor prescribing pain relief medications and encouraging you to
drink lots of fluid. Follow-up in the clinic is advised. Severe forms of
hyperstimulation may need drainage of some of the excess fluid that
collects inside the abdominal cavity to reduce the bloating and pain. It
usually allows the condition to resolve quicker and usually improves your
symptoms. In some cases, you may need to be hospitalized for proper
care and monitoring.

Multiple Pregnancies

Fertility treatment has increased the number of multiple pregnancies
including twins, triplets, quadruplets and so on. Clients who get
pregnant with more than one fetus at a time run an increased risk in
the pregnancies for both mother and babies.
These risks include:

 Fetal Challenges

1. Risk of miscarriage in any of the trimesters
2. Premature birth before 37 completed weeks
3. Birth defects in one or more babies

 Maternal Challenges

1. Pregnancy-induced hypertension
2. Pregnancy-induced Diabetes
3. Risk of having a cesarean section
4. Antepartum or postpartum haemorrhage

FOLLOW-UP

2 weeks after the IUI procedure you will be expected to come in for a
serum pregnancy check.
However, we note some women will commence their menses before
this time indicating the procedure was not a success.
One week after the HCG administration, you may be instructed to visit
the physician for an " ovary check." This is to ensure that the ovaries
have not over-responded. This visit is not always necessary.
Women who get pregnant are counseled to see their healthcare personnel
for further advice and counseling.

For a man to impregnate a woman, his sperm count needs to be over 15
million/ml in a single ejaculation. Men with sperm count less than 15
million/ml will have challenges with natural conception. With counts below 5
million/ml, even IVF may not assist couples in achieving a pregnancy.

ICSI is a revolutionary treatment for treating male infertility. In the normal
IVF, over 50,000 motile sperm cells are placed by the egg in a dish and
one of the sperm cells will penetrate the egg and fertilize it.

The ICSI procedure utilizes a microscope fitted with a micromanipulator to
inject a single sperm into a matured egg to help achieve fertilization, unlike
IVF which requires millions of sperm cells. It carries a higher fertilization
rate and birth rate than traditional IVF. Hence, it improves the success rates of
IVF in men with male factor infertility.

This procedure has brought hope to men who would not have been able to
have children despite using the IVF procedure. ICSI programs ensure
couples with low sperm count have the best chances of achieving a
pregnancy with the male partner’s sperm.

BENEFICIARIES OF ICSI

ICSI is a treatment for male infertility and may be offered when:
The sperm count is too low
The sperm cells cannot swim properly
After a previously failed IVF where there was no fertilization
Where the sperm cells had to be removed from the testicle using a
surgical procedure in men who cannot ejaculate
Retrograde ejaculation (semen flows backward into the bladder).
Where traditional IVF has failed

The ICSI procedure involves the following steps:

1. Ovulation induction
The woman is given daily injections called gonadotropins to stimulate the
growth of multiple eggs. Normally, every woman produces one egg at the
time of ovulation; however, the drug aims to help produce many eggs to
increase the chances of a pregnancy.
The injections are administered for about 9 to 12 days. While taking the
injections, several times Ultrasound scans are carried out to monitor the
growth of the ovaries and response to the treatment.

When the doctor decides that your eggs are large enough, Human
Chorionic Gonadotropin [HCG] will be administered to cause the final
maturation of the follicles.

2. Retrieval of the eggs
The eggs will be expected to mature 36 hours after the HCG injection and
be ready for retrieval from the ovaries. Egg retrieval involves the removal of
the eggs from the ovaries using a long ovum pick-up needle attached to a
transvaginal ultrasound probe. The procedure is carried out under some
anesthesia to ensure you do not feel the pain of the needle prick. A few
hours after the procedure you should be able to go home.
The client is given a progesterone suppository to insert into her vagina after
the procedure. Progesterone helps prepare the lining of the uterus for the
implantation of the embryo.

3. ICSI
On the day of your egg retrieval, the male partner is expected to provide a
fresh semen sample to the laboratory. He could produce the sample at
home or in the hospital. Fertilization occurs by injecting a single sperm into
the egg using a special microscope called a micromanipulator.
Following the injection, they will be placed in an incubator to enable
development.
For the next 3 – 5 days, the embryologist will monitor the growth of the
embryo, assessing their growth and quality, and deciding which ones are
best for transfer.
The client will be updated on the progress of the embryo during this period.
Clients do not need to present to the hospital; however, the woman is
counseled to continue her progesterone insertion as recommended.

4. Embryo transfer
Embryo transfer is usually done on day 3 or 5 days after the retrieval of the
eggs depending on the clinic protocol. Day 5 transfer is more popular.

For the transfer, the best-quality embryos are used. Your doctor will
discuss with you the number of viable embryos to transfer into the womb. In
most cases, 2 – 3 embryos are transferred back into the uterus. In
countries like the UK, single embryo transfer is done to reduce the
risk of multiple pregnancies.

The transfer which is a painless procedure involves loading the embryo into
a special catheter and under ultrasound guidance depositing it gently into
the uterus.

You will be advised to remain in bed for about an hour after the procedure
and then you can go home and resume normal activities.

5. Embryo freezing
After the transfer of the best-looking embryos, there may still be some
excess embryos remaining. Any unused high-quality embryos may be frozen
to allow the option of future implantation. Your doctor will need your
consent to freeze these embryos and the terms of freezing would have
been discussed with you during your initial consultation.

6. Follow up
After embryo transfer, you will continue your progesterone insertions at
home. You will be advised not to engage in any strenuous activities outside
your routine.
Two weeks after the procedure, you will receive a call to present at the
clinic for a blood pregnancy test.
If the pregnancy test is positive, you will continue the progesterone until
you are about 11 weeks when your placenta begins to produce enough of
the hormone to support the pregnancy.
An ultrasound scan will be done in the 6 th week to check for fetal heart
activity.
If the pregnancy test is negative, your health team will discuss with you the
possible reasons why this occurred and you may choose to have another
IVF cycle.

The ability to remove eggs from a woman and fertilize them outside her
body, and subsequently place the fertilized eggs back into the woman
opened up a world of opportunity for women with challenges carrying their
pregnancies for a variety of reasons. They simply get help to carry the
pregnancy and nurture it.

TYPES OF SURROGACY

I. Traditional Surrogacy
In this procedure, the surrogate's egg is fertilized by the intended father's or
a donor’s sperm.
The surrogate can get pregnant through sex with the intended father or by
artificial insemination. In many cases, the intended father's sperm is used
in the insemination resulting in a child who is genetically related to both the
intended father and the surrogate.
If a donor’s semen is used, the child born will not have any genetic
relationship with his/her parents.
It was a common practice before the evolution of IVF and was practiced in
the bible. It is not commonly practiced anymore.

COUPLES WHO BENEFIT FROM SURROGACY

It is beneficial for:

For couples who want a genetic linkage with the baby and plan to use a
relative.
If the intended parents are a single male or a couple where the woman is
not capable of using her eggs, traditional surrogacy may give them the
the genetic link they desire.
For couples who cannot find an egg donor of their choice or want a donor
they know.
For couples who want to reduce the cost of their surrogacy.

II. Gestational Surrogacy
Here, the parents create an embryo using their egg and sperm or using a
donated egg or sperm and the surrogate agrees to have the embryo
implanted in her uterus. Her womb is simply borrowed to nurture the
embryo and after delivery, the baby is reunited with the couple who will be
the rearing parents.

COUPLES WHO BENEFIT FROM SURROGACY

It is beneficial by:
Allowing mothers to have a genetic linkage with their babies
Allowing couples who have frozen embryos from previous IVF treatments
could use them in gestational surrogacy.

It is important to note that the baby delivered has the genetic components
of the parents from whom the egg and sperm were taken.
The surrogacy program involves carrying out the IVF procedure on the
couple and then transferring the embryo to the surrogate after preparing
the uterine lining of the surrogate to receive the embryo. The surrogate
undergoes several tests before being used to carry the embryo. Couples
could choose their surrogate of choice or the clinic could arrange to make
one available. The process of getting a surrogate involves legal
documentation to prevent the surrogate from absconding with the child.

COUPLES WHO BENEFIT FROM SURROGACY

Women with no uterus
Cases of recurrent IVF failure
Recurrent miscarriage
Severe heart and kidney disease in a woman

SURROGACY COMES WITH ITS CHALLENGES

Couples who plan to have babies through surrogacy need a lot of
counseling and support all through. It is:
More expensive than traditional IVF
There could be emotional turmoil knowing someone else is carrying
your baby
In our environment, people ascribe the pregnancy to the one who
carries it
The surrogate may bond to the baby and decide not to hand over the
baby after delivery.

Surrogacy has a lot of ethical questions with some religious groups viewing
it as immoral and a means of exploiting poor women for commercial
purposes.

Whatever the case, surrogacy provides a means of childbearing for
thousands of couples hoping to commence their reproductive journey.

These women may find it difficult or impossible to have children using their
eggs.

An option for these women to have babies is to undergo egg donation.
Egg donation is a process whereby eggs/oocytes produced in another
woman’s ovary are fertilized by the husband’s sperm and transferred to the
recipient mother’s uterus.

The egg donor is a young woman preferably in her early 20s. The
the procedure typically involves a doctor giving the egg donor injections to stimulate the production of many eggs, removing the eggs from the donor when they are matured fertilizing in a laboratory with sperm from the
recipient’s partner, and then transferring the resulting embryos into the
recipient’s uterus for implantation and the establishment of pregnancy.
Following the delivery of the baby, the recipient will be the rearing parent of
the offspring. Doctors do this through a procedure called In-Vitro
Fertilization (IVF).

In the majority of cases of egg donation, the donor and the recipient are not
aware of their identity and the clinic keeps this a secret. In a few cases, the
recipient may decide to provide an egg donor after proper counseling on
the future possible challenges of such a decision.

CRITERIA TO BE USED AS AN EGG DONOR

Before a woman is accepted as an egg donor, she has to meet certain
criteria which include:

1. She has to be between 20 and 35 years of age. In our practice, we
utilize donors less than 25 years of age because they tend to respond
better than fertility medications thus increasing the chances of a healthy
pregnancy

2. They should be free of infectious diseases such as HIV, Hepatitis B,
C, and Syphilis.

3. Their genotype has to be AA to prevent them from passing the sickle
cell trait to the offspring

4. Women who have given birth or successfully donated eggs which
resulted in a pregnancy in the past are preferable

5. Women with a family history devoid of genetic diseases [this may
pose challenges because some persons may not have details of their
family history or may choose to keep such information secret

TESTS FOR EGG DONORS

When a client has been chosen for the egg donation program, she will
undergo:

Physical examinations to document their weight, height, and
complexion, and document other physical parameters.

Drug testing to ensure she is not on any recreational drugs

Ultrasound scan to examine the uterus and ovaries

AMH is carried out to document her ovarian reserve

Medical history is noted

Psychological history and counseling to ensure the donor is mentally
fit to undergo the procedure

Up to 50% or more of women using donor eggs will experience pregnancy.
The success rate depends on the age of the eggs, stimulation protocol, and
process of egg retrieval amongst other factors.
Egg donors are counselled on the legal implications of the procedure and a
a contract document will be signed informing her that she has no
responsibilities or legal rights to any children born via the donor eggs.
Egg donors may or may not be paid for the donation of the eggs; they may
receive compensation for their efforts in assisting another family to have
children.

Discuss with your fertility doctor if you think you will benefit from the egg
donation program.

Sperm donation may be done directly to the recipient woman or through
a sperm banking facility. The semen donated can be used for intrauterine
insemination [IUI], in-vitro fertilization, or via ICSI to achieve a pregnancy.

CLIENTS WHO NEED A SPERM DONOR

Single women
Couples with male factor infertility.
Recently, lesbian couples have been included on this list

Sperm donors may or may not be paid depending on the agreed
arrangements. Depending on the country’s laws, men may donate
anonymously or agree to provide identifying information to their offspring in
the future.

Sperm can be provided for use in fertility treatment through:

1. Sperm banks

Sperm banks provide donors with the chance to provide semen under a
contract deal depending on the number of pregnancies the bank hopes to
produce from the donor.

The sperm is produced by a donor either through masturbation to provide
an ejaculate or by the use of a collection condom to collect the semen
during sexual intercourse.

Semen is collected in small vials, mixed with chemicals and frozen for six
months. The sperm donor is retested for infectious diseases after six
months before the sperm can be used for fertility treatment.

Sperm banks typically screen potential donors for sexually transmitted
infections that may be transmitted through sperm. Genetic screening and
screening for chromosomal abnormalities are usually not done in most
centers in Nigeria. A six [6] months quarantine period is recommended in
which the semen samples are stored after which the donor will be re-tested
for sexually transmitted diseases. This ensures that the donor has not
acquired any new infections during this period. Sperm samples are used for
fertility treatment if results for STI tests are negative.

2. Private donations

Another way of getting semen for fertility treatment is through the use of
friends, family members, or through an agent who links the clinic or
recipients with a sperm donor.

The donor may or may not be known to the couple and in many cases, the
sperm is used fresh.

CHOOSING SPERM DONORS

Most couples have characteristics they wish for in a sperm donor such as
racial origin or tribe, the colour of skin, height, weight, the colour of eyes,
and blood group. The level of education may matter to some couples.
The genotype of the sperm donor must be AA to avoid transferring the
sickle cell trait to the offspring.
The sperm bank or clinic must choose donors with consistently high sperm
counts.
An important factor in choosing a donor is deciding if the donor should be
known to the client or anonymous. Some donors want to be known by the
mother and child, while others only want to be known by the mother.
Known donors offer a level of transparency about family history and other
important information. On the other hand, if you’re sure you don’t want the
donor to connect with your child later in life, an anonymous or unknown donor
might be best for your family.

CONTROVERSIES ABOUT SPERM DONATION

1. In the early days of sperm donation, a marriage was dissolved in a
US court on grounds of adultery because a woman used donor
semen despite the consent of the husband. The child conceived was
said to be born out of wedlock and belonged to the mother and not
the father.

However, the following year, another US court became the first state
to pass a statute legitimizing children conceived by donor
insemination, on the condition that both the husband and wife
consented in advance in writing to the procedure and the husband
legally considered the natural father of the donor-inseminated child.

2. In a recent Guardian article published on 28 Apr 2023, Dutch judges
have ordered a man suspected of fathering more than 550 children through sperm donations to stop donating. The man, identified in
Dutch media only as Jonathan M, 41, was taken to court by a
foundation protecting the rights of donor children and by the mother
of one of the children allegedly fathered from his sperm.
Dutch clinical guidelines say a donor should not father more than 25
children in 12 families, but judges said the man had helped produce
between 550 and 600 children since he started donating sperm in
2007.
The court therefore “prohibits the defendant from donating his semen
to new prospective parents after the issuing of this judgment.

3. The use of sperm donation among single women, lesbians or
transgender people. This has produced ethical questions about the
ideals of conventional parenting between a male father and a female
mother.

4. Some donor children may grow up finding that they have dozens of
siblings produced from the same sperm donor. In Nigeria, there are
no laws restricting the number of offspring from a single donor.

5. Religious responses
a. Catholicism
Catholicism officially opposes both the donation of sperm and the use of
donor sperm on the basis that it compromises the sexual unity of the
marital relationship and the idea "that the procreation of a human person is
brought about as the fruit of the conjugal act specific to the love between
spouses.

1. Ova/Egg Banking

Egg banking is a viable option for:

Women who want to postpone childbearing till much later in life so
they can pursue their career goals
Ladies who donate eggs to be used by couples with fertility
challenges
Women who are about to commence cancer chemo/radiotherapy and
desirous of children in the future. Chemotherapy and radiotherapy
destroy the ovaries; making egg banking a viable option

PROCEDURE FOR EGG BANKING

The procedure involves the stimulation of a woman’s ovaries with
ovulation induction drugs to produce a large number of follicles which
are then extracted, frozen, and then stored in nitrogen chambers.

The eggs are usually frozen through a process called vitrification,
which rapidly freezes the eggs. The stored eggs could be used much
later and they have a comparable pregnancy rate with fresh eggs.
Ova are usually collected for women less than 35 years of age.

When the woman or the couple decides to use the eggs, they are
thawed and then fertilized with the husband/male partner’s sperm,
and cultured in an IVF lab incubator to produce embryos.

2. SPERM BANKING

Sperm banking is a process that involves a man providing his semen in a
banking facility for use at a later date or to earn some money by donating
sperm which is sold to couples.

Sperm banks have assisted a good number of women to bear their children
in conditions where this might otherwise not be possible. It enables people
to have more choices over the issue of reproduction.

BENEFITS OF SPERM BANKING

Sperm banking is beneficial in cases where:

The man wishes to use the sperm cells later and feels he may have
challenges in the future with his fertility.
Men on treatment for cancer
Couples who need fertility treatment and the man may not be
available to provide fresh sperm cells such as in cases where couples
don’t live in the same city
Men having a vasectomy and feel they may change their mind about
having more kids in the future.

In most countries where sperm banks are allowed to operate, they are
regulated by local laws to protect the unborn child.

STORAGE OF SPERM

The sperm is stored in small containers holding less than 1ml and
preserved in nitrogen tanks. Sperm cells can be stored for more than 15
years

USE

The sperm stored in banks for commercial use can be sold to single
mothers, women whose male partners have severe sperm challenges and
recently to LBTQ couples to enable them to have children.

CRITERIA FOR COMMERCIAL SPERM DONOR

Sperm donors must be:

Healthy males between 18 to 45 years of age
Be willing to undergo frequent testing
Be willing to donate his sperm so that it can be used to impregnate
women who are unrelated to, and unknown by, him.
Must not be gay.
Free from STIs

3. EMBRYO BANKING/FREEZING

This involves freezing embryos below -198 degrees Celsius to save them for
use at a future date. It is an important part of routine assisted reproductive
programs where surplus embryos are preserved. Embryo freezing is a
viable option for the use of the embryo at a later date. This increases the
IVF success rate and reduces the cost of subsequent treatment for the
client and the risk involved with ovulation induction and egg retrieval.

BENEFITS OF EMBRYO FREEZING

It is beneficial:

If the IVF procedure fails or the IVF cycles are canceled because of
risks from the procedure
Women with cancer on treatment who are desirous of children may
also benefit from this program as cancer treatment impairs fertility.

Good-quality embryos can be frozen for as long as possible and stored for
use at a later date. The average length of time of storage is 10 years;
however, it could be longer.

The use of a frozen embryo for achieving pregnancy gives the same
pregnancy rates as a fresh embryo.

METHODS OF EMBRYO FREEZING

There are two methods of freezing embryos. They include:
1. Slow or gradual freezing in a freezer
2. Rapid freezing or vitrification

Here the embryos are rapidly frozen in nitrogen. Chemicals called
cryoprotectants are used during this process to prevent ice crystals from
forming, which could damage the embryos. It is the preferred method of
freezing embryos.

Embryo freezing is relatively safe and often leads to a successful
pregnancy and delivery. However, some of the embryos may get damaged
during thawing and there may be the possibility of a slightly higher chance
of genetic abnormalities in the children born from it. It is still a developing
field and more research is still ongoing about its safety.

If you’re considering embryo cryopreservation, talk to your gynecologist
or fertility specialist for further information.

Embryos that have been tested and are free of the condition will be
replaced later in your womb to continue to develop. The procedure was
developed as an alternative to current prenatal diagnoses where the fetus
in the mother’s womb is checked for genetic abnormalities from the 10th
week of life in-utero.

INDICATIONS FOR PGD

PGD is indicated for:

Couples who have had a child with a serious genetic disorder
Couples with a family history of serious genetic anomalies
Couples with a family history of chromosomal problems
Couples with recurrent IVF failure.
Couples with recurrent miscarriage
Women over 40 years of age

The PGD procedure is safe and does not increase the risk of
developmental challenges in babies born after the procedure. However, it
doesn’t guarantee that the IVF procedure will be successful and there is a
small chance that the biopsied embryo may be damaged during the biopsy
procedure necessitating discarding such an embryo. PDG is also not 100
% correct; hence the test may produce a wrong result and mislead the IVF
team.

PGD is popularly used in sex selection. Sex selection is a means of
achieving the desired sex of an offspring mostly before the implantation of
the embryo. It is also called family balancing because it attempts to ensure
the presence of the desired gender in a family, particularly a male child.
In many cultures of the world including Nigeria, there is a preference for
male children. Factors responsible for sex selection include:

1. A preference for sons who will continue the family lineage and inherit
the family property thus securing its future

2. Reduced childbearing, thus encouraging couples to determine the
sex of their children

BENEFITS OF PGD

PGD has been known to improve IVF success, reduce the risk of
miscarriage, and reduces the risk of multiple pregnancy and birth outcome.
Advancements in technology and increased adoption of PGD in the field of
reproductive medicine may lead to potential cost reductions over time. As
more clinics and laboratories offer PGD services, there could be increased
competition, which may drive down prices.

Additionally, improvements in genetic testing techniques and laboratory
processes could help streamline the PGD procedure, potentially reducing
costs. As technologies evolve, more efficient and cost-effective methods for
genetic testing may be developed, making PGD more accessible and
affordable. It would be best to consult with fertility clinics or genetic testing
laboratories to inquire about the current costs and any potential changes or
trends in pricing.

Picture credited to Invicta  published on https://www.invitra.com/en/preimplantation-genetic-diagnosis-pgd/

WHAT TO DO AFTER A FAILED IVF

The following are steps to take after a failed IVF.
1. Discuss why the IVF Failed

There are many reasons why IVF fails. They could be due to advanced
female age, poor sperm quality, poor ovarian response, and implantation
failure.

2. Repeat IVF Cycles 

The chances of pregnancy increase with the number of IVF cycles a client
undergoes. While many women get pregnant with the first cycle, some may
require up to 3 cycles to get pregnant.
Women below 35 years have the best chance of conceiving with their eggs.
For women above 35 years, the chances are reduced and they may require
donor eggs for a successful IVF.

3. Use of Donor Eggs

For women with a poor ovarian reserve and repeated IVF failure or
miscarriages, the use of donor eggs may be considered to improve the
chances of IVF success. Egg donors are usually younger girls in their early
20s with good-quality eggs.

4. Preimplantation Genetic Screening

This is an advanced laboratory test which analyses the embryos for genetic
challenges before they are transferred into the uterus. Embryos without
genetic challenges are transferred.
In many cases of failed IVF, a condition called aneuploidy is responsible.
Aneuploidy is the presence of too few chromosomes in an embryo. This
may further help individuals or couples have success after repeated
implantation failure.

5. Gestational Surrogacy 

Gestational surrogacy involves the use of the client’s egg and the intended
father’s sperm to create an embryo which is then transferred into a
gestational surrogate’s uterus. The surrogate carries the baby and delivers
it after which the baby is reunited with the genetic parents.
The surrogate has no genetic relationship with the baby.

Surrogacy is an option in the following circumstances.
Women with no uterus
Recurrent IVF failure
Recurrent miscarriage
Women with medical diseases which make pregnancy a risk
Same-sex couples
Personal choice

6. Adoption

Some couples after counselling opt for adoption. Adoption could bring joy
to the family in the process of raising a child in your home. The adopted
child gets better attention and a stable home to live in.
A failed IVF is not the end of the road. Keep hope alive. There is surely
light at the end of the tunnel.