Episode 44 – Dr Shadi Khashaba – IVF Australia

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Thanks for watching!

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Or if this is your first time, thank you so much for taking the time to listen to Surrogacy Australia’s podcast series with me, your host Anna McKie. My guest on this episode was a co-host on the regular webinar series that I run. Those one-hour webinars are free and will take you through the surrogacy process in Australia. You will hear from a surrogate or parent and there are opportunities to type in your questions and we will try to answer them. You can find upcoming dates on our website at surrogacyaustralia.org

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This episode, recorded in May 2023, was different to the standard webinars as it featured Dr Shadi Khashaba. Dr Shadi takes us through an overview of IVF in relation to surrogacy. Shadi is a fertility specialist with IVF Australia and is a dad himself to two children born through surrogacy in Australia. He covers the topic of eligibility for surrogacy, both for intended parents, IPs and surrogates,

01:08
How the egg collection process works for both intended mothers and egg donors, finding an egg donor, clinic recruited donors, genetic testing of embryos, the tests required for a surrogate, and how an embryo transfer works. As part of question time, we covered having a natural versus a medicated cycle for surrogates and why one is preferred over the other, how many tests are required for an egg donor, both medically and for counseling, and if the intended parent is HIV undetectable,

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How is that considered? I found Shadi’s presentation empowering and he really encourages his patients to be the pilot of their journey, not just the passenger. You will come away from this recording feeling ready to ask your own IVF specialist questions so that you too can pilot your journey with your doctor by your side. I hope you enjoy this episode.

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Thank you everyone for giving the time to join us tonight. Part of the process I’ll present, I’ve got a few slides. They’re actually around 20 or 22. Feel free to be kind of interactive session. If anyone has any questions about the slides at that point, Anna will keep an eye on it and she can actually pop up this question and ask me. She’s sharing her screen. So she’ll be actually flipping the slides for me. Hurry about that.

02:23
Another technical issue. Going through the first slide, as you can see over here, surrogacy in Australia, it is legal. I mean, I still find it fascinating that when you go out and they ask you, okay, you have kids, you’re a same-sex couple. How did you approach surrogacy? Which country do you go to? And we tell them, well, we had it in Australia and they’re surprised. Is it legal? Everyone thinks it’s legal and it’s still like a common thing. But actually it’s legal and it should be altruistic. And that’s the…

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caveat over here. It could be for couples like same-sex couples that need it or heterosexual couples that they need surrogacy due to medical reasons. Even single person like single dads single mom due to medical reasons they can access and become eligible for surrogacy. Compensation only occur for costs incurred like travel, obstetric care, delivery and needs that are related to pregnancy, but I’m sure there will be other

03:18
kind of webinars run by Anna that covers this part. So who can surrogacy help when they say, the first step to check for the fertility clinic if they’re eligible for surrogacy? Because surrogacy, you can’t like just say, I need a surrogate, I don’t want to fall pregnant. There must be a medical reason, either physiological for same sex male couple, they don’t have a uterus, or female that she can’t carry the pregnancy due to medical conditions,

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condition it is absent uterus as in this case, or women with serious medical illness like they got like lung pressure problems, severe problems that she had during the pregnancy that doesn’t allow her that could risk her life falling pregnant again, that will make her eligible to fall pregnant. So this is the intended parents. So it covers a lot of background if any medical conditions for the woman that can fall pregnant or male person or male couple.

04:16
that they need to start a family. Now, who can be a surrogate on the other hand? The surrogate usually should have her own children. Now, this is not actually a law, but some clinics implies that as a prerequisite. The conditions and these requirements has been changing along the years and are becoming more and more flexible within the clinics. So you should approach the clinic and discuss with them your own unique situation. And again, the surrogate usually cannot use her own eggs. There are two components, either traditional surrogacy

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carrier. So those two terms, a traditional surrogate who carries the pregnancy but using her own eggs at the same time, a gestational carrier who actually using someone’s as a someone’s else eggs and sperm. So there is no biological contribution to the pregnancy. And most clinic in the past used to have a prerequisite of using only gestational carrier, not a traditional surrogacy. The other part of the surrogate

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and the intender parents should know each other for around six months to establish a relationship. And again, no history of significant mental health problem. The mental health issues, we know that they’re quite common in our society. Mild anxiety or mild depression that happened at a certain point is not necessarily a no-no. There is a psychological assessment that the intender parents and the surrogate go through, and usually they clear them prior to

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starting the surrogacy journey. And again, no history of obstetric complications in pregnancy or birth. So you need the surrogate to be healthy with good obstetric history. So someone who had previous problems during her pregnancy that led to severe medical condition that affects her health or even the outcome of the baby like some

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a woman who have like general metabolic disorders like diabetes could have larger babies, could have increased risks of carrying the pregnancy. So of course, I mean, these are kind of requirements, but it’s not a set in stone. So the surrogate will need to have to be fully informed about carrying the pregnancy. And we advise like if she discloses that to the intended parents and the intended parents should see also.

06:28
a higher risk of obstetrics to discuss this condition, and they agree mutually to move forward or not. Add in a question there, or no, I’ll add one comment. From some data gathering, it’s about 90% of surrogates who are gestational, so it’s not their own egg, and maybe one in 10 there, it is traditional.

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And most of those teams do home inseminations, haven’t gone through clinics. One question has come up there, which is sort of relevant to IP eligibility. Jamie asks, a same-sex male couple still needing a referral from a GP for assisted fertility? Backtrack. So how would the system works in Australia? To access Medicare rebates, you’ll need a GP referral. Now, are you eligible for Medicare rebate? Of course, if you live in Australia, you do have Medicare item numbers.

07:14
to assess your fertility for all the doctor’s appointments for the fertility test, you are eligible to get Medicare rebate for that part. So if you want to get rebates for all your appointments, all your blood tests, your semen analysis, then…

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you should get a GP referral. Great, that’s some good guidance there. All right, we’ll move on to the next slide now. All right, so how do we get started with domestic surrogacy? Okay, so you meet with a fertility specialist to assess eligibility. As we say, if someone has medical condition, they need to get a letter and assess, okay, you’re clear, you can actually fall pregnant, and then you’re eligible for a surrogacy. There is independent assessment, either they need medical high-risk

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or they need psychological assessment. There’s counseling, they’ll need independent legal advice, and then obstetric review for the surrogate. She meets a high-risk obstetrician. Once we got all those documents, we have internal review. Now, in the past, there used to be, say, an IV of Australia and ethics committee that needs all these documents to go, to be discussed and approved. Due to the surrogacy becoming more and more common, and we have long experience with surrogacy now in the past 10 years, we decided not

08:25
to submit all cases to ethics committee. It’s usually automated once it gets cleared with, they have the independent illegal advice, two legal advices for the surrogate and the intended parents. If there is the counseling letter and the psychologist clearance, the medical kind of recommend the doctor, usually within the donor team internally, it goes through automatically. So you don’t have to wait to an ethics committee to meet to discuss. There are some special cases that needs to be discussed. Of course, every…

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time there is something new, but when the special case is, we submit it to the ethics committee. This is the donor egg. Who needs a donor egg? Of course, if someone has poor quality eggs, they’ve tried IVF and did not work and they can’t produce any embryos. There’s a problem with the egg quantity and quality due to

09:13
previous chemo or radiotherapy, women who reached a certain age that affected their egg quality. So generally above the age of 40, the egg quality drops and the chances of success of an IVF cycle after the age of 45 drops dramatically. And again, the same patients who had prior failed IVF cycle or actually younger women who had premature ovarian insufficiency. That means they reach menopause at a very early stage of their lives around the age of 30 or even in their 20s. There are other conditions that they need egg donor.

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like medical conditions, someone who is born without an ovary. So these will need donor eggs and single male or male same-sex couple. So who can be an egg donor? If you’re trying to find an egg donor, usually you would prefer the age of 21 to 38 years old. And that’s only like the clinic recruited ones. So there are two sources of egg donors.

10:05
either clinic recruited or patient recruited. The clinic recruited, that means like those, we got young female patients, like they come in and they say, I want to donate my eggs. We put them on a website. They got a special website. They go and see recipients who want their eggs. And then the donor actually chooses the recipient, just because of the numbers of having recipients much higher than the egg donors. Of course, if you got your own donor, the age restriction.

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does not apply. If she’s 40 years old and you really want to use that donor because you know her or she’s a family member or a sister, then you could go ahead with that donation knowing that the success rates are lower at that age. Ideally, completing their family is not a prerequisite, but it’s ideal for them. They’re not a relative of the male partner for obvious reasons. You can’t use the male partner like your sperm with a sister as an egg donor.

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So it has to be find someone else. But she should be healthy, no medical conditions or risks that could be either for her going through the procedure of IVF or harvesting the eggs or to the children, actually she could pass inheritable medical conditions that could affect the genetics of the.

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Now, the egg recipient process, if someone using their own body to transfer those eggs, usually we have a medical consultation, they go on the wait list, then they have some counseling in our clinic, they go on our website, they select the donor, and then we start the treatment and commence the cycle. Now, you can see this is a more, more, more forward cycle, and this is when, like, intended parents…

11:43
choose a donor from our overseas egg bank. So we do have an overseas egg bank. In that case, you go on the website and just choose the egg donors and you get the eggs transferred to Australia and you can use it. I might add in a question at this point. So there’s the overseas egg bank option that you’ve connected with. And then you’re saying some women do step forward to be a clinic recruited donor. Do you happen to know any numbers or have you noticed it’s a growing trend, even if a slow.

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growing trend or? Yes, it is definitely growing trend. I mean, currently say in our clinic, I believe we have 12 donors on that website, actively talking and they’re been increasing. And each of those donors in New South Wales, they can give to four different families. So they can create four different families, each of those. So that might be dependent on the clinics, cause our listeners would be across Australia at the moment and some would be with IVF Australia, but some not. So it might be dependent on each clinic, whether or not they have.

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much of a donor list there. Exactly. Or would they have overseas egg bank that they actually use? Yeah, great. So the part of exchange of information, in New South Wales, the donation process is not anonymous. It’s de-identified. That means at the age of 18, the child could access the government registry and know who the donor is.

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was. Now the donors when they come and they donate their eggs or their sperm, the donors are entitled to know the number, the gender, and the year of birth. Every time a child is born through that donation process we inform them you’ve got one child, female, born in this year, and the number of families. In New South Wales it’s a total of five families including the donor, so we reserve one for the donor and four as donation process. The intended parents are entitled to know all the medical history of the donor and the donor’s family

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if there’s any medical conditions that are run in this family. We also have a questionnaire completed by the donor that covers all medical conditions, genetic conditions, and also specific traits, like their hobbies, their likes, dislikes, and their personality, how do they describe themselves, and actually the motivation that they’re doing this. So all of that, the recipients can go and check for these kind of things that helps them to reach a decision to choose the donor. And of course, if it’s sperm,

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donation, there is a date of sperm collection and suitability for treatments and total number of other families. I’m like, was this donor ever successful in creating a family? I’m on using someone with unknown success rates. So we reveal that and they know how many families are created through that process. So the treatment options basically to fall pregnant through surrogacy, other artificial insemination, and that will lead to a gestational traditional surrogacy. Sorry. So that’s when we get the sperm and put it inside the uterus at a perfect

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time at the round of elation. Usually these are more natural, there’s less medications than that, but the success rates are much lower. They’re around one in six each time.

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you do insemination. So per cycle per month is one in a six. Second option is doing IVF. And IVF basically there are two components. They say IVF and then you can see slash ICSI. So what’s the difference? IVF basically we get the eggs, we get the sperm, we put them in a dish, turn the light off, play romantic music, see what will happen overnight. Now XC is when we get the egg and inject the sperm directly inside the egg. And we use that in certain situations just to make sure that this egg gets fertilized.

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or if we got sperm over lower quality or the way it was frozen with less number of sperm. Once we created those embryos, we can freeze them and you can use them as a frozen embryos. They’re transferred at a later stage. Or for same sex female couples, they can have egg sharing. And egg sharing with one will produce the eggs, create the embryos, and we transfer that embryo into her partner. So the IVF and the XC…

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process, how it works. Usually we call it an IVF cycle because it mimics a natural cycle. What does it mean? It starts with a period. 28 days later, you should miss a period if the person is pregnant. So it starts with a bit of orientation. We explain the process, we give the medication and explain how those medications work. Once a period starts, we stimulate the ovary using hormone stimulation. And these come in the form of a PENs or injection that are injected in the tummy every night.

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once a day. We follow that for around 8 to 10 days. We do ultrasound once or twice. And once those eggs are ready to harvest, we do the egg collection. Egg harvesting is a simple procedure. There’s no wound or incision. We do an ultrasound that has a small needle.

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We just put it into the ovary and suck those eggs. Get the eggs, get the sperm, do the IVF and create embryos. Can see here there’s a fresh embryo transfer. In most cases of surrogacy, now we’ll freeze those embryos and then we’ll put them at a later stage into the surrogate. And so a question on that, so if there’s surrogates listening, every step up to there, they don’t do until the last step. So they just come on board for the embryo transfer because the egg collection’s been done either from the intended mother or the egg donor. Is that right? Correct.

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The other process is the frozen embryo transfer. And we’ll get into that in a tick. Sounds good. The benefits of using a clinic generally, it’s the donors are screened and quarantined for infectious diseases. We screen them for hepatitis B, hepatitis C, HIV, chlamydia, gonorrhea, syphilis, mycoplasma and HDLV. So these are all STIs. They’re screened for hundreds of genetic disorders.

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Currently the panel that we use have 550 genetic conditions. And of course there is security of identifications and records keeping of the number of families that have been produced and if there is any siblings created through that process. And of course you have implications counseling. What does it mean to fall pregnant using a donor with the current legislation? Now the possible costs for different options, you can see it over here that listed the website.

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And this is including Medicare. So the cycle payment, the initial one, that’s the non Medicare kind of costs of an IVF cycle or an XC cycle. So around $10,000, generally the estimated out-of-pocket cost if you’re Medicare eligible, you get like half of it roughly back from Medicare and you end up being $5,000 out-of-pocket. That’s for an IVF cycle for intended parents. For a frozen embryo transfer, it’s around $4,000.

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embryo and for an insemination cycle is around $2,600. If there’s Medicare you get around out of that around $600 back. To use an embryo donor generally there is a few costs. If you have a known egg donor it costs around $2,000 to prepare that egg donor through the whole process.

18:35
getting all the genetic screening, the infectious screening, the medical clearance and the egg collection bit later on. So how to best manage the process? We have counseling sessions with IVF’s Australia counselor and this is for the donation process. That’s not for the surrogacy process. So we didn’t get to the surrogacy process yet. They provide support and guidance. They explain to you what’s the process. They educate you about the medical and legal aspects of the process.

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informed decision making. So these are questions that we reached to. So I’ll explain a little bit because it wasn’t included under the sites. What happens once you get a frozen embryo? So these are intended parents who either created their own embryos using an egg donor or.

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they intend to parents on eggs. So they went through the IVF process, created the embryos and the embryos are frozen. Now, how do you use them as a surrogate and how is the process of surrogacy itself? So the intended parents are already a patient in that clinic and they have the embryos frozen. The next step, the surrogate comes and have a medical appointment. So we make sure that she’s fertile and there’s not any significant medical issues. So usually those are two appointments. The first appointment is to take all history and to go through it and discuss the process.

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and a second appointment to go through all the results and put a plan for next step. The surrogate will need to provide an independent legal advice certificate and the intended parents need to provide another independent legal advice. They will need to have counseling and psychological assessment with report going through that. Once they have those two components filled and cleared by the medical, the surrogate can go ahead with…

20:16
embryo transfer. Now the embryo transfer is a very simple process. It’s just like a pap smear, basically how it works in the lab. You go in and it’s a five minutes, we put a small straw and put the embryo back in. But actually you can’t put the embryo at any time. The embryo is actually five days old and it’s five days from the day that we collected the eggs. So that mimics the five days from the day that you’re the surrogate ovulates. So there are three ways of putting the embryo back in.

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The first way is to do a natural cycle. We do some blood tests and tell you, all right, you’re about to ovulate. You ovulated today. We count five days and then we put the embryo back in. So that’s one way. The second way we say, well, your periods are a bit irregular. Let’s give it a little bit of stimulation. So we give a small injections, not like the IVF, but not like the IVF. So the dose is much smaller because with the IVF, we need good numbers of eggs.

21:09
In this case, we only need one egg. So we give just minimal stimulation to get the follicle to grow. And then we induce ovulation and then five days later, we put the embryo back in. In certain cases where they need to have very tight schedule of timing or someone that doesn’t have a period, like she doesn’t ovulate a surrogate who reached the menopause, we can use.

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hormonal replacement therapy. So we use a bit of tablets of estrogen and then we start progesterone and then we put the embryo back in. So there are multiple ways to use that embryo. Once we put the embryo back in, 10 days later we do a pregnancy test. Success rates depends on the embryos, depends on the egg donor, depends if they’re tested or not. So there’s a lot of variables that affect

21:52
Generally, I advise all my intended parents when they come and create embryos for the purpose of surrogacy, I advise them to test all those embryos for a lot of reasons. First of all, it improves success rates. When you improve the success rates, we know each tested embryo reach around 60% chance of a baby per transfer. So that’s a very good rate. It almost doubles it. If someone…

22:17
at 35 an egg donor, that’s roughly 30%, the chance of each untested embryo, you double it to around 60%. So reduce the number of transfers. So the surrogate and the intended parents do not need to go for multiple transfers. Reduces also the risk of miscarriage, because most causes of miscarriage is due to genetic abnormality in the embryo. So reduce that. And you avoid…

22:40
transferring an embryo that might have genetic conditions that lead to further discussions and an anxiety during the pregnancy. I think that’s super helpful what you said there. You’ve touched on some of these questions about the natural versus medicated cycle and there’s sort of, you know, the really natural sort of an in-between and then a fully medicated based on each circumstance there. And…

23:02
Yeah, really highlighting the value of the genetic testing there, because you’ve got a surrogate here who’s putting her body on the line, you know, to help you get pregnant. If we can avoid as many miscarriages for her and failed embryos as possible for her time and for her body, and then obviously the costs too, then that’s a win for everyone. So that’s really valuable to hear all of these from you. Absolutely. I agree. I’ll just show the three slides we’ve got here, but I reckon you’ve pretty much covered them.

23:27
In terms of the tests to expect beforehand, I think this question was referring to, are there blood tests and STIs that a surrogate will have to have and any internal scans of her own body? Absolutely. We will need to do clear of infectious screen. We need to make sure that all the hormones of the body are fine. So we check the brain hormones, the thyroid hormones, the brain hormones to make sure everything is communicating perfectly fine. We do urine tests also for infections.

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like health checkup, like the vitamin D levels, the folate levels, the iron levels, and the hemoglobin, the type of blood group to make sure she can carry the pregnancy and there’s no risk for the child. And we also combine that with a pelvic ultrasound to make sure that the uterus is fine and healthy to carry a pregnancy, yeah. It’s not overly invasive. It’s just some basic tests there. Yeah, it’s just a urine and blood test and an ultrasound. That’s good.

24:23
a lot but it’s basic yes. Yeah and so this question here that we had had prior to the webinar is it okay for a surrogate to ask her doctor her IVF specialist for a natural versus a medicated cycle if the IVF doctor is proposing medicated cycle is it okay that she might propose something different? Absolutely I mean it’s all about discussion and I’ll tell all my patients and even surrogates and

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the pilot of this journey, not just a passenger. As a role of a fertility specialist, I advise and discuss and give all the options and the pros and cons of each. It’s up to them to choose their adults, have their autonomy and choose what they want and write for them, what could work for someone.

25:08
might not work for you. I think that’s powerful for listeners to hear, to feel like they are in control. There’s just sometimes an extra dynamic in surrogacy isn’t there, because it’s not just a couple, it’s the surrogate’s body, but caring for the parents and what they want. So hence why it’s really important to have the counselling to discuss all of these options as a team. Exactly.

25:26
Especially that medically, I mean, if someone, if someone with an menopausal, they can’t have natural cycle. That’s right. There are certain conditions. Well, yeah, it might not work, but you go of the reasoning. If the doctor is suggesting medications, well, why, and what’s the success rates? What’s the difference between success rates and is this essential or not? That’s good. That’s helpful. That’s some questions there for people to ask their clinic. And the last one we had before the webinar was.

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which I think you’ve answered as intended parents, how does the genetic testing work and should we ask our clinic about it? I think you’re saying, yes, do you have it? Yeah, yeah. I mean, there are multiple genetic tests, but the major one that we talk about over here is the number of chromosomes, which relate to success rates. Of course, prior to creating the embryos, there’ll be like a genetic check of the sperm provider and the egg provider to make sure that they’re not having any…

26:18
genetic condition that could be transmitted or diseases to the children. Yes, excellent. Well, they were all the questions that we had prepared ahead of time. So I think we’ll go back to answering questions that people have entered in tonight. Right, let’s do it. One question here from Kayla says, is the three month quarantine period mandatory or can it be waived at the discretion of the surrogate? Is that a common practice in most IVF clinics across Australia? Yeah, I mean, it’s 90 days to clear.

26:45
the embryos if there is a sperm component. Now the surrogate knows the intended parents and they want to discuss it.

26:53
be one of the special occasions that could be raised to the ethics committee. And is that the scenario if the surrogate knows her intended parents and the embryos were made a year before, those embryos are clear of quarantine? I know with my surrogacy team it was actually checking that the humans, not the embryos, were cleared of infections then and 90 days later as well. That’s what we did. Usually we test the people not the embryos. So whoever, like when we got a sperm

27:22
We test them, they’re clear, but we wait 90 days and we retest that donor again. Just in case they pick something up on the day of the donation, which wasn’t picked up at that first blood test. Exactly. Yes, so I hope that answers that question.

27:36
It’s making sure that the humans, the role involved in the surrogacy process are clear. I know Marlena’s question at the top here might be sort of a little bit more specific. Is there ever any chance for other rebates with IVF or egg collection? For example, if the egg donor has PCOS. I think this relates back to the fact, and I clarified in the chat, where the intended parents are entitled to Medicare rebates for the appointments and the tests, but when it comes to egg collection and transfer,

28:03
this point in time they don’t get Medicare rebates there. That’s true, correct? As you know, I mean we’re working really with the government trying to remove that description of the Medicare item number. So Medicare has item numbers and they specifically excluded surrogacy for accessing the Medicare item number. Now when they end in the parents come and they do fertility checks as anyone in the population they got Medicare, they’re eligible to get screened.

28:32
and checked for their fertility. Now, when we use like do the IVF for stimulation and getting the eggs out, we’re using actually the Medicare for the egg donor, not for the intended parents. So the egg donor and she’s fertile and she’s doing it for the intended parents for the purpose of surrogacy. And that’s why they can’t access the Medicare item number for that pot. Yes. Yeah, hopefully it changes. That’s right.

28:58
Shardi’s on the board of Surrogacy Australia and that’s one of the sub-projects that, you know, we’re all very passionate and people are working towards getting that changed. I’m hoping it’ll change the next year or two. That’d be nice. We can dream. It will happen, I’m pretty sure, at some point. So Jamie asks, he’s heard that some clinics will not create embryos to freeze until the IPs already have a surrogate on board. Any clarification you can provide on that? I believe that certain states that…

29:24
prerequisite that. You should ask within your clinic and within your state what’s the rules and regulations. Yeah, I think that is a bit clinic dependent and state dependent too, Jamie. Good question. Rocco asks, can we only register with an IVF clinic in the state we live in or could we also register at an interstate clinic? Absolutely interstate. It doesn’t mean where you live has to be the clinic that you’re in line with. Rocco, I know sometimes people who they might live in South Australia like me, but their egg donor might be in Sydney where Shadi is.

29:53
And so they might engage with a clinic there because it might be more convenient for their donor or they go to a particular clinic for a particular reason. Yeah. Alex and Carlo ask, how many counseling sessions are usually required for egg donation on both sides? So the donor’s having some and the intended parents have some too? I would say it’s two by two process. Two medical appointments.

30:12
The first one to take history and order bloods. Second appointment to discuss those results and put a plan. Two counseling sessions, one first implications. The second one to make sure that the first one answered all questions and nothing else has risen. Two for the intended parents counseling, two for the egg donor. And then they combine, if it’s a known egg donor, they do a combined joint session to make sure everyone is on the same page. Great, yep. And from the clinics across Australia, I think that’s fairly consistent. Yeah. Oh, here’s a good one.

30:40
An anonymous question, can a particular gender be selected from those embryos in Australia? We’re not allowed to do gender selection or sex selection for the embryos. There are certain genetic conditions that allow you to choose a certain gender because it’s less likely to have that condition. So it depends if you do have like a reason to choose a certain gender, yes for medical purposes but not for family balancing as most cases is. Yeah.

31:08
Good question though. That’s the type of question people want to know the answer to, but.

31:12
Sometimes they’re not brave enough to ask it. So I’m glad that was asked. Kayla asks, what are the side effects for the surrogate that she might experience if she has a medicated cycle? Well, it depends on the medications itself. Usually, I mean, and what medicated cycle she’s talking about, is it the HRT or the mild stimulation? Everyone is different and everyone’s reaction is different. I can see one question over here. Does the chances of successful pregnancy increases with medicated cycle versus a natural cycle in a healthy surrogate? Not necessarily.

31:42
every case has its own merits and there must be a reason for a medicated cycle. But that being said, we prefer natural cycles. When we put an embryo back in, it’s preferably to be natural. If there is a reason to use medicated, then we’ll discuss why we’re using the medicated one. The side effects, everyone is different. Some people react to hormones differently, some they’re OK with it. Some the progesterone itself doesn’t make them feel great. It’s because some…

32:08
because it’s hormonal action, but the pregnancy produces tons of progesterones as part of it. So is it a bit like your body goes into pregnancy earlier? So any of the possible pregnancy symptoms that you might experience what those hormones are creating? Yeah. And so some people might be fine with pregnancy hormones and others suffer more, so to speak, don’t they? Oh, yeah. Yes. People are very warm on the questions tonight, which is great.

32:33
Can a HIV undetectable person be a sperm or egg donor without infecting a surrogate? A sperm or egg donor? Is he a donor just for donor purposes or is becoming a part of the intended parent? So a donor process with the clinic sperm donation? No, we do not accept that. With HIV positive undetectable, there has not been documented cases of being transmitted through the IVF. Not even like that. So it all depends on

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them and what they discuss and we don’t have any discrimination. No clinic has any discrimination policy based on that. They can have fully access to that. And of course, it’s all, we always encourage open disclosure and they can discuss it and they’re all willing to go ahead and that’s fine. Again, one of the special circumstances will go to ethics committee, but they’ll discuss it and then you’ll hear back from that. Great. Well, I think we might wrap the webinar up tonight, even though we might not have got to every question, my recommendation would be for people, cause they’re starting to get to some.

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specific individualized questions now, engage with your IVF clinic. And if you haven’t found a doctor at an IVF clinic, you head to your GP and you get a referral to a clinic and that would be your starting point. And then start the conversations rolling from there. Before I wrap up, Shadi, is there any last parting advice you’d like to give to anybody or last bit of information you can think to share? Oh, tell them good luck. It’s not easy, but it’s totally worth it. Yeah, it’s certainly a marathon.

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of a journey to get through, isn’t it? But it can be done. Plenty of us have done it. Yes.

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Until next time, welcome to the village.