Since a remarkable number of infertile couples turn to egg and embryo donation or surrogacy as a last resort, for the first time in Iran AIC proceeded to establish donation clinic to handle this services. General health of a donor, phenotypic compatibility between a donor and a recipient besides the confidentiality of both parties’ information are considered in this clinic. Moreover, special attention is given to the ethnic and religious backgrounds of the recipients. When there is a necessity for replacement therapies (donation), this clinic evaluates the both parties involved in treatment considering AIC protocol derived from the Act on Gamete and Embryo Donation as well as the latest related guidelines approved in international bodies. In this process, the advisory comments of the relevant specialists (gynecology, embryology, andrology, endocrinology, infectious diseases, genetics, psychology, law and social medicine) are taken into account in approving or disapproving of the treatment. Egg donation: Many childless women wait for egg donation in the below cases: Hypergonadotropic hypogonadism such as premature ovarian failure, Oophorectomy ( removal of ovaries), chemotherapy or radiotherapy, Turner syndrome Poor ovarian response or impaired ovarian reserve Untreatable recurrent miscarriages, repeated ART failures (women with at least 3 unsuccessful IVF cycles or poor quality eggs/embryos). Genetically transferable diseases that are not treated and detected by existing lab procedures like PGD and PND and geneticist’s diagnosis Age-related infertility (women over 40 years old) In this regard, Avicenna Infertility Clinic has set up an egg bank in order to provide the possibility of this therapeutic option for the infertile couples. Egg donation is the process by which a donor’s ova are obtained and fertilized in a laboratory; afterwards the resulting embryos are placed into the infertile woman’s uterus. Embryo donation: Many childless couples find themselves unable to conceive their own biological child owing to the lack of healthy ovum, sperm or inability to produce an embryo. Couples in this situation may need to choose gamete donation, otherwise they have to use donated embryo. Today, in the laboratory of IVF centers, the washed sperm is microscopically injected into the eggs obtained through transvaginal puncture of ovarian follicles in order to produce an embryo. This surgery is performed after induction of ovulation by applying hormone medications and assisted reproductive techniques. Stimulation of the ovaries often triggers the release of multiple eggs and subsequently results in extra embryos. Couples who have excess frozen embryos can elect to donate them for other couples attempting to become pregnant. In some cases, the couples just refer to the clinic with the purpose of donating their embryos. Before treatment the significant subjects for us are to provide legal consultation, obtain informed consent, evaluate the health of both parties and determine the necessity of this therapeutic procedure for the recipients. The initial consultation and evaluation Donors are being accepted into the egg/gamete donation program under the ethical guidelines and principles. During the counseling meeting (one or more session), a community medicine specialist inquires about the donor and her husband consent (if the woman is married), their motivation, firmness of decision, criminal record, education level and marital relationship. Considering that each individual has the privacy of his religious beliefs and there is dissimilarity among maraji’s fatwa on donation procedures, it is emphasized that the couples need to be informed about their own marja’s opinion so that the clinic accepts no responsibility or liability for their oversight. Legal counseling and obtaining informed consent Relevant experts should illuminate the legal standards, donors’ responsibility plus the treatment consequences for the couples and finally obtain their consent. After providing initial counseling and obtaining informed consent, the related specialists evaluate donors in terms of their reproductive health, clinical and para-clinical tests, genetic and infectious disease, psychological status and social wellbeing. Egg & embryo recipient According to the “Act concerning Embryo Donation to Infertile Couples” and its Bylaw, upon receiving the written consent of embryo owners to transfer the embryo to the uterus of women whose infertility or their husbands’ (or both of them) have been confirmed after marriage and undergoing medical treatments, all licensed fertility clinics are authorized to transfer embryos resulting from in vitro fertilization of legally married couples to infertile couples based on Shari’ah. Additionally, if infertility is due to female reproductive problems alone, based on fatwas, infertile couples may resort to egg donation. Replacement therapies are initiated for the couples suffering from the lack of healthy egg or embryo following diagnosis of the specialized committee. These activities must be performed to confirm no alternative is available except donation and avoid the subsequent legal issues. After providing initial counseling and obtaining informed consent, the related specialists evaluate the recipients in terms of their general health, psychological and social wellbeing besides genetic and infectious disease. Surrogacy The inability of a woman to carry a baby in her uterus is recognized as one of the important causes of infertility. The importance places on surrogacy when couples are deprived of parenting due to the abnormality or the lack of healthy uterus. Using IVF in this manner provides an opportunity for applicants to form healthy embryo in laboratories and transfer it into the uterus of a third party. Surrogacy is a complicated procedure from medical, legal and psychosocial aspects which demands thorough medical assessments, mental health evaluation of both biological parents and the surrogate A surrogate is a woman who bears a child for another couple using their embryo and hands the baby over to them shortly after birth. In this condition, the surrogate is biologically unrelated to the child. It is noteworthy that when a donated egg becomes imperative for infertile couples besides applying surrogacy, the guidelines of health evaluation in the process of egg donation come into force. With respect to the Iranian social and legal rules, it is prohibited to accept an individual simultaneously as a surrogate mother and egg donor for a single person. Childless couples seeking for a surrogate should fall into one of the below cases: The congenital and acquired absence of uterus such as Mayer-Rokitansky-Kuster-Hauser Syndrome and hysterectomy due to uterine malignancy. Congenital or acquired abnormalities of uterus (multiple large fibroids in uterus and Asherman's Syndrome) Unknown recurrent miscarriages Repeated failures in ART cycles in spite of having high quality embryo and appropriate growth of endometrium Pre-existing medical condition that may exacerbate during pregnancy and jeopardize a woman’s health such as acute heart failure, renal failure, some malignancies, autoimmune diseases (Lupus erythematosus and diabetes) Evaluation of Applicants Couples looking for a surrogate should be evaluated from different areas before the treatment and receive guidance on therapeutic cycle and existing legal and social rules. The length and frequency of counseling sessions depend on the specialist and considering of a couple’s need. In the sessions, related experts should clarify the legal standards, treatment consequences, In a meeting conducted with both parties (genetic parents, surrogate and her husband), the consent forms must be completed and the surrogacy contract has to be signed. Couples seeking a child through surrogacy should be assessed by the relevant specialists (gynecologists, andrologists and urologists) in terms of reproductive health. Evaluation of surrogate and her husband The purpose of providing counseling for a surrogate and her husband is to inform them of the treatment process and any possible long and short term effects. During counseling, legal, ethical, psychosocial and medical issues as well as probable side effects are fully explained for surrogate and her husband (if she is married). Moreover, their consent, motivation, firmness of decision, criminal record, education level and marital relationship are also considered. After providing legal counseling and obtaining informed consent, the gynecologists evaluate surrogate candidate in terms of reproductive health. The specialized team should evaluate surrogate candidate in view of physical and mental health, drugs addiction, incurable diseases and factors of high risk pregnancies. Upon confirming healthy of the surrogate and providing required information, a contract is signed in the presence of both parties. In this situation, Avicenna Infertility Clinic plays a significant role in executing the contract, resolving any possible problems and monitoring the time of health evaluation for both biological and surrogate mother.