Clinic or Agency? Two Contracts, Two Ways to Be Replaced

Most people arrive at surrogacy planning to buy a programme, and a programme is not a thing you can hold responsible. It is an agency, a clinic, a lawyer, an escrow administrator and a carrier, gathered under one word because naming them separately would raise a question the brochure would rather answer later: who is accountable for whom.

That question is worth more than the brochure. The clinic and the agency hold different obligations, answer different questions, and can be replaced independently of each other. Treating them as one decision means you cannot tell which half has failed, or which half you are allowed to change.

What each party signs

Four rows, four documents, and a program that describes all four as its own has told you it is a coordinator. That may be true. It is not the same as being the party who owes the obligation, and the distinction is what you are checking.

What only the clinic can answer

These questions cannot be answered by the agency on the clinic’s behalf, however helpful the agency is being:

• Which protocol is used, and who decides how many embryos are transferred.
• Who performs the transfer, and who is in the room for it.
• What the laboratory does, how embryos are stored, for how long, and what happens to them if the arrangement stops.
• What the clinic does after a cycle fails: which tests, on what schedule, and at whose cost.
• Which screening the carrier underwent, and whether you can read the record of it.

The last question is the one to press. A carrier’s screening can be described in a profile and still not be visible as a document, and it is the document that tells you which standard was applied and by whom. The distinction between the profile and the guidance behind it is the subject of what a carrier profile does not tell you.

What only the agency can answer

• How a carrier is found, and against which standard she is screened before she is offered to you.
• What the fee covers, when each part of it stops being refundable, and what is returned if the arrangement ends early.
• Who coordinates between clinic, carrier, lawyers and you, in which language, and with what authority to make a decision.
• What happens if the carrier withdraws, or if the clinic declines to treat her.
• Which of the other parties in the arrangement the agency has a financial relationship with.

That last question is not an accusation. Referral arrangements are ordinary in this field. The point is that an agency paid by a clinic is not neutral about which clinic you choose, and you are entitled to know the direction the money runs before you take a recommendation.

Which one constrains the other

The order is not symmetrical, and getting it the wrong way round is the usual source of wasted months.

1. The destination narrows the clinics. A clinic can only offer what the jurisdiction permits, and eligibility rules may exclude you before any clinical question is asked. That is why the legal questions come first.
2. The clinic narrows the agencies. An agency that has no working relationship with the clinic you want, or no carrier in that country, cannot deliver the arrangement you have designed.
3. The agency’s answers do not change either of the first two. A persuasive coordinator cannot make a clinic treat you, or a country admit you.

People who choose an agency first and then discover that its clinic list does not include the destination they want have bought coordination for a plan they cannot execute. The reverse order costs a little more research and wastes less money.

The test of a bundled programme

Four questions, put in writing, that separate an arrangement from a package:

• Which company signs each of the four documents above, and is that company named in the proposal?
• If the clinic misses a screening the agency assumed had been done, who is accountable, and under which clause?
• Which party holds the money, and who has authority to release it if the two disagree?
• If you wanted to replace one of the two, what does the agreement allow, what does it cost, and what happens to the money already paid?

A programme that can answer all four has told you something real about itself. One that answers the first with “we handle everything” has told you that the answer to the second does not exist on paper.

What a clinic’s number cannot describe

A clinic’s published outcome figure describes its own treatment. It does not describe the agency’s matching, the carrier’s screening, the legal work, or what happens to your money when a cycle fails. When a programme quotes one number as evidence of the whole arrangement, the number is being asked to carry a claim it was never built for, which is the argument set out in how to read a clinic’s published success rate.

What this does not solve

Whether a particular clinic or agency is competent is not answered by a page about how to tell the two apart, and no register exists that would answer it for you. Licences, where they exist, attach to specific activities, and the work of checking what a licence covers belongs to the destination research rather than here.

What is settled here is the split: which questions belong to which party, and which document you should be able to read before you sign.

Questions people ask

Can one company be both the agency and the clinic?

Sometimes, and then the four documents may collapse into two. That is not automatically worse. It does mean the fourth question above matters more, because replacing half of the arrangement is no longer possible, and the party answering for the clinic is the same party selling it to you.

Should we choose the country before the clinic?

Choose the country’s rules before the clinic, and the clinic before the agency. A clinic can only work inside the rules of where it operates, and an agency can only match within the clinics it actually works with.

Do we need our own lawyer if the agency provides one?

The agency’s lawyer represents the agency. Your own lawyer represents you, and the two roles are not interchangeable when a question about the carrier’s or the clinic’s obligation comes up, which is exactly when you need the advice.