The Gestational Surrogacy Process
An Overview of a Typical IVF Cycle
1. Egg Production
The IVF cycle is performed on the donor (or intended mother) using one or more fertility drugs to increase the number of eggs produced. Multiple follicles (the part of the ovary that contains the eggs) are needed to increase the number of eggs retrieved, thereby increasing the number of embryos developed and hence the chances for conception.
The process begins with the synchronization of both donor and carrier's menstrual cycles and may require using the medication Lupron. The donor will also be taking daily injections of Fertinex, Follistim, or Gonal-f to encourage this multi-follicular development. Follicular maturation is evaluated by daily blood levels and ultrasound. At a time determined by the physician, an injection of human Chorionic Gonadatropin (hCG) is given to bring the eggs to final maturity. Approximately 35 hours after this injection, the donor will undergo the egg retrieval that is done in the clinic on an outpatient basis.
2. Preparing The Uterus For Implantation
The carrier will be hormonally synchronized to the donor using Estrogen and Progesterone. The carrier's endometrial receptivity will be evaluated similarly using blood tests and ultrasounds. In addition, the angle and depth of the cervix and uterus will be determined using a catheter identical to the one that will be used for the actual embryo transfer.
3. Egg Retrieval
Aspiration of follicles for eggs is performed through an ultrasound guided approach under IV sedation. The retrieval consists of aspirating the ovarian follicles and identifying the eggs in the follicular fluid under a microscope. The eggs are then held in an incubator until the time of insemination in the laboratory. On this day, the sperm donor (or intended father) will be expected to produce a sperm sample that will be used to inseminate the eggs.
4. Embryo Transfer
The embryo transfer may be done 3-5 days after the retrieval. The physician performing the transfer will discuss with the carrier and the intended parents the status of the embryos and the number to be replaced. The number of embryos transferred varies according to their quantity and quality. At this point, there may be an opportunity to cryopreserve any remaining embryos that continue to develop normally, for possible transfer in future cycles.
The embryo transfer is done under sterile conditions, in a reclining position with legs up, as if having a pap smear. The transfer is easy and virtually pain free in most cases. Following the transfer the carrier is required to lie flat for a half hour and afterwards may return home to relax for the remainder of the day.
5. Testing for Pregnancy
Approximately 2 weeks after the transfer, the carrier will take a blood pregnancy test. If it is positive, the clinic will generally monitor you for several more weeks before discharging you to your own obstetrician.