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[1] Ovarian Stimulation and Egg Retrieval |
Step 1 > Step 2 > Step 3 |
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| Baseline Test |
Donor & Recipient: Office visit is scheduled day 2 or day 3 following the donor's and recipient's respective onset of menses for the purpose of a baseline ultrasound examination and a blood test (usually for follicle stimulating hormone (FSH) and estradiol.) |
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| Ovarian Suppression |
2-4 Weeks
Donor & Recipient: A combination of oral contraceptives and/or Lupron is then used to synchronize the two women's cycles. (If the recipient has no cycles of her own, this makes the synchronization easier in that no medications are needed to control her cycle.)
Oral contraceptives are begun to help begin the ovarian suppression process. They are continued for two to four weeks.
Overlapping with the oral contraceptives, Lupron is begun about two weeks before the start of ovarian stimulation. Lupron is a daily injection that is used to complete the pre-stimulation ovarian suppression. Down-regulation with Lupron takes about two weeks to achieve. For this reason, Lupron is begun 14 to 17 days before the anticipated start of stimulation. At the end of this time, another office visit is scheduled and an ultrasound and blood test performed to ensure that down-regulation has been achieved. |
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| Ovarian Stimulation |
8 - 12 Days
When both donor and recipient have achieved low estrogen levels, treatment proceeds as follows:
Donor: Begins ovarian stimulation with injectable fertility medications. Lupron is continued at a lower dose and a precise number of ampules of fertility medications per day is begun. Since we may need to change the dose of medication during the day, it is most convenient if the patients take their injections in the evening.
Recipient: Begins oral estrogen therapy |
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| Cycle Monitoring |
Starting Day 5
Donor: Regular office visits are now begun, starting with day five of stimulation and then continuing every one to two days until follicle aspiration. During each office visit, an ultrasound and blood test for estradiol are performed. You must call at the end of the day (about 3:00 p.m.) to obtain the results of your blood test and to receive further instructions for continued medication.
Recipient: The recipient's cycle is adjusted to that of the donor as determined during the donor's monitoring. |
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| Ovulation Induction |
Between Day 8 and 12
Donor: Ovulation is triggered with an injection of human chorionic gonadotropin (HCG), administered when the follicles are judged to be mature. HCG is most often prescribed between 8 and 12 days after the start of injectable fertility medications. The timing of the HCG dose is very important, because follicle aspiration is performed 36 hours after the HCG. |
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| Egg Retrieval |
36 Hours After HCG
Donor: On the day of follicle aspiration, you will be asked to come to the office about one hour before your scheduled retrieval procedure. You will go home approximately two hours afterwards. For example, for a 10:00 a.m. aspiration, you should come to the office at 9:00 a.m. and expect to go home sometime after 12:00 noon. The aspiration procedure itself takes less than 30 minutes.
Recipient: Begins progesterone suppositories on the day of the donor's egg retrieval. |
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[2] Fertilization & ICSI |
> Step 1 Step 2 > Step 3 |
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| Sperm Collection |
Day of Egg Retrieval
Recipient's Male Partner: Sperm are obtained from the recipient's male partner on the day of egg retrieval, typically about 12:00 noon. In about 50 percent of cases, an additional specimen is obtained 48 hours prior to follicle aspiration, on the day of HCG. Occasionally, a final specimen may be requested on the morning after egg retrieval, if fertilization is sub-optimal and the embryologists have reason to believe that an additional sperm specimen would be useful.
In order to optimize sperm quality, it is best to abstain from ejaculation for two to seven days prior to the first sperm specimen. In most cases, this will mean abstinence after the seventh day of fertility medications to the donor. |
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| Fertilization |
Day of Egg Retrieval
Sperm are then joined with the eggs to allow fertilization.
If Indicated: Intra-Cytoplasmic Sperm Injection (ICSI) will be conducted. |
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| Assisted Hatching |
Day of Egg Retrieval
If Indicated: Assisted Hatching is conducted to facilitate fertilization. |
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| PGD |
3 Days After Retrieval
If Indicated: PGD (testing for genetic conditions and/or gender determination) is done when the embryo is at the 8 cell stage, typically 3 days following fertilization. Results returned within 24 - 48 hours. |
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[3] Embryo Transfer and Luteal Phase Support |
> Step 1 > Step 2 Step 3 |
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Embryo Transfer
Note: Tubal transfers are done within 24-48 hours of aspiration. |
3-5 days After Retrieval
Recipient: This is a simple procedure, which does not require anesthesia, but the patients are given Valium to help relax the muscles. Therefore, it is important that each patient have someone to drive them home afterwards. Patients are asked to arrive 30 minutes prior to embryo transfer and must remain in bed for 30 minutes afterwards.
In rare instances, such as when the uterus is anomalous, thus making the standard embryo transfer very difficult to achieve, the embryos may be replaced via the fallopian tubes in a procedure called, "tubal embryo transfer", or "TET". The TET procedure requires a laparoscopy and general anesthesia, and is therefore only used when necessary. It has proved extremely successful for patients with a history of difficult embryo transfer in the past and for women with pre-natal DES exposure. |
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| Excess Embryo Cryopreservation |
Any viable embryos in excess of those transferred to the Recipient's uterus may be cryopreserved (frozen) at this time. |
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| Luteal Phase Support |
Recipient: Since the ovaries are not producing any hormones during the egg donation process, it is important for the recipient to continue to take estrogen pills and progesterone suppositories until they are specifically advised to stop. |
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| Pregnancy Testing |
Day 14 and Day 21
Recipient: Two pregnancy tests are typically done. Blood is drawn in the morning on Day 9 and again on Day 12 following transfer. Your Physician will contact you with the results, which are typically available later that afternoon. |
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