Overview of IVF with Gestational Carrier

Gestational Carrier - Main Page

The specific steps involved in an IVF cycle with a Gestational carrier are outlined below:

1) Intended Parent Screening

Evaluation of the intended parents involves a number of tests, some of which may have been done in the past (and some of which do not need to be repeated). Additional testing may be indicated in some couples. At this visit, the doctor may perform a pelvic ultrasound. Standard testing includes:

• Semen analysis
• Recent Pap/mammogram
• Ovarian function
• Infectious disease testing
• Psychological evaluation
• History and physical exam

Donors

There are two types of donors:

• Known donors:  A friend or relative of the recipient who is willing to undergo ovulation induction and sonographic egg recovery.
   
• Anonymous donors: Awoman who has been selected through an agency. Anonymous donors receive compensation from the recipient for their time and inconvenience.

2) Gestational Carrier Screening

All intended parents and Gestational Carriers must undergo psychological evaluation prior to starting a cycle. This can be done by our counselor for all parties or if using an agency recruited carrier the agency may arrange for the same. This is to ensure that all parties involved are emotionally stable, and recognize that the carrier has no “claim” to a baby born as a result of the treatment cycle. The Gestational carrier must be seen for a history and physical exam. Records from previous pregnancies, deliveries, and any OB/GYN treatments are required. The carrier is also required to complete a medical history form. All parties involved in the gestational carrier cycle, including the partner of the prospective carrier must have infectious disease screening. An evaluation of the uterine cavity of the carrier may also be performed.

3) Donor Screening

All donors must be screened by a counselor trained in the issues related to Reproductive Medicine unless they are acquired through an outside donor program. This is to ensure that the donor is emotionally stable, recognizes the commitment and the expectations of the oocyte-donation process and that she understands that she has no “claim” whatsoever to a baby born as a result of the Donor Oocyte Program. Both known and anonymous donors are asked a list of questions mandated by the FDA to ensure that they have no risk factors for transmitting disease and are seen for a history and physical exam by our physician. They must also complete a medical/genetic history form. Blood tests drawn on donors include blood type and Rh factor, HIV1+2, HTLVI+2, HIV1/HCV NAT, HepB SAg, HepC, RPR, Chlamydia and Gonorrhea, Cystic Fibrosis, Complete blood count, and any other genetic testing recommended by the physician. The potential donor will then identify a “target” month to undergo the ovarian stimulation process.

4) Gestational Carrier Preparation for the Active Cycle

Once the gestational carrier and intended parent/donor baseline data is complete and a match has been made, the intended parents will be contacted to discuss schedules.
If the gestational carrier is not on oral contraceptives, she will be asked to start them, and then start agonist such as Leuprolide Acetate prior to the actual cycle. This medication works to suppress her reproductive cycle to ensure she doesn’t ovulate or menstruate during the time she receives the embryo(s). This medication is given by a small subcutaneous injection. The carrier will be taught how to self-administer this injection.
When the gestational carrier’s ovulation is suppressed and when the intended parent/donor is ready to begin the ovarian stimulation, the gestational carrier will come to the clinic for a baseline ultrasound.

• Gestational Carrier will begin the Estradiol Patches/Estrace as shown on the sample outline. She will then follow the scheduled appointments to check her lining.
   
• If using fresh semen, the male partner is required to be available on the day of the intended parent/donor’s egg retrieval (when the oocytes are recovered). He will need to be retested for infectious diseases within 7 days of the retrieval of eggs, per FDA law. He will need to donate sperm the morning of retrieval. He should abstain from ejaculation 3-5 days prior to the day of egg retrieval.
   
• The Gestational carrier should plan on being available 3-5 days after egg retrieval for the embryo transfer.

Note: The exact days for egg retrieval and embryo transfer may vary depending on the intended parent/donor’s stimulation.

5) Intended Parent/Donor’s Preparation during Active Cycle

The intended parent or egg donor’s stimulation cycle will have to be synchronized with the Gestational carrier. The intended parent or donor will receive detailed information about their medications and how to take them. The medications used for the oocyte provider generally are agonist such as Leuprolide Acetate to suppress ovulation, an FSH to stimulate multiple follicle development and HCG to trigger follicle maturation. These medications have been used for years in fertility programs with few associated adverse side effects. These medications are given by injection and the patient will be taught how to do this prior to starting the cycle.

We emphasize that timing is extremely important! The gestational carrier’s uterus must be ready to receive the embryo(s) and the intended parent/donor’s oocyte(s) must be mature at the precise time of removal. Therefore, the intended parent/donor will be monitored by ultrasounds and occasional blood tests. In spite of these measures, there is an estimated 1-5% chance that ovulation will occur prematurely. If this happens, egg retrieval will not be done and another cycle may be attempted later if the intended parent/donor is willing. There are a small number of donors that don’t stimulate on the dose selected and the cycle may have to be canceled Egg Recovery from Intended Parents or Donor.

The egg donor or intended parent will be required to sign consent for the procedure needed to remove the oocytes. The egg retrieval involves ultrasonic location of the follicles and aspiration of the eggs by means of a special needle. Moderate sedation is used for this procedure, so the patient will need someone to drive her home after the procedure.

6) Fertilization of Oocyte(s) and Development of the Embryo

This is broken down into several sequential steps which are described as follows:

Sperm (semen) collection - if using a fresh sample it needs to be collected the morning of the egg retrieval. The sample must be collected in a sterile container and be brought to the lab within 45 minutes of collection, or the sample can be collected at our facility on the morning of the retrieval.

Oocyte culture and fertilization -Once the eggs are received by the embryology laboratory, the eggs will be placed in special fluid media and allowed to stabilize for a few hours. The sperm specimen will be washed, incubated and then placed in with the egg(s). If Intracytoplasmic Sperm Injection (ICSI) is being used it will be performed at this time.

Results of Oocyte Retrieval - A preliminary report of the number of eggs obtained will be given to the intended parents as soon as possible after the egg recovery. Not all the follicles aspirated can be expected to yield an oocyte (egg). All stages of oocytes can be recovered: mature, immature and post-mature. The following day, the intended parent will be contacted about the fertilization of the eggs. This is not the final number of embryos but an early assessment of fertilization. The embryos will be evaluated on day 3 after retrieval and the decision of a 3 day or 5 day transfer will be discussed.

If more embryos develop than should be transferred, the embryos will be evaluated at the blastocyst stage to determine if they are appropriate for cryopreservation.

7) Transfer of Embryos to Gestational Carrier

The Gestational carrier will return to the clinic 3-5 days after the intended parent/donor’s retrieval. The intended parents and partner of the carrier may come with the carrier to the embryo transfer. No anesthetic is required but a mild oral medication may be given if relaxation is requested. A very fine catheter will be placed inside the uterus through the cervix and embryo(s) will be transferred into the uterine cavity. The carrier will then rest for approximately 1/2 hour. After the transfer, the gestational carrier should not do any strenuous activity for the first few days.