Surrogacy & Oocyte Donation
Oocyte donation combined with gestational surrogacy is one of the most effective treatments available to help infertile couples achieve pregnancy. The probability of a live birth depends greatly on the fertility potential of the oocyte donor and with good quality eggs the probability of a baby is 60-80% at NOVA IVF.
This treatment is used if the intended mother is unable to conceive or carry a pregnancy in her uterus and cannot or should not for genetic reasons get pregnant with their own eggs. It allows a couple to have a child genetically linked to the intended father.
The most common reasons for surrogacy are the intended mother’s previous hysterectomy, congenital uterine malformations and medical conditions that may make being pregnant too risky for the intended mother. The most common reason for needing egg donation is age-related suboptimal oocyte quality.
Finding an egg donor and a surrogate is the first step in initiating the surrogacy with oocyte donation treatment. The donor and the surrogate can be your relatives, friends, or you may use one of the many oocyte donor and gestational surrogacy agencies nationwide. These agencies have a number of pre-selected young oocyte donors and surrogates available. The above document lists oocyte donation and surrogacy agencies NOVA IVF has been working most closely with. Your donor and surrogate do not have to live locally or even in this country.
All potential egg donors are screened at NOVA IVF for over 100 genetic diseases.
Family gender balancing/pre-implantation genetic diagnosis (PGD) can be added to the oocyte donation with gestational surrogacy treatment.
If sperm cannot be obtained by masturbation, it can be aspirated from the testes or epididymis.
Process of Oocyte Donation with Gestational Surrogacy
The gestational surrogacy with oocyte donation procedure is similar to in vitro fertilization: after the egg donor’s ovaries have been stimulated, the eggs are aspirated, inseminated with sperm from the intended father, incubated and one or more of the resulting embryos are subsequently transferred into the surrogate’s uterus.
Below is an example of a gestational surrogacy with egg donation treatment sequence. Actual treatment is individualized.
All medications are given as pills, skin patches, vaginal capsules or small injections. All stages of this treatment take place in our clinic.
1. Ovarian Stimulation
To maximize the probability of a live birth, the egg door takes FSH (follicle stimulating hormone) to stimulate production of as many high quality eggs as possible (usually 6-14 eggs). During the 8 to 12 day ovarian stimulation, several ultrasound examinations and blood estrogen determinations are used to monitor the development of the eggs. When the eggs are ready for retrieval, your donor will take a trigger injection. This injection completes the maturation process of the eggs.
The ultrasound image above shows fully stimulated ovaries. Each of the follicles (15 to 25 millimeters in diameter) contains a practically microscopic egg.
2. Egg Retrieval
Thirty-six hours after the trigger injection, a non-surgical oocyte retrieval is done in our center. This is typically a 3-7 minute procedure.
Using ultrasound guidance, a thin aspirating needle is passed through the top of the vagina into the follicles. Only the tip of the aspirating needle enters the pelvic area. Since the ovaries are located just above the top of the vagina, the tip of the needle is passed into the follicles without penetrating the uterus, cervix or the fallopian tubes.
The intended father collects a semen sample by masturbation either at home or at our office and the highest quality sperm are added to the eggs several hours after the egg retrieval. If your infertility history suggests the possibility of a male factor significant enough to keep the eggs from being fertilized using regular laboratory methods, the ICSI procedure will be recommended. ICSI or Intracytoplasmic Sperm Injection, is a micromanipulation technique in which a single sperm is inserted directly into an egg.
The next day, NOVA’s embryologist will examine the eggs for signs of fertilization. A normally fertilized egg (zygote) will show two pronuclei representing the genetic material from the egg and sperm (first image below). The following day, embryos reach 4 cells, the day after, 8 cells and by day 5 after egg retrieval, they should reach the blastocyst stage.
4. Embryo Transfer
One to five days after the egg retrieval, the resulting embryo(s) are transferred into the surrogate’s uterus by passing a thin embryo transfer catheter through the cervix to the top of the uterus. This procedure is always done under ultrasound guidance. This dramatically increases the chance of the embryo(s) implanting and causing a pregnancy. Sometimes the ultrasound will be transabdominal and other times it is better to be transvaginal. Regardless of the ultrasound method, embryos are never “blindly” placed into the uterus.
Extra embryos that are not transferred at this time can be cryopreserved and stored in liquid nitrogen.
5. Establishment of Pregnancy
A blood pregnancy test is scheduled approximately two weeks after the embryo transfer. A fetal heartbeat ultrasound is done two weeks after a positive pregnancy test. Estrogen and progesterone supplementation of the pregnancy continues for 6 to 8 weeks. By that time, the placenta produces enough of its own estrogen and progesterone so that the supplementation can stop.
This ultrasound picture shows an eight week pregnancy. The baby inside the sac is about an inch long, yet it is possible to already distinguish the head and the bottom portion of the baby’s body.