Overview of the IVF Procedure via Surrogacy
Surrogacy = In Vitro Fertilization
IVF is a form of assisted reproductive technology (ART). In this case, medical techniques are used to help a woman become pregnant. The first step involves using fertility medicines to stimulate the ovaries for the production of several mature eggs. This process is commonly referred to as controlled ovarian hyper stimulation. After the intended mother's ovaries have been stimulated, the eggs are retrieved, inseminated with sperm from the intended father and incubated. The resulting embryos are subsequently transferred into the surrogate's uterus.
Dr. Nandita Palshetkar talked about IVF and surrogacy
Ovarian Stimulation of the Intended Mother
The medicines, commonly called fertility drugs, are given to the woman to boost her egg production. They can maximize the probability of a live birth. Hormone injection is one key to this success. Our Indian doctor uses stimulating hormones and other hormones to stimulate production of as many high quality eggs as possible. During the 7 to 12 day ovarian stimulation, multiple ultrasound examinations and blood estrogen determinations are used to follow the development of the eggs. When the eggs are ready for retrieval, another subcutaneous injection is administered of human chorionic gonadotropin (HCG) to optimize the process, completing the maturation of the eggs.
Retrieval is usually scheduled between 34 and 36 hours after the HCG injection, and non-surgical oocyte retrieval is performed in our clinic. The surgery is normally done as an outpatient procedure in the doctor’s office. Typically, procedures only last about 20 minutes. Using ultrasound guidance, a hollow needle is injected through the back wall of the vagina into the follicles. Only the tip of the aspirating needle needs to enter the pelvic area. Being that 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 fallopian tubes. Each follicle usually contains a single egg, which is not visible on the ultrasound. The fluid in the test tube is inspected under a microscope in the laboratory to find the egg(s). The woman may have experience residual side effects after the surgery – cramping, nausea (from the anesthesia) and spotty bleeding are possible, but they usually subside within a day. A day after the procedure, women may resume normal daily activities.
In rare cases, a pelvic laparoscopy may be needed to remove the eggs. If a woman cannot or does not produce any eggs, our partners’ donated eggs program may be used.
The intended mother’s fresh quality eggs are placed together with the best sperms and stored in an environmentally controlled chamber, which is the culture dish containing the ovum to allow for fertilization. Male infertility - an intracytoplasmic sperm injection (ICSI) can be performed to directly inject a single sperm into the egg to achieve fertilization. The next day, embryologists examine the eggs for signs of fertilization. A normally fertilized egg (zygote) will show two pro nuclei, which represent the genetic material from the egg and sperm. A healthy zygote will multiply 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.
Embryo Transfer to Surrogate mother
When the fertilized egg divides, it becomes an embryo. Our laboratory staff will regularly check the embryo to make sure it is growing properly. One to five days after egg retrieval, the embryo(s) are transferred to the surrogate's uterus. In order to transfer, the embryo is passed with a thin embryo transfer catheter through the cervix to the top of the uterus.
No more than 3 embryos may be placed into the surrogate mother womb at the same time because it could lead to multiple births. The exact number of embryos transferred is a complex issue that depends on many factors, especially the woman’s age and the quality of the embryos. Embryos that are not transferred at this time are stored in liquid nitrogen for later use.
Testing of Pregnancy
Two weeks after the embryo transfer, our doctor will perform a blood test, and two weeks after a positive pregnancy test, a fetal heartbeat ultrasound is done. Estrogen and progesterone supplementation of the pregnancy continues for 6 to 8 weeks. The placenta now produces enough of its own estrogen and progesterone so that the supplementation can stop. Six weeks into pregnancy, the pregnancy sac is approximately an inch in diameter. The baby inside the sac is about 0.5 inch long.
REMEMBER – You are two weeks pregnant at the time of your transfer, so your 1st ultrasound is approximately four weeks from your transfer. At this ultrasound, a fetal heart should be detected.
Intended Parent Risks
IVF requires a significant physical, financial, emotional and time commitment. Stress and depression are common among couples dealing with infertility. A woman taking fertility medicines may have abdominal pain, bloating, headaches, mood swings and other side effects. Many IVF medicines must be given by injection, often several times a day. (Our doctor will show the couple how to properly mix the medicines and give a shot.) Injections can cause bruising.
In some cases, fertility medications may cause ovarian hyper stimulation syndrome. This condition causes a buildup of fluid in the chest and abdomen. Other symptoms include abdominal pain, bloating, rapid weight gain (10 pounds within days), decreased urination despite drinking plenty of fluids, vomiting, nausea and shortness of breath. Mild cases can be treated with bed rest. More severe cases require draining of the fluid with a needle.
Risks of egg retrieval include reactions to anesthesia, bleeding, infection and damage to structures surrounding the ovaries, including the bowel and bladder.
There is a risk of multiple pregnancies when more than one embryo is placed into the womb. Carrying more than one baby at a time increases the risk of premature birth and low birth weight. (However, even a single baby born after IVF is at higher risk for prematurity and low birth weight.) It is unclear whether IVF increases the risk of birth defects. Medical studies to date have concluded that fertility medications/drugs are not linked to ovarian cancer.