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The process of becoming pregnant through gestational surrogacy is very similar to a typical in-vitro fertilization (IVF) cycle. The main difference is that the woman implanted with the embryo(s) is not the same as the woman undergoing egg retrieval. The IVF process involves fertilizing an egg with sperm, outside of the mother's body. Once fertilized, it is placed inside the surrogate mother's uterus for development and ultimately, a normal birth. The IVF process was developed in 1978 and has been tested and refined over the past three decades.
The IVF and embryo transfer procedure involves five basic steps, but each patients' individual medical history and condition may require additional procedures or treatments. The following is a step by step outline of the general treatment.
Step 2: Oocyte (Egg) Retrieval
Step 3: Sperm Collection and Preparation
Step 4: Insemination of Eggs and Development of Embryos in the Laboratory
Step 5: Embryo Transfer
step by step gestational surrogacy cycle
Step 1: Ovarian Stimulation with Fertility Medication
Fertility medications are used to stimulate the ovaries to produce multiple mature eggs (oocytes) rather than the single egg that normally matures during a natural cycle. Retrieval of multiple eggs increases the probability of pregnancy since it means several embryos may be available for placement in the uterus.
The medications used to maximize egg production include: GnRH Analogues — Used to suppress the natural production of follicle stimulating hormone (FSH) and luteinizing hormone (LH) hormones in order to control the menstrual cycle and improve the quantity of eggs retrieved. Gonadotropins (FSH) — Synthetic forms of pituitary hormones used to stimulate the growth of follicles in the ovaries, which nourish the eggs. Follicle growth is needed during stimulation to produce healthy eggs. |
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Human Chorionic Gonadoropin (hCG) — Used at the end of a stimulation cycle to induce final maturation of the eggs. While these drugs sometimes are used to induce ovulation, when given in this process, the egg retrieval is timed to allow the eggs to be collected before ovulation occurs.
During the use of gonadotropins, the concentration of estrogen and progesterone circulating in the blood reach levels higher than normal. In a typical stimulation cycle, approximately five blood tests will be collected during the course of medication to monitor these levels. The follicle growth will also be monitored by vaginal ultrasound. Once the appropriate follicle size is achieved, FSH is discontinued and a single dose of hCG is given for final maturation of the eggs. The egg retrieval typically occurs 35-36 hours later.
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Step 2: Oocyte (Egg) Retrieval This procedure is performed under conscious sedation and is conducted by inserting a needle through the vaginal wall into the ovaries. Ultrasound is used to locate each follicle and the follicular fluid is suctioned to collect the eggs. Generally, the oocyte (egg) retrieval takes 30-60 minutes. Patients usually go home within a couple of hours after the retrieval. |
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Sperm for the IVF process is usually collected prior to the egg retrieval. The man is asked to abstain from sex for two to five days prior to the collection, which is usually achieved through masturbation. Stress can sometimes inhibit the man's ability to produce a specimen when needed. In those instances, a semen specimen can be produced and frozen ahead of time. Once the sample is produced, the sperm will be prepared for inseminating the collected eggs in our laboratory.
Step 4: Insemination of Eggs and Development of Embryos in the Laboratory
After the eggs have been retrieved, they are immediately transferred to the adjacent laboratory for identification, evaluation and preparation for insemination. In the process of collecting follicular fluid, usually many eggs are obtained. It is sometimes recommended that all of the eggs be inseminated to maximize the number of embryos available for implantation.
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The prepared sperm is added to each egg, and they will be allowed to incubate under controlled laboratory conditions. In some instances, micro-injection of an individual sperm into each oocyte will be performed in a procedure called Intracytoplasmic Sperm Injection (ICSI). The next day, each egg is evaluated for evidence of fertilization. |
The fertilized eggs will be allowed to develop for one or more days under controlled laboratory conditions before they are placed inside the woman's uterus. Depending upon the patients' wishes, some fertilized eggs or embryos may be frozen and stored for future use in a process called Cryopreservation. Before embryos are transferred to the uterus, the woman will receive progesterone which has been shown to create a more favorable environment for embryos.
Step 5: Embryo Selection and Transfer
Embryo quality is a critical factor affecting the success of IVF. The best embryos are transferred to the uterus based on grade and cell number. In some instances, Assisted Hatching is used to increase pregnancy and implantation rates by enhancing the embryo's ability to escape from the zona pellucida at the blastocyst stage.
Embryos are transferred into the uterus through a small tube or catheter. This procedure does not require anesthesia, as it is usually painless. The embryos are placed in a small amount of fluid inside the catheter, which is threaded through the cervix during a speculum examination. |
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The embryos are implanted so that they reach the top part of the uterus. Abdominal ultrasound is used to confirm the correct placement. Depending on the patient's wishes and age, one or more embryos may be transferred in one treatment cycle.
Depending on the clinic, a pregnancy test will be done approximately ten days after the transfer to determine pregnancy.
Some women become addicted to taking home pregnancy tests as early as two days after the transfer. Some women get faint positive results as early as three to five days following an IVF transfer.
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