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Once the match has been made, it is time for the cycle to begin. Treatment is usually individualized, depending on the diagnosis of the recipient and on her response to the medications involved. The goal of treatment is to carefully synchronize the menstrual cycles of the donor and recipient so that when the donor’s eggs are retrieved and fertilized, the lining of the recipient’s uterus is ready to receive and nourish them. A typical treatment plan will be reviewed here.
We begin by synchronizing the menstrual cycles of the donor and recipient. This is accomplished by pretreatment of the donor with a drug called Lupron that quiets, or down-regulates, the ovaries completely. If the recipient has ovarian function, she is also treated with Lupron. Once down-regulation of both donor and recipient has been confirmed, an artificial common menstrual cycle is established. On the first day of this “artificial” menstrual cycle, the recipient begins taking medication that will prepare the lining of her uterus. Six days later the donor begins medications that will cause multiple egg-containing follicles to develop within her ovaries. The donor comes to our office for frequent blood tests and ultrasound examinations of her ovaries so the follicle development can be monitored and medications adjusted, if necessary. The recipient is contacted with updates as to how the donor is progressing during the course of the donor cycle. When the follicles have reached the right point of maturity, one last injection causes the eggs to complete their preparation for harvest, and the egg retrieval is scheduled.
The egg retrieval generally takes place in the IVF Lab area of our Rookwood office. The donor will be greeted by the IVF staff, admitted and transported to the procedure room. She is given intravenous medications that will keep her comfortable during the egg retrieval.
Using a thin needle and ultrasound guidance, the physician removes the fluid from each follicle. In the IVF Lab, highly trained technologists search through the fluid to find the eggs, which are transferred into dishes containing nutrient growth medium. It is not unusual to have 10 to 12 eggs retrieved from one donor. When the procedure is over, the donor rests for approximately one hour, and then she can go home. Two weeks later she has a final check up. On the morning of egg retrieval, the recipient’s husband will provide a semen specimen so that the eggs can be inseminated. Most often the husband will come to the ART Lab at the Rookwood office to collect the specimen so that no harm from temperature changes or delay in processing occurs. The specimen is then prepared to provide the best chances for the fertilization of the eggs. If your doctor has recommended Intracytoplasmic Sperm Injection (ICSI), that procedure is performed early in the afternoon on the day of egg retrieval. Fertilization is confirmed on the morning following the retrieval. Typically 50% of the eggs will fertilize. Several fertilized eggs are selected for transfer and will remain in the incubator for two more days. The remaining fertilized eggs can be cryopreserved (frozen) for later transfer procedures.
On the day of embryo transfer, the recipient couple should arrive at the Rookwood office about one-half hour before the transfer takes place. The transfer involves placing the embryos in a narrow tube or catheter, which the physician inserts into the uterus through the cervical opening. Following the transfer, the recipient rests for approximately one hour. She is then free to go home and maintain her normal daily routine. Fourteen days later, a blood test will determine whether or not a pregnancy has begun. Pregnancy rates will average 40-60% per fresh cycle.
A positive blood test-how wonderful!-but that is just the beginning. Other tests are also run to check on the levels of estradiol and progesterone in the blood, an indication of the health of the uterine lining. Adjustments to the medications may be made to create the best environment for the embryo to continue its development. Two weeks after the positive pregnancy test, the first ultrasound examination is done to see the developing fetal sac and the fetal heartbeat. A second examination two weeks later will show appropriate growth and development. Bi-weekly blood tests are conducted to monitor hormone levels until the supplemental medications are no longer required, otherwise the recipient continues in the care of an obstetrician.
The use of donor eggs has created many families, and we hope that the information provided in this brochure helps you in your own quest. Please feel free to contact our donor egg program nurse coordinator, Sarah Price, APRN, by calling 513-924-5578 or contact us for additional information.
For more information, please check out our Informational Videos.