Exploring the Stages of IVF in Surrogacy

IVF (abbreviated as In Vitro Fertilization) is a process that involves the creation of an embryo outside the body, which is transferred into a woman’s uterus. 

A complete IVF cycle involves steps like ovarian stimulation, egg and sperm retrieval, fertilization, and finally, embryo transfer. The process typically takes between two to three weeks, and sometimes more than one IVF cycle may be needed to achieve pregnancy. Here are the stages of IVF.

Preparatory Phase

Before starting IVF, it is customary for a medical center to obtain consent from involved parties, evaluate medical history, and perform a physical examination to ensure a high probability of conception. 

Various blood tests are also taken to detect and exclude infections that may be sexually transmitted and blood-borne.

Downregulating Natural Hormone Cycle

The first step in IVF is often downregulation. This involves using medication to temporarily stop a woman’s natural menstrual cycle, sort of like inducing a temporary menopause. Medications are taken either in the form of self-administered daily medication or nasal spray, taken for about two weeks.

Ovarian Stimulation

Ovarian stimulation follows downregulation. This involves the administration of medications to stimulate the ovaries to produce multiple mature eggs.

In a typical menstrual cycle, only one egg is released each month. However, in IVF, we aim to collect multiple eggs to increase the chances of successful fertilization.

Medications used for ovarian stimulation often include injectable drugs containing follicle-stimulating hormone (FSH), luteinizing hormone (LH), or a combination of both. To further help the eggs mature, other medications, such as HCG, are used. These ensure that the eggs are ready for retrieval.

When the eggs are ready for retrieval, doctors recommend progesterone supplements to prepare the uterus lining, making it more receptive to implantation.

The exact timing for these medications can vary. Doctors work with individuals to determine the most appropriate medication and timing for each case.

Egg Retrieval

When the eggs are considered mature, a minor surgical procedure is performed to retrieve them, typically done under sedation.

Around 36 hours, a “trigger shot” is given to help the eggs mature. The eggs are retrieved in an office-based procedure. The timing of the retrieval is critical because waiting too long can risk ovulation and the loss of viable eggs. It is a minor procedure that typically takes between 15 to 20 minutes.

During this procedure, the eggs are extracted using a needle guided into each ovary using ultrasound. The eggs are then kept in a culture medium, to which sperm is added to achieve fertilization.

Based on the feedback from reproductive experts and women who have undergone the procedure, some may experience mild cramps or slight vaginal bleeding afterward. Doctors usually provide medication to relieve these cramps and discomfort after the retrieval procedure. 

Sperm Retrieval

If fertilization is to be done using a partner’s sperm, a semen sample is requested on the morning of the procedure. If donor sperm is to be used in a specific case, it is harvested well in advance and frozen in a sanitary environment.

In most circumstances, a semen sample is collected through masturbation. However, depending on various fertility and health factors, sperm may be obtained surgically in a procedure called testicular aspiration. Skilled experts then separate the sperm from the semen fluid in a laboratory.

Fertilization

In most cases, the retrieved eggs are combined with the collected sperm in a laboratory dish for fertilization. This can be done using two primary methods. These methods include;

Standard/Conventional Insemination

Healthy eggs and sperm are mixed in a laboratory petri dish and left to incubate overnight, aimed at achieving natural fertilization.

Intracytoplasmic Sperm Injection (ICSI)

Standard insemination depends on the availability of between 50,000 to 100,000 motile sperm. If the sperm parameters are abnormal, ICSI is used to pick a single sperm with microneedles, which is injected into the cytoplasm. 

Thus, ICSI increases the chances of fertilization if the semen sample shows low sperm count, motility, poor morphology, or progression.

The fertilized eggs, now called embryos, are left to grow in the lab for about six days before they’re ready for transfer.

Embryo Culture

The fertilized eggs (embryos) are cultured in a special incubator for a few days, typically up to five days. During this time, the embryos develop and are assessed for their quality and viability.

Embryo Selection

The best-quality embryos are selected for transfer into the woman’s uterus. The number of embryos to be transferred depends on various factors, including the woman’s age and the quality of the embryos. Up to three embryos are transferred for women above the age of 40, while up to two embryos are used per cycle for women under the age of 40.

Extra embryos may be cryopreserved (frozen) for future use.

Embryo Transfer

The selected embryos are transferred into the womb using a catheter, a thin medical tube passed into the vagina. The process is relatively straightforward compared to egg collection and does not require sedation.

The number of transferred embryos depends on the age and health of a woman undergoing the process.

After the embryo transfer, medications like progesterone are often given to support the uterine lining and help with embryo implantation.

After the embryo transfer, medications like progesterone are often given to support the uterine lining and help with embryo implantation.

Pregnancy Test

About 10-14 days after the embryo transfer, a blood test is done to determine if the woman has become pregnant.

IVF in Surrogacy

IVF in surrogacy is a thoughtful process that helps individuals or couples create families with the support of a surrogate. This approach offers various options, from fresh cycles to using frozen embryos. Surrogacy provides opportunities for intended parents to create a family when a natural pregnancy is not possible.

In gestational surrogacy, an egg from an intended mother (or egg donor) is fertilized with sperm from the intended father or that from a sperm donor in a laboratory. The fertilized egg is then transferred into a surrogate’s uterus, after which she carries the pregnancy to term. 

In surrogacy, when a fresh cycle is chosen, both the surrogate and the intended parents actively undergo fertility medication to synchronize their cycles. Alternatively, embryos can be created and immediately cryopreserved (frozen) for later transfer.

If there is a failed implantation, intended parents can opt for a second embryo transfer. If the implantation is successful, an IVF clinic monitors the surrogate until 10 to 12 weeks, after which a certified OB/GYN attends to her.Stages of IVF in Surrogacy

Conclusion: Making Families with IVF and Surrogacy

In the journey of IVF, each step plays a crucial role in the dream of parenthood, from the preparatory phase to egg retrieval, fertilization, and embryo transfer.

Surrogacy, especially gestational surrogacy, offers intended parents a chance to fulfill their parenthood dream. In this process, IVF brings together an egg and sperm in a laboratory, and the resulting embryo is transferred into the surrogate’s womb.

IVF used in surrogacy is a powerful combination of science and compassion. It’s a beautiful part of the journey to making families and achieving the dream of being parents.

 

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Written by David
I work daily to make surrogacy available to as many intended parents, surrogate mothers and egg donors around the world as possible.

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