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The 9-Step Process of IVF with Egg Donation
See IVF Tour for a more detailed explanation of the IVF process.
Step 1: Recipient Screening
The recipient or aspiring parent is required to undergo thorough clinical and psychological evaluations:
- A mid-cycle ultrasound, post-menstrual hysteroscopy, or hysterosonogram is required, regardless of findings from a hysterosalpingogram. Hysteroscopy is usually performed within one week of cessation of menstruation and may be performed in your doctor's office under local anesthesia. Hysterosonography is also performed within one week of cessation of menstruation and is usually performed in a radiology department of a hospital, or in our clinic.
- The male partner of the couple must provide evidence of sperm function with a semen analysis.
- The male partner will have blood drawn for Infectious disease screening (HIVI, HIV II, VDRL/RPR, Hepatitis B Surface Antigen and Hepatitis C Antibody). The female partner
will be tested for levels of
Prolactin and TSH, Rubella, Varicella, ABO/Rh type and infectious diseases. Genetic screening is also recommended, based on
the couple’s family history and
ethnic background.
- According to the American Cancer Society, all women between the ages of 35 and 40 are recommended to obtain a baseline mammogram, if one has not been performed within the last five years. Women between the ages of 40 and 50 should obtain a mammogram every one to two years, and women over the age of 50 are encouraged to have a mammogram performed every year. Pacific Fertility Center (PFC) strongly encourages women to obtain screening mammograms prior to attempting pregnancy, and requires women 40 years of age and older to supply documentation of a normal mammogram.
- If a pap smear (a screening test for cervical pre-cancer and cancer) has not been performed within the last year, PFC strongly recommends you contact your gynecologist and have a pap smear performed.
- A careful uterine measurement will be performed and is critical to the outcome of IVF. This is performed with the use of a thin, flexible embryo transfer catheter, which is introduced through the cervix to the apex of the uterine cavity. This measurement is critical with regard to the placement of the embryos within the uterine cavity at the time of embryo transfer. This can be done at the time of the mid-cycle ultrasound (prior to any uterine hormonal preparation) or at the time of the baseline ultrasound just prior to starting estrogen.
- If the female partner is 45 years old or older, PFC requires a letter of medical clearance from the primary doctor, who may recommend appropriate tests such as EKG, chest x-ray, or even exercise tolerance tests.
- The intended parent(s) must also meet with our marriage and family therapist, clinical coordinator (for medical clearance), and financial coordinator.
After all of the meetings are complete,
the intended parent(s) can select a donor.
Step 2: Egg Donor Selection
Patients interested in the third party service of egg donation have two options available to them. They can select a known donor (e.g., a family member, a friend) or work through a third party egg donor program that provides anonymous egg donors. If you are considering the option of using an anonymous donor, we suggest you contact the Pacific Fertility Center Egg Donor Agency: our in-house program that offers a diverse donor database and excellent patient services. You can also opt to work with an independent agency that will help you to select a donor.
Step 3: Egg Donor Screening
PFC's donors are thoroughly screened before they are added to the database. Once the donor has been selected by a patient, she will undergo additional psychological and medical evaluations by the PFC team. These pre-cycle appointments include:
Appointment #2
A consultation with a clinical coordinator is made to explain the donor's role in the program and give her medical instructions.
Appointment #3
A general medical history and gynecological evaluation is performed as well as a medical evaluation and pelvic ultrasound with a doctor.
Step 4: Synchronization of the Donor and Recipient
After all parties have completed the required PFC screening, the Donor and Recipient will usually be started on low dose oral contraceptive pills (OCP's). After a minimum period of at least 14 – 21 days of the pill, a hormone called "Lupron" or "Synarel" will be prescribed for both parties. The hormones work to down-regulate the pituitary gland and, in essence, shut down the ovaries. Lupron is taken as a subcutaneous injection, whereas Synarel is administered as a nasal spray. Once it is determined
that both the pituitary gland of the donor and the recipient have been adequately suppressed by the medication, stimulation of the ovaries and endometrium may be initiated respectively.
Step 5: Ovarian and Endometrial Stimulation
Both donor and recipient continue with Lupron injections or Synarel sprays. The recipient will begin estradiol injections in order to prepare her endometrium or uterine lining for the embryo implantation. The donor will begin injections of fertility medications in order to stimulate the growth of numerous follicles in her ovaries. This process is known as controlled ovarian hyperstimulation.
Step 6: Monitoring
During the timeframe that the donor is on fertility medications, she is monitored through routine tests of her estradiol levels and transvaginal pelvic ultrasounds. The monitoring enables physicians to follow the rate of her follicular growth and observe any rise in her estradiol levels. When the physician determines the optimal time for the egg retrieval, the donor receives a final injection of hCG, which will help the eggs to mature for retrieval. During this time, the recipient is also monitored through periodic testing of her estradiol levels and ultrasounds to observe her endometrial thickness.
Step 7: Egg Retrieval
The egg retrieval is a transvaginal ultrasound-directed needle aspiration. This is a minor surgical procedure and is performed under general anesthesia. A vaginal probe (transducer) is placed in the vagina and a needle is inserted through a needle guide attached to the probe. The ultrasound image allows the physician to accurately guide the needle through the vagina directly into the follicles for aspiration under direct visualization. The process takes about 30 minutes. Following the retrieval, the donor recuperates for 1 – 2 hours and is then discharged to resume light daily activities.
Step 8: Fertilization and Embryo Transfer
Fertilization, the union of the sperm and egg, is a very complex process that occurs in the laboratory in Petri dishes (hence the term "in-vitro," which translates to "in glass"). Once the retrieved eggs are in the lab, the embryologist examines them and places them into a specialized culture medium. After the sperm sample is prepared for IVF, it is added to the culture medium: a process known as insemination. Several hours later, fertilization takes place, at which point the sperm enters the egg. Either 3 or 5 days following egg retrieval, selected embryos are transferred to the r ecipient's uterus. If there are embryos of sufficient quality remaining, they may be frozen for subsequent transfers.
The embryo transfer requires no anesthesia. A catheter is inserted through the cervix into the uterus. The embryos are then gently released into the uterine cavity. The recipient is maintained in a recumbent position for approximately fifteen minutes,
at which point she is free to go home.
Step 9: Post Embryo Transfer Management and Follow-up
The recipient will need to take daily hormone injections in order to sustain an optimal environment for the embryo implantation. Approximately two weeks after the embryo transfer, two pregnancy tests are performed. If the beta hCG titer is rising, implantation has taken place. Hormone injections will then be continued until 10 weeks of gestation at which time the placenta will supply all the hormones necessary to sustain the pregnancy. In the interim, ultrasound examination(s) will be performed to definitively diagnose pregnancy between 5 to 6 weeks after the embryo transfer. If the pregnancy test is negative, all hormonal treatments are discontinued and menstruation will usually ensue within two weeks.
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