OUTLINE OF THE STAGES INVOLVED IN IVF USING DONATED EGGS
2. Obtaining oocytes
4. Embryo transfer
5. Hormonal supplements
To prepare for your cycle we recommend you make certain adjustments to your lifestyle. You should avoid smoking, reduce alcohol consumption and increase your intake of folic acid. Also during this time a sample of the husband or partner’s semen is examined to make sure it is suitable for IVF.
When you have been matched with a donor, you will be given the treatment schedule and a prescription for the necessary medication. An appointment will be arranged with the Nurse Coordinator to discuss the treatment plan, to ensure a clear understanding.
The preparation for ovum donation treatment involves the synchronization of the ovarian cycles of both the donor and the recipient. This ensures that the embryos are placed in the recipient’s womb at the optimal time for their implantation. The preparation of the recipient’s womb is achieved by the use of subcutaneous injections which make the ovaries inactive. This is known as “down regulation”. Many women requiring donor eggs do not menstruate and therefore will not need to use this medication.
Once down regulation has been achieved, hormone tablets, Estrofem or Estradial Valerate are given daily for two weeks before eggs are to be obtained. This hormone prepares the lining of the recipient’s womb to receive the embryos.
An ultrasound scan will be carried out on Day 8 and 11 following commencement of these tablets. This will allow the Doctor to assess the womb lining to ensure that it is the appropriate thickness for embryo transfer.
If the womb lining is satisfactory, an additional hormone, PROGESTERONE in oil, Intramuscular injection is commenced once daily, when directed. This hormone ensures that the lining of the womb is in the best possible condition for implantation of the embryos.
2. Obtaining Oocytes
On the day that eggs are due to be obtained from the donor the recipient’s husband/partner must be available that morning to leave a sperm sample at Barbados Fertility Centre. He should have abstained from ejaculation for at least 2 days beforehand, but not for longer than 5 days.
It is possible that the donor may not respond to her treatment and therefore no eggs become available. This will happen approximately 10% of the time, so couples must be prepared for a last minute disappointment. If no eggs are available, the hormones are stopped and another donor is found as soon as possible, although again there may be a waiting period.
Fertilisation of the eggs is attempted by the manner which offers the highest chance of success. This will have been discussed and agreed earlier with your consultant. The process of fertilization takes 12 to 18 hours and is recognized by characteristic changes which occur in the egg and can be seen under a microscope. The recipient couple will be contacted by the Barbados Fertility Centre on the day after the donor egg collection to inform them of how many eggs have fertilized. If fertilization has occurred you will be advised of arrangements for embryo transfer. If fertilization does not take place, you will be given an appointment to see your consultant to review your treatment.
4. Embryo transfer
The fertilised eggs (embryos) develop in the laboratory for 2-3 days until ready for transfer into the womb. They are replaced through the neck of the womb using a small plastic catheter. This is a painless procedure rather like having a cervical smear test and takes 5-10 minutes to perform.
Only embryos that have been carefully checked and appear to be developing normally are replaced.
Although there is no evidence that resting for a prolonged period increases the chances of pregnancy, strenuous exercise is not advisable in the days following the embryo transfer. Smoking, alcohol and non-prescribed drugs should be avoided.
5. Hormonal supplements
Following embryo transfer the Estrofem tablets and Progesterone Injections should be continued daily as indicated in the treatment schedule you will also start Cyclogest Pessaries after the transfer. These hormones reflect the changes which normally occur in a woman’s body at this time.
While the hormone supplements are being given, a period will not occur, but this does not necessarily mean pregnancy has started to develop. Two weeks after the embryo transfer a urine pregnancy test is carried out. If this is positive, a scan is performed two weeks later to ensure that the pregnancy is inside the womb and that the fetal heartbeat can be seen. The hormone tablets and injections are continued until approximately 10 weeks of pregnancy.
If the pregnancy test is negative the hormones are stopped and a period starts approximately 2 to 3 days later. Another attempt at treatment is possible but other couples who have not yet had treatment will be given priority, so a further wait, which may be lengthy, can be expected. However if you have spare embryos in storage a frozen embryo transfer can usually be arranged within the next few months. A review appointment with your consultant will be arranged following unsuccessful treatment.