Cycle Synchronization
Your actual cycle will begin once you and your recipient couple agree to work together either after meeting the recipient as facilitated by our agency or from information given. Next, you will make an appointment with a therapist located near you for a psychological evaluation. You will sign a release so that the psychological evaluation may be sent to the fertility physician. Once you have passed the psychological evaluation, we will send you a contract to sign, date, and return to us. We will mail you a fully executed contract. Ideally, you should have had a pap smear within the past 12 months and be on the birth control pill, patch or nuva ring after agreeing to work with recipient.
Your first appointment with the fertility clinic is the Medical Screening Appointment (MSA) which may take up to 2 hours. You will have a consultation with the nurse and the physician regarding the procedure sequence, schedule of future appointments, and testing to be done. The medical evaluation includes a medical history and physical examination which includes a pelvic ultrasound to evaluate your uterus and ovaries. Cultures for gonorrhea, chlamydia, mycoplasma and ureaplasma are taken. Your blood will be drawn to check for infectious diseases (HIV, HTLV, Hepatitis B, Hepatitis C, and syphilis). The nurse coordinator will send you a calendar of your cycle and you would fax or email a copy to our office.
Suppression Phase
You will continue taking birth control pills and after completing an injections class at your clinic, begin your injections of Lupron. Lupron brings down your estrogen blood level so that your pituitary gland does not tell your ovaries to release eggs. Once you stop the pill, you will continue the Lupron. A light menstrual period should begin in 1-2 days. On the first day of your period, call the fertility clinic to schedule your baseline ultrasound examination. At this appointment, an ultrasound with a vaginal probe will check for the number of primative follicles.
Stimulation Phase
Follicle Stimulating Hormone (FSH), increases follicle production and matures the eggs. Brand names for FSH are Gonal-f and Follistim. You will know the date of your first monitoring appointment - either day 5 to day 7 - and then you will be told when to return to the clinic based on how responsive your ovaries are to the FSH. Pelvic ultrasounds measure the number and size of the follicles and blood draws determine your estradiol levels because the follicles release estrogen as they grow.
Side effects from the FSH are like PMS: breast tenderness, TIREDNESS, irritability, moodiness, abdominal swelling. Get lots of sleep, no heavy exercise, no heavy lifting (as your ovaries will feel like water balloons), and no alcohol intake, keep stress down, no sexual intercourse and nurture yourself. Be sure to wear loose clothing around your waist as your stomach will swell and this may happen post retrieval for several days.
When your follicles are 18-20mm long, the fertility physician will give you an ampoule of Human Chorionic Gonadotropin (HCG), ( the hormone that pregnant women carry), and your blood will be drawn to measure the blood estradiol level. You must be reachable in the late afternoon when lab results are determined. If the blood estrogen level is 100 times the number of follicles, the physician will tell you the exact time (usually between 8pm-11:30pm) to take the final injection of HCG. The HCG injection is the most important injection as it matures the eggs and helps the ovaries to release the eggs during the retrieval. If the HCG is not taken or improperly taken - not at the hour instructed or not administered correctly- the retrieval could be canceled or no eggs would be retrieved.
Retrieval (36 Hours after HCG Injection)
If your HCG injection was at 9:30 p.m., you will arrive at clinic at 9:00 a.m. At the clinic, you will be given a light analgesic agent by I.V. and go into a light twilight sleep. The retrieval takes about one hour or less. The physician uses the same ultrasound probe with a needle attached and a small catheter attached to the needle which leads into a test tube. The physician uses an ultrasound guided needle and goes through the vaginal wall and pokes into the follicles and aspirates the fluid containing the eggs from the follicles that can be reached. When the test tube is full, the doctor passes the test tube to the embryologist whose lab is next to the operating room. The embryologist mixes the eggs with the sperm in a petri dish and incubates the embryos for 3 days or 5 days before transferring 2-3 of the best into the recipient’s uterus.
There will be residual eggs as not all follicles can be reached so it is critical that you do not have any sexual intercourse while taking the FSH and until after your menstrual period post retrieval. Bring a piece of paper to the retrieval so the nurse may write down the number of eggs retrieved because the analgesic agent will cause you to forget. You will be in recovery for up to 2 hours and the nurse will check you for bleeding from the needle poke. Once you are oriented and are able to drink and eat soda crackers you may leave. A friend must drive you home, no cabs, and a friend should stay with you this first day. If you have problems, such as bleeding or severe cramping, call the fertility doctor immediately and the doctor will instruct you. You may need to return to the clinic or the doctor will tell you to go to an emergency room after the doctor has first notified the E.R.
You may be 2-3 days into recovery when your abdomen swells up again with fluid from the hormones. Be sure to follow post retrieval instructions as to drinking ensure and/or gatorade. You will get your menstrual period about the same time that the recipient is having her blood pregnancy test in 7-12 days. We will tell you the results so you can have closure. There is approximately a 60% chance that the recipient can have a positive pregnancy on the fresh transfer. If she is not successful, hopefully there are frozen embryos for her to have another transfer.
You may have another retrieval three months after your previous retrieval. Most physicians will let you do 6 cycles in total.
CONGRATULATIONS!!! You gave the chance of life to a very grateful couple. |
