The Surrogacy Guide
Many women request surrogacy late in life, but the unfortunate truth is that after 35 years a woman’s fertility begins to diminish rapidly. For this reason, women over the age of 35 should carefully confirm their ability to donate eggs. Here is the process required to confirm that a Future Mother is also a viable egg donor.
You can use your own eggs (a “self-cycle”) so you remain the genetic mother of the child.
Not every woman qualifies — fertility tests such as AMH, FSH, and ultrasound follicle count are required to confirm you can successfully donate eggs.
Egg donation involves hormone stimulation, baseline scans and hormone tests, followed by an egg retrieval procedure.
The number and quality of eggs retrieved strongly affect how many healthy embryos you’ll have, and therefore your pregnancy chances.
Women over age 35 must carefully assess egg quantity and quality, since fertility and egg reserve decline more rapidly with age.
If fertility tests don’t support your own egg donation, using a donor egg may be the recommended path forward.
The results of your egg retrieval will depend on a number of factors, from the age of the donor, her stimulation protocol, and the polices of the reproductive endocrinologist handling the procedure. A young donor (in here early 20s) with an aggressive stimulation protocol and a doctor who is focused on the quantity as well as quality of eggs retrieved, could result in 20 or more eggs. An older donor in her 30s could cut that number in half. Aggressive stimulation can lead to ovarian hyperstimulation syndrome (OHSS), so your doctor may prefer a lighter touch, reducing even further the number of eggs retrieved.
As an example, let’s assume an egg donation retrieves 12 eggs. In a typical cycle, these eggs may result in 10 successfully fertilized embryos, of which 4 may be of very good quality. Even though only one embryo is needed to make a successful pregnancy, in reality a standard Embryo Transfer with medium to good quality embryos will result in a pregnancy only about 60% to 75%. So the more eggs are retrieved, the more high-quality embryos will be available for transfer (and the grater the likelihood of pregnancy). This is why a successful donation that provides multiple eggs and many high-quality embryos is so critical.
1) On day 2 of your cycle, you need to do a ‘Baseline Ultrasound’ (also known as a Follicular Scan). This is used to gauge the ovarian volume and an antral follicle count. The number of follicles seen is a strong indicator of the number of eggs to be retrieved.
2) Also on day 2 of your cycle, you will need to undergo a blood test to gauge hormone levels and overall fertility. Along with basic information, the scan should include fertility hormones including LH Hormone, FSH Hormone, Estradiol, and AMH hormone levels.
Note that If the FSH level on day 2 is more than 10 and the AMH level is less than 1.0, you would not be considered a viable candidate for egg donation. In addition, the clinic normally requires a minimum of 6 visible follicles.
After this baseline scan and blood tests are completed, the doctor will review the results and provide an evaluation.
Assuming you test positive as an ED (egg donor), the next steps will be to choose a date for your donation and the implantation of the surrogate. You will donate and the eggs will be immediately fertilized with your partner’s sperm. You should plan to be at the clinic for about 2 weeks to fully prepare you for the donation, and then make the extraction.
For more information about improving your chances of a successful egg donation (and fertility health generally), check out this article by the American Pregnancy Association.
To help your chances of being a successful egg donor, you can begin taking these over the counter supplements well in advance of your medical evaluation. Here are some supplements that are generally recommended to help with general fertility as well as egg quality.
It’s important to work with a doctor or nutritionist to figure out the right supplements and doses for you.
Also known as Vitamin B9, Folic Acid is important in all aspects of pregnancy from pre-conception onwards. Some of B9’s important functions are:
DHEA is a hormone made in the body that leads to the production of estrogen in women. However, at a certain age DHEA levels start to decrease, which can lead to fertility issues, such as decreased egg quality.
Studies have shown positive effects on egg quality about 6 weeks of DHEA supplementation. The positive effects of DHEA continued to accumulate up to about 16–20 weeks of supplementation.
The antioxidant coenzyme Q10 (CoQ10) is found in most living things and is used by cells to process energy. CoQ10 decreases as people age so some fertility doctors suggest supplementation with CoQ10, as they believe it might help protect the DNA of eggs and mitochondria from long-term damage as well as enhance energy metabolism of eggs, which is needed for normal cell division.
Zinc plays an important role in many key reproductive health areas including egg production, as a woman’s body needs zinc to produce mature eggs that are ripe for fertilization. Zinc is also one of the minerals that helps regulate hormone levels.
Selenium is a mineral that protects the reproductive system from free radical damage and also promotes healthy cell division. Selenium also aids the development of healthy ovarian follicles, which are responsible for the production of eggs.
Omega-3 fatty acids help to regulate hormones and have been shown to help fertility. They also assist in increasing cervical mucous, promoting ovulation and increasing blood flow to the reproductive organs. They also reduce inflammation and can help normalize a woman’s cycle.
Please check with your pharmacist or doctor that over-the-counter supplements are available.
(Obviously any potential donor should not smoke or abuse alcohol or drugs.)
Bill Houghton is the founder of Sensible Surrogacy, author of the Sensible Surrogacy Guide, 2x surrogacy dad, and a dedicated advocate for secure, legal and ethical Gestational Surrogacy. Read Bill's Biography
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