IVF: The Step-by-Step Guide to Conceiving Your Embryos

In-vitro fertilization (IVF) is the most critical factor in the success of your surrogacy journey. Every healthy embryo is one chance to become pregnant. Even perfect embryos will produce a pregnancy in only 70% of transfers. So, the more high-quality embryos your IVF conceives, the more likely will be your ultimate success.

by William (Bill) Houghton & Caitlin Goodwin ,
Egg Donation Step 1

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The first step of any surrogacy journey is to conceive several healthy embryos through an in-vitro fertilization procedure. To begin an IVF cycle, the Intended Parents must visit their chosen IVF clinic to donate eggs and sperm. The eggs and sperm are combined in the embryology lab to conceive multiple embryos.

“In vitro” literally means “in glass,” referring to the laboratory glassware used in the process. Once conceived, the embryos are incubated until they are ready for transfer to your surrogate. At that point the embryos can be stored frozen at the clinic until you and your surrogate are ready for the next step.

It all starts with excellent egg and sperm donation by the Intended Parents. More on donations can be found in the Surrogacy Guide. Here is a summary of what you need to know.
 


Egg and Sperm Donation for IVF

Sperm donation is easy and can be done in an afternoon. Egg donation is more complex and requires about 2 weeks of hormone treatments (called ovarian stimulation).

A successful stimulation will result in many mature and healthy eggs to retrieve (which will then translate to many healthy embryos to transfer). The more eggs that are retrieved, the more embryos will be fertilized, and the better are your chances of a pregnancy.

Within the donor’s ovaries are fluid-filled sacs called ‘follicles’. A healthy follicle contains one egg. Under normal circumstances, one follicle matures each month and the egg is released toward the midpoint of the woman’s menstrual cycle.

Surrogacy-costs-worldwideIn an IVF cycle, “stimulation” treatments are used to force the maturation of many available follicles within the ovaries. The fertility doctor then retrieves the contents of each follicle by using a long needle inserted into the ovary, through the vagina. Once collected, the contents of the follicles are examined to see how many follicles contained eggs, and how many eggs were adequately matured.

An “average” donation may retrieve 12 follicles, which would provide 10 mature eggs, which could result in 8 embryos, of which 3 may be of very good quality. Some younger and very fertile donors may provide 20 follicles or more. Women in 40s may have only 1 or 2 follicles.

While it is true that a single embryo can result in a successful pregnancy, becoming pregnant often requires several attempts. The reality is that the standard Embryo Transfer has a success rate of 65%. For this reason, it is important for parents to understand the importance of a successful donation that provides multiple eggs and many high-quality embryos.
 

Egg Donation Made Simple

Whether you donate your own eggs or hire a donor through an agency, the stimulation process is the same. Stimulation can best be described in 3 steps, each is required of every egg donor:

1) Check that your egg donor is qualified. Blood tests will determine fertility hormone levels, which are an indication that the ovaries are producing healthy eggs. An ultrasound scan will visibly confirm if the ovaries have multiple “follicles”. Each follicle should contain one egg, so we hope for many visible follicles. Poor results in either exam means you should consider a different donor.

2) Plan your IVF cycle. The egg donor must travel to the clinic at the start of her menstrual cycle. Egg donation will require about two weeks of hormone injections under the watch of her fertility specialist (also known as a Reproductive Endocrinologist). Those two weeks will begin on Day 1 of her cycle.

It’s possible to synchronize the beginning of a donor’s cycle (and thus the donation) by taking standard 21-day oral contraceptives. The pills will suppress the donor’s cycle until she’s ready to be begin her fertility treatments. When the woman is prepared to donate, she can simply stop the pills and her cycle should start about 4 days later. Using this method, it’s possible to manage the donor’s cycle and the IVF schedule.

The egg donor must be under the care of a fertility specialist when her cycle begins. In most cases this will be the doctor at the IVF clinic, but in some cases may be her own private doctor in consult with the IVF clinic.

3) Stimulate your follicles. On Day 1 of the egg donor’s cycle she will immediately begin 14 days of hormone injections. Stimulation will mature the ovarian follicles and produce several viable eggs. A successful donation will result in 10 to 16 mature eggs. Stimulation injections typically happen at the IVF clinic, although the first week often can be done at a local clinic in consult with the clinic doctors.

Throughout the stimulation program the donor will receive regular blood tests and occasional ovarian scans. After the first week, the doctor may adjust the medication based on how well she is responding. A final ovarian scan around Day 12 will determine when the donor will donate.
 


What is the IVF Process?

Immediately after the eggs are retrieved, they are fertilized with the genetic father’s sperm. Fertilization can be done using a traditional fertilization technique, but more often clinics will now use a technique called intracytoplasmic sperm injection (ICSI).

Human eggs do not freeze as well as sperm or embryos, so we recommend fertilization of all the eggs following retrieval. Embryos freeze much better. In our experience, frozen eggs have about an 80% survival rate during freezing/thawing, while frozen embryos have over a 90% survival rate. Besides, research shows that pregnancy rates with fresh eggs are slightly higher than with frozen eggs. For this reason, most clinics prefer to perform IVF immediately and freeze the resulting embryos.

To fertilize the eggs, most IVF clinics now use a process of Intracytoplasmic Sperm Injection (ICSI). This process captures a single healthy sperm cell under a microscope and directly injects it into an egg. This process alleviates many problems related to poor sperm count or quality. Many men with low sperm count can have successful IVF cycles using ICSI.

Once the eggs have been retrieved and fertilized, they are left to develop in an incubator for 5 days. After that time, most embryos will have advanced to the “blastocyst” stage. A blastocyst is the development stage just before the embryo begins to attach to the uterine wall, develop a placenta, and grow into a fetus.

Quality of embryos may be rated from “Very Good” to “Poor”. The basis of the quality score is in the number of times the embryo has divided (it’s development) and the form and structure of the cells and cell components.

On Day 5 the clinic will present the parents with a summary of the IVF procedure showing the final development of all the surviving embryos. In a typical IVF cycle, around 50% of all fertilized eggs should develop into useable Blastocysts.

Not all blastocysts are equal quality. Even though they may reach Day 5, there will likely be some embryos that are poor quality or are underdeveloped according to different criteria. These may be unlikely to develop into a pregnancy. Your clinic may be kept in storage or discarded depending on their policy.

At the Blastocyst stage the embryos must either be transferred into the surrogate’s uterus or frozen for transfer later on.
 

Fresh or Frozen Sperm for IVF

Most IVF cycles will use frozen sperm. The frozen sperm is thawed when the donation is underway. Fresh sperm donation needs to be made at the same time that the egg donation occurs. If egg donation is delayed (which is not uncommon due to the unpredictability of women’s menstrual cycles), sperm donation would be delayed also, sometimes by several days.
 

PGD/PGS Analysis

During the embryo development, you may choose to have some “Preimplantation Genetic Screening” (PGS or PGD) performed on the embryos. PGS is s generic term for several different tests, but two are most common. A PGS/PGD test using FISH technique will remove a cell from a Day 3 embryo and test it for specific chromosomes. FISH test will find chromosomal abnormalities in about 6 of the 23 chromosomes. It will also determine the sex of the baby.

PGS/PGD-cGH uses a microarray technique and a cell from a Day 5 embryo, and tests for abnormalities in all 23 chromosomes. This test is more complete and accurate. However because the PGD-cGH test requires a Day 5 embryo (and takes a full day or two to return a result), the PGD-cGH requires that all embryos be frozen while the test results are processed. Some beleive that freezing the embryos reduces the probability of success, although the research on this is conflicted. For this reason, many clinics recommend PGD-cGH only in cases where there is a suspected risk of chromosomal abnormalities, while other clinics include it as a general protocol in every IVF case.
 


Shipping Frozen Embryos

In many cases the IVF clinic will ship embryos to clinics worldwide for transfer to an overseas surrogate. It’s possible to conceive embryos at an overseas clinic and send them to the United States, and some parents consider this as a way to reduce the cost of the surrogacy program, but it’s not as easy as it sounds. It’s much more common for couples to conceive their embryos close to home and send them abroad for transfer to a surrogate mother.

Shipping frozen embryos internationally takes advantage of favorable exchange rates and the lower cost of living, making surrogate compensation more affordable in US Dollars. Parents also benefit from more secure surrogacy legislation in countries like Ukraine.

Your surrogacy agent can manage the transport of frozen embryos to clinics worldwide, including shipping costs and paperwork.
 

For more details, read these articles in the Surrogacy Guide:

 

About the authors

  • William (Bill) Houghton
  • Author: William (Bill) Houghton

    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
  • Caitlin Goodwin
  • Reviewer: Caitlin Goodwin

    Caitlin Goodwin is a Board Certified Nurse-Midwife and Advanced Practice Registered Nurse. She has an M.S. in Nurse Midwifery and an (M.S.) in Nursing from University of Toledo. She is a regular contributor to nursing blogs and academic resources. Caitlin lives in Berea, Ohio.

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