Overview of the Cycling/Transfer Process

For some of you with questions of what is involved in cycling and transfer, I thought I'd share with you the details that go into this process. The protocols vary but this information is pretty accurate in describing all that it entails. ~ Tiffany

The surrogate and the egg donor (intended mother) synchronize their cycles, usually with birth control pills. About 14 days into the birth control pills, usually both surrogate and egg donor will start Lupron. Lupron is a subcutaneous (just under the skin) injection to shut down the bodies normal hormone production so the doctors can control your cycle and be sure the surrogate's uterus is ready to receive the embryos at the exact time for the best chance of success.

The surrogate is usually about a week or so ahead of the egg donor to ensure her uterus will be ready when the eggs are retrieved and fertilized, and because they can keep the SM in a holding pattern for up to 2 weeks once her uterine lining is at optimum.

When your menstrual cycle starts while on Lupron, your Lupron dose is usually decreased by half and you start adding Estrogen replacement to the mix (in the form of pills, patches, or shots depending on your doctor). Some doctors have you take other medications as well (Dexamethasone to suppress male hormones to increase implantation, antibiotics to guard against any infection that might have gone undiagnosed, etc.)

The egg donor starts on injectable fertility hormones on her cycle day 3 to stimulate her ovaries to produce several eggs as opposed to just 1 or 2. Fertility hormones continue anywhere from 7 to 12 days depending on the egg donor's response to the hormones. The egg donor is checked about 3 times a week via ultrasound and blood tests to determine her response to the drugs.

Once the follicles are the right size (about 18-20mm) she is given an HCG shot which induces an LH surge which also matures the eggs. 36 hours after the HCG shot, they do the egg retrieval. Up until this time, the date/time of your transfer is in limbo.

The eggs retrieved are fertilized with sperm from either the Intended Father or a sperm donor and incubated for 2-5 days. Lupron usually stops the day before egg retrieval. Progesterone replacement (most often in the form of intramuscular injections, but sometimes with suppositories or Crinone gel) starts the day of the retrieval and continues until the 12th week of pregnancy or a negative pregnancy test. Estrogen replacement also continues until the 12th week of pregnancy (when the placenta takes over hormone production). Because you were on Lupron and your natural hormones were suppressed, you need to take external sources of these very important hormones in order to maintain any pregnancy that occurs.

When the fertilized embryos are at the proper stage, they are loaded into a special syringe with a thin flexible catheter at the end. The catheter is inserted thru the cervix into the uterine cavity (sometimes with the assistance of abdominal ultrasound to ensure EXACT placement of the embryos) where the embryos are "injected". Most doctors will only transfer three to four 2-day old embryos or two 5-day embryos. Any unused embryos are frozen for a future attempt if a pregnancy doesn't result from the fresh cycle. Bedrest of anywhere from 2 hours to 3 days is usually required immediately following embryo transfer.

Hopefully after all this a pregnancy is achieved, if not the process starts all over again.


Information summary from http://www.surromomsonline.com/articles/gs_process.htm