PATIENT GUIDE for IN VITRO FERTILIZATION (IVF) PROCEDURES
What is In Vitro Fertilization?
In vitro fertilization refers to a procedure in which your eggs are removed and fertilized (usually with your husband’s sperm) outside the body, in a laboratory dish, and then several days later the embryos are transferred back into your womb. The IVF procedure is, in fact, much more involved than that and involves a series of steps that lead up to the actual laboratory portion of the procedure. This booklet will describe those steps in detail, what is expected of you during each stage and discuss the risks and benefits of the IVF procedure. It is important that you read this manual thoroughly, and bring up any concerns with your doctor at the earliest possible opportunity.
Is IVF an experimental procedure?
No, IVF has been around for a number of years. The first child conceived by IVF is in her thirties and even has had children of her own. Since that time the procedure has improved to the point that its success rates (per cycle) are higher than of natural conception. Millions of babies have been born as the result of IVF cycles. It is possible, though not certain that IVF, and particularly ICSI (where the sperm is injected directly into the egg) may be associated with a higher risk of birth defects. This is a very gray area in the medical literature. If a risk does exist, the absolute risk is relatively small.
What are the some of the reasons for Doing IVF?
- Damaged, ligated (tied) or missing fallopian tubes
- Unexplained infertility
- No success with IUI cycles
- Poor sperm quality
- Antibodies to sperm
How do I reach the doctor and clinical staff?
In order to have your questions answered during regular business hours, please call us at 609-896-4984. Routine clinical (not financial or insurance related) questions can be directed to our nursing line (option 3) or by logging into our secure web portal. Messages left on our voice mail before 2 PM on regular business days will be returned as soon as possible on that date. If you have call blocking, we may not be able to reach you. If you have an urgent issue that cannot wait, enter 0 and a member of our staff will locate the doctor.
All insurance/ financial/ precertification issues should be addressed to Samantha, our infertility benefits coordinator at option 4. She has a direct line at 609-512-4031 and her email is Samantha@delvalobgyn.com.
If you have questions about your embryo storage issues, you will need to address these directly with the embryology lab at Abington. The lab director Dr. Smith can be reached at email@example.com or 215-481-7550.
At night or on weekends, please call Delaware Valley’s main number 609-896-0777, and the answering service will put you through to the person on-call for Dr. Derman or whomever is on call for infertility. Please let the person answering the phone know that you are a patient of Dr. Derman, and that it is IVF/infertility related.
Our affiliation with Abington
In order to have the best chances for success with IVF, an excellent laboratory is crucial. We pleased to be affiliated with the Toll Center for Reproductive Sciences / Abington Reproductive Medicine. The Toll Center is one of the most experienced IVF facilities in the Philadelphia area and has among the highest pregnancy rates in the area. Dr. Derman will perform the egg retrieval and embryo transfer for you on site at Abington, as these procedures need to be done in a procedure room immediately adjacent to the laboratory. All the remainder of the office visits including office visits, blood tests and ultrasounds will be done at Princeton IVF in Lawrenceville.
Toll Center for Reproductive Sciences
Abington IVF and Genetics
1200 OLD YORK RD
ABINGTON, PA 19001
Directions to Abington from the Princeton area:
- Follow I-95 or US-1 to US-1 South
- Get on the Pennsylvania Turnpike at Neshaminy- West towards Harrisburg
- Get off at the first exit 343, PA-611 South towards Willow Grove/Abington
- Follow PA-611 South for 4 miles
- Turn right onto Horace Ave, then right onto Highland Ave
- Turn right into the Woodland Parking Garage
- After you park the car, enter the hospital on the G-level
- After you pass the Price Office Building elevators, make a left into the Arches Building and the Toll Center is right there
- On weekdays, there will be a receptionist to greet you. On weekends, take the elevator directly to the second floor.
The following items must be completed prior to starting an IVF cycle:
(instruction sheets for the first four items are available in the office or online)
(1) Sonohysterogram (SHG) must be performed at some point to check the lining of the uterus, and to give us a chance to figure out how best to replace your embryos. The procedure is done weekday mornings 6-9 AM. A trial (practice) transfer and cervical cultures will done be at the time of your SHG.
(2) Day 3 FSH/LH/E2 level- this blood test is drawn on the third day of bleeding or the next closest weekday in order to determine if you are a candidate for IVF and how best to stimulate your ovaries. It measures the “ageing” of your ovaries. A good level is below 10. The AMH blood test and antral follicle count on ultrasound gives us similar information, but do not replace day 3 FSH levels.
(3) Semen analysis- this is done after 3-7 days of abstention, and run in our office. Samantha can help set up the appointment. This is important to determine whether we can do standard IVF or require ICSI.
(4) Endometrial Biopsy- this is done within the week prior to the start of your fertility medications. In some patients, this may improve the effectiveness of IVF.
(5) Injection Teaching- this appointment will be scheduled within the week prior to the start of your fertility medications. One of our staff will sit down with you to go over the medications individually and teach you how to administer the meds which will you start shortly. You may wish to bring your partner to this visit if they are planning to help you with the injections. Please bring in your box of medications to this appointment. It is our hope that this appointment will make you more comfortable with your treatment.
(6) You and your partner must have screening bloodwork for sexually transmitted diseases. You will also need a blood count and blood type.
(7) Review and sign the IVF consent form and the cryopreservation (freezing) consent form. We recommend embryo freezing whenever possible. Please make sure your partner signs where indicated, and that all pages are initialed. We must have this form by the day you start medications!
(8) Consultation with Dr. Hirshberg - required only if the male partner has no sperm and TESA or MESA is required. He is a subspecialist urologist who performs sperm aspiration and biopsy procedures at Abington. In some instances, the sample can be frozen and saved for the upcoming egg retrieval. This must be scheduled well in advance.
(9) Financial clearance- you must be cleared by Samantha before fertility injections can begin. It is your responsibility to make sure this happens. We cannot allow Follistim, Gonal-F, Menopur or any fertility drugs to begin until this are done.
(10) Special arrangements- if you are using donor sperm, preimplantation genetic testing or screening, PICSI, or any non-standard procedures, all arrangements must be made well in advance.
The Steps involved in the IVF procedure:
(1) Shutting down the ovaries with leuprolide and/or birth control pills
(2) Stimulating the ovaries with fertility drugs
(3) Harvesting the eggs
(4) Fertilization in the laboratory
(5) Embryo transfer
(6) Support of the luteal phase
(7) The pregnancy test
Here is a description of each step:
1. Shutting the Ovary Down with Lupron and/or Birth Control Pills
Most of our patients with undergo a stimulation protocol that involves the use of Lupron or leuprolide, an injection that starts on day 20 of the cycle before the actual IVF cycle. Leuprolide is a GnRH antagonist, which initially stimulates and then suppresses the ovary. Sometimes taken along with birth control pills, the leuprolide will synchronize the egg development, and then later on, prevent premature ovulation. It can cause headaches and hot flashes. In order to be instructed to be on this protocol, you will need to come in by day 20 for injection teaching in order to start the medication. Your medication will start on at a dose of 10 units and then later on drop to 5 units. You will be given a cycle calendar which tells you when drop your leuprolide dose to 5 units and your schedule for the week when you start stimulation.
Birth control pills may also be used and can be started during the first week of the cycle before we do the IVF or on day 20 of that cycle. This helps to balance out your hormone levels, improve the quality of your eggs and minimize the hot flashes if you are on Lupron. If you are on the pills, you will take the pills, daily at the same time, and continuously. That means no placebo/blank pills and no skipped pills until you are instructed to stop. If you run out, you will start a new pack. In order to avoid confusion, you may wish to discard the placebo pills. Some women will experience nausea, bloating or irregular bleeding on the pills. If this happens, do not be concerned.
If you are on a protocol that uses Ganirelix or Cetrotide, you will almost certainly take birth control pills beforehand.
When you start the pills, be sure the doctor knows, so that we may give you a date to stop the pill. If you start your period and the pills over the weekend, you may wait until Monday morning to call us. The pill stop date will be after about 1 1/2 weeks, and is almost always on a Sunday. If you stop the pills too early or too late or take placebo pills instead, we may not be able to start your cycle when planned.
We will help schedule you for an appointment for ultrasound and bloodwork, on the Friday of the week you are scheduled to start fertility drugs. We will also set you up for an endometrial biopsy and injections teaching (if needed) on that same week. You will likely start your injectable medications on SATURDAY. We call this “Day 3” though it may not really be the third day of your period. Your period most likely will begin a day or two before “day 3,” but do not be concerned if it has not begun.
2. Stimulation of the Ovaries with Injectable Fertility Drugs
Human Menopausal Gonadotropins (hMG, Menopur) and Follicle Stimulating Hormone (FSH, Follistim, Gonal-F, Bravelle): Menopur is a fertility drug which contains equal amounts of FSH and LH and is extracted from the urine of postmenopausal women. FSH and LH are hormones that will stimulate multiple eggs in a given cycle, when given in higher than natural doses. Follistim and Gonal-F contain only FSH (synthesized in a laboratory), and are given by a specifically designed pen that is similar to an insulin or epi pen. Bravelle also contains FSH (extracted from urine) is given by a small subcutaneous needle after reconstitution. The FSH-only drugs are generally given at night so we may adjust the dose as needed. In the morning you will use Menopur, which you will need to reconstitute each day before injecting. Most of these meds are given subcutaneously, in the thigh or abdomen. In patients who respond poorly to the medications, the shots may be given by intramuscular injection in the buttocks.
Once your ovaries have been suppressed (leuprolide and/or birth control pills) you will be brought in for an ultrasound and blood work and will be started on the fertility medications. The start day is called “DAY 3” and may or may not coincide with the third day of your period. Most likely your fertility drugs will start on a Saturday. We will give you instructions on the timing and dosage of your injections. You should not start your fertility medications unless you have had blood work and ultrasound the day prior (Friday). During the stimulation, you will have ultrasounds and blood work 2-4 times a week until the follicles have reached a mature size, usually when the largest 2 are 18 mm in diameter. Maturation of the eggs typically takes 7-10 days.
Ultrasounds and bloodwork are scheduled as follows:
Mon-Fri 6-9 AM, Sat 7 AM only
Patients are seen on a first come-first served basis. If you show up later, we cannot guarantee you will be seen.
Most patients receive their fertility injections twice a day. They may be subcutaneous (a small 25-30g needle or pen just under the skin) or intramuscular (a larger 22G needle in the buttocks or a small needle in the shoulder). The doctor will make a determination on what will be the best mixture for you. The medications may include a mixture of Follistim, Gonal-F or Bravelle, and Menopur.
The major side effects include risk of ovarian hyperstimulation and multiple pregnancies. Although these preparations are considered generally safe, the long-term effects, if any (including concerns about the risk of ovarian cancer), from their use are currently unknown. Headaches and mood swings may occur as well.
Ovarian Hyperstimulation is one of the major, potential complications of treatment with injectable fertility drugs. Mild to moderate hyperstimulation is quite common and consists of a mild to moderate degree of ovarian enlargement and abdominal discomfort, and usually resolves on its own. Limited activity and Tylenol are normally all that are needed to alleviate symptoms. Severe ovarian hyperstimulation syndrome is far less common but is potentially life threatening. Severe ovarian hyperstimulation syndrome involves massive ovarian enlargement due to multiple ovarian cysts, accumulation of fluid in the belly and chest cavities and rarely blood clots (thromboembolism). This disorder is most common in women with polycystic ovaries, and those who produce more than 20 eggs or have very high estradiol levels. The best treatment is prevention. The disorder rarely becomes severe unless a cycle results in pregnancy. Ways of minimizing this problem from occurring include decreasing the doses of medications, taking Metformin, giving intravenous albumin infusions, withholding hCG and canceling the cycle, and retrieving the eggs but freezing the eggs for transfer at a later time.
Signs that should alert you to the development of this syndrome include abdominal distention (bloating), rapid weight gain of more than 2 pounds in one day and difficulty taking a deep breath. When diagnosed, hospitalization is rarely required. In some patients, aspiration of the fluid with a needle in the office may be helpful.
Multiple pregnancies occur in over 1/4 of IVF pregnancies and are mostly twins or occasionally triplets. If you have triplets or especially quadruplets or more, you should seriously consider a fetal reduction procedure to bring the number down to 2. As this may be a difficult moral dilemma for many couples, you should discuss this possibility with your partner in advance.
For those patients who are not taking leuprolide, after 4-5 days of stimulation with fertility drugs, you will start a third daily injection. Ganirelix is subcutaneous needle that comes in a premixed syringe and is taken each morning from the time you are instructed until the hCG shot (described below). It is a GnRH antagonist and is there to prevent your eggs from releasing prematurely. Side effects such as headaches are uncommon. If you do ovulate prematurely, your cycle will most likely be cancelled. On occasion we will use another drug Cetrotide which has a similar mechanism of action and similar side effects
3. Harvesting the Eggs
When the eggs are of mature size, usually 18 mm, you will receive instructions on when to take your hCG shot (Novarel, Pregnyl, Chorionic Gonadotropin, Ovidrel). For Ovidrel, you will inject one prefilled syringe in each should at the exact prescribed time. For the other types of hCG, the mixing is as follows: The box contains a vial of water and a vial of powder that says 10,000 IU. It is mixed as follows, draw up 3 cc of saline into the 22G needle/syringe and add it to the hCG powder, mix and inject intramuscularly in the buttocks. Be sure that once you have added the saline, you have drawn back all of the mixture. This injection must be given exactly at the time you were told to take it. If you are more than 15 minutes off, you must let the doctor know first thing in the morning. On the day of hCG, you will also begin a short 6-day course of antibiotics (doxycycline) and steroids (Medrol-methylprednisolone).
Egg retrieval is performed transvaginally with ultrasound guidance under IV sedation, and takes approximately 15 minutes. Dr. Derman will perform the procedure at Abington. An ultrasound is performed at which time a needle is inserted into each follicle and the egg and follicular fluid is aspirated. You will receive deep sedation given by an anesthesiologist. The risks of transvaginal aspiration of follicles include infection, bleeding and damage to the adjacent organs. Occasionally hospitalization, transfusion, intravenous antibiotics and/or surgery are required. Though exceedingly rare, deaths have been reported following the procedure.
Please keep the following things in mind for your retrieval:
1. You should arrive in Abington 1 hour before your retrieval
2. Your male partner should abstain 2-7 days before the retrieval. He will produce his sample on site at Abington
3. Both you and you partner will need to bring a driver’s license or other form of photo ID.
4. You may not eat or drink after midnight the night before or morning of your retrieval. You may shower and brush your teeth but no swallowing water
5. Wear comfortable clothing
6. Please do not bring jewelry, valuables or children
7. Do not wear perfumes of any kind- the scent may be toxic to embryos
8. You will stay at the center for 30-60 minutes after the procedure. Do not plan to return to work that day.
4. Fertilization in the Laboratory
After the retrieval, the eggs are immediately handed over to the embryology lab. Your partner will provide a fresh semen sample shortly after you arrive at the Toll Center and our staff will prepare the sperm. (If you are using donor sperm you must arrange for the sperm to arrive at Abington Reproductive Medicine- not Princeton IVF at least a week before retrieval) The eggs and sperm are placed together overnight and we will find out if the eggs have fertilized the following day. If you are having ICSI, the sperm are injected directly into the egg, but even then, fertilization is not always assured. A member of Abington's staff will call to inform you about fertilization the day after retrieval.
Intra-Cytoplasmic Sperm Injection (ICSI) is a laboratory procedure in which a single sperm is inserted directly into the cytoplasm of an egg cell. This is done in cases of very poor sperm quality or failed fertilization in the past, or if the number of eggs is very small. It is performed on the day of retrieval. This is usually necessary in cases of sperm abnormalities. Some studies have suggested a slightly higher instance of abnormal sex chromosomes in infants conceived by ICSI while other studies have shown no risk with ICSI. In the case of a male child, this may cause your husband to pass on a gene that may cause his male offspring to be infertile.
PICSI is a sperm selection method for patients with highly fragmented sperm DNA who have failed previous IVF cycles. PICSI is used in conjunction with ICSI. This method may help to select mature healthy sperm for injection.
Assisted hatching is a laboratory procedure in which an acid solution or laser is used to drill a hole in the zona pellucida, a protective coating around the egg. Women who are over 35, have embryos with thick zonas, doing frozen embryo cycles or have failed IVF in the past may benefit from this procedure.
If you have excess fertilized eggs, you have the option of embryo cryopreservation (freezing and storage). The extra embryos will be frozen and then stored for transfer at a later time, without having to undergo stimulation with the fertility drugs. We routinely freeze only embryos that reach the blastocyst stage on day 5 or 6 and are of good quality. Choosing to participate in the freezing program will give you extra chances at IVF, at a lower cost, with less monitoring and with fewer medications. If you wish to participate in the cryopreservation program, you must tell us in advance, and sign the cryopreservation consent forms. The forms contain places where you indicate what you want done with your embryos should we be unable to find you in the future.
Embryo cryopreservation, assisted hatching and ICSI incur extra charges which may or may not be covered by your insurance. If not, any charges may be required up front, before you start your fertility drugs.
During this time there are a number of events that may prevent you from reaching the next stage. The eggs may fail to fertilize or those that do fertilize may not divide properly or look grossly abnormal. A culture dish where the embryos are kept may become contaminated making the embryo(s) not suitable for transfer. Additionally, power outages, acts of g-d and other unforeseen events may occur.
5. Embryo Transfer
This procedure is usually performed three or five days after the egg retrieval and without the use of anesthesia. The timing of the transfer will be based on the number of eggs fertilized. While we prefer a day 5 transfer, it may be risky if there are not enough embryos available. An abdominal ultrasound is used, so you will need to have a full bladder. You should drink one liter of water on the way in to Abington. Women who are younger or who have a large number of fertilized eggs may undergo a blastocyst transfer in which embryos are transferred at a later stage on day 5. This will minimize the risk of high order multiple pregnancies. The procedure is brief and lasts only a few minutes. A soft plastic catheter is introduced into the uterus through the cervix and the embryos injected, while we watch on the ultrasound. Embryo transfer is rarely painful. Rarely, it may impossible to pass the catheter. Side effects of the procedure include mild cramping and minimal bleeding. After a brief period of recovery you will be discharged and kept at home on bed rest for the next 24 hours.
6. Support of the Luteal Phase
The last part of the menstrual cycle is called the luteal phase, and during this time, large amounts of a hormone called progesterone is secreted to help maintain the early pregnancy. Since we will be removing some of the hormone producing cells, it will be necessary to replace it with medication.
Most patients will receive intramuscular progesterone-in-oil injections. These are daily shots which usually start 1 day after the retrieval. A 3cc syringe with a large 18G needle is used to draw up 1 cc of the medication. Warming up the oil may help in drawing the medicine up. You will then change to the 22G needle and inject high in the buttocks.
You will also be on Estrace (estradiol) 2 mg orally daily beginning the day after retrieval.
Instead of the progesterone injections, you may be given Progesterone vaginal cream (Crinone 8%) or vaginal inserts (Endometrin). These medications start 2 days after transfer. Crinone is given twice a day and Endometrin 3x a day, morning, day and night.
The progesterone shots and/or suppositories will continue until the doctor clears you to switch to progesterone pills or you have a negative pregnancy test. Progesterone levels will be drawn several times to make sure the dosing is correct.
Do not stop progesterone until you are instructed to do so by the doctor. Vaginal bleeding does not always mean the procedure has failed.
7. The Pregnancy Test
You will have a progesterone level drawn 4-5 days after the transfer. Then two pregnancy tests will be done, on approximately days 10 and 12 after the embryo transfer. Most of the time, results will be ready the same day. You will not be given the results until the second beta (pregnancy test) is back. That way we can give you an accurate assessment on what is going on. Once positive, it is essential we follow you closely will biweekly hCG and progesterone levels and ultrasounds as needed. As with all pregnancies, the risk of miscarriage and even ectopic (tubal) pregnancy exists with IVF pregnancies.
- In some cases IVF cycles need to be canceled, and it is very important that you understand this. The following are some of the reasons:
- you do not respond adequately to the medication
- you over respond to the medication and the physician decides that it is too risky to your health to allow the cycle to proceed. In such a case, you may be given the option to go to retrieval and freeze vs. withholding the hCG shot.
- the LH or progesterone hormone levels rise prematurely indicating that the eggs are likely to release prematurely
- you do not take the hCG when or how instructed to do so
- egg retrieval procedure yields no eggs
- the eggs do not fertilize
- the fertilized eggs do not divide or look grossly abnormal
After cancellation, we can discuss if any additional testing is needed and make plans for a new IVF start if that is appropriate.
IVF and Stress
Infertility and its treatment are among the most serious sources of psychological stress you and your partner are likely to endure. It is important that the two of you are both strongly committed to doing IVF and are supportive of each other. If not, you may wish to consider counseling before beginning the cycle. Reducing your stress levels will improve your chances for success. We have a counselor to whom we can refer you if you need. Some of our patients find acupuncture to be helpful, and we can assist you with that as well. Other sources for support include Resolve (a national network of infertility patients with a local chapter), books and internet chat sites.
Special Types of IVF
Patients who are carriers for known genetic diseases, desire gender selection or have a history of recurrent miscarriages due chromosome abnormalities, may be candidates for Preimplantation genetic diagnosis (PGD) or Preimplantation genetic screening (PGS). PGD refers to testing for specific genetic diseases. PGS (also known as CSS or comprehensive chromosomal screening) also can help us maximize your chances of embryo implantation and lower the risk of multiple pregnancy. We now prefer to do PGS only when the embryos reach the blastocyst stage on day 5 or 6 since it is far more accurate. If we are able to do a biopsy on day 5, it may be possible to have the results back in time for a fresh day 6 transfer. Since is not often the case we recommend on planning for freezing the embryos and the transferring the frozen embryos back the next month if the testing results are normal.
On day 5 or 6, a small portion of the outer cell mass (the portion of the embryo that becomes the placenta) is removed by the staff at Abington. The cells are sent offsite of one of several tests:
1. Array CGH or NexGen Sequencing. This is used to screen for imbalances in the numbers of chromosomes such as Downs syndrome and Turner syndrome, and can help select the embryos most likely to take and least likely to miscarry. It can also be used for sex selection. This is the technique used for PGS/CSS
2. Single gene PCR. This is used to screen for disorders cause by a single abnormal gene such as Cystic Fibrosis or Sickle Cell Anemia
3. FISH. This is currently used to screen to screen for chromosomal translocations that cause recurrent miscarriages.
Arrangements for PGD/PGS will need to be done well in advance and the cost is usually not covered by insurance. At the current time, our genetic testing is done through Genesis Genetics one of the premier genetic testing laboratories in the world.
Frozen Embryo Transfer
As discussed above, we strongly encourage couples doing IVF to freeze any extra embryos. This will enable you to have extra chances for having a baby, with much less hassle and cost than normally is associated with IVF. We use a mixture of hormones to simulate a natural unstimulated cycle.
The frozen embryo cycle works as follows: You will start a medication called Lupron (leuprolide) on day 20 of your cycle. Lupron is a GnRH antagonist, which suppresses the ovary and throws you into a temporary menopause. It can cause headaches and hot flashes. We will teach you how to do the injections at that time. The dose will start at 10 units daily (0.1 ml). When your period comes, the dose will drop to 5 units (0.05 ml) and you will schedule an endometrial biopsy during your period and an ultrasound and blood work at the tail end of your period, during our morning hours. Please make sure you have filled out and returned to us the consent form as soon as possible.
At the time of ultrasound, if your endometrium (the uterine lining) is thin enough and your estradiol level is low enough, will be begin a protocol of increasing doses of estradiol pills and eventually intramuscular progesterone shots, and given a tentative date for transfer. You be instructed when to come in for one additional ultrasound, and if the endometrium is adequately thick at this time, your transfer date will be finalized.
When you show up for the transfer in Abington, you may eat but please avoid caffeine and have a full bladder. You should drink a liter of water of water on the way in. The transfer is done under ultrasound guidance and is generally painless. You will be given a schedule for blood work as described above for “regular” IVF.
Women who have failed multiple IVF cycles, have high FSH levels or are too old to be candidates for IVF, are usually advised to consider Donor Egg IVF. While a child born following such a procedure will not have any of your genes, the chances for having a child with this technique are extremely high, and minimally age dependent.
The first stage for egg donation is finding a suitable donor. You may have a friend or relative in mind, or we will put you in touch with the nursing staff at Abington who can find a match for you. Using an anonymous donor can be very expensive, but the chances for personal and family conflicts are much lower, and the pregnancy rates are higher. If you use a friend or family member to donate, we will ask you to sit down with a counselor first to ensure you have thought through the implications of using a known donor.
If you would like to use donor egg, the staff at Abington can assist us in finding you an egg donor and performing the required screening. The contact person at Abington Reproductive Medicine is Charlene. She can be reached by phone (215) 887-2010 ext1525 or email firstname.lastname@example.org.
If Abington is unable to find a suitable donor for your, we also work with a company called SEEDS where the director Patricia can help locate you a donor. She can be reached by phone 800-733-1673 or by email at email@example.com. The donation process is tightly regulated by the US FDA and all donations need to be approved by the staff at Abington.
During the process your donor will be prepared for retrieval as described in steps 1-4 above and fertilized with your husband’s sperm. Your uterus will be prepared with leuprolide, and then estradiol and progesterone shots similar to what is described under the frozen embryo transfer section above, except that we will need to synchronize your and your donor’s cycles.
You and your partner are about to embark on an exciting, yet strenuous adventure, one that has helped millions of couples have children of their own. While you may at times feel overwhelmed, you should realize that you have an opportunity not available to earlier generations of women. Remember to set your sights on the goal at hand, but still try to be realistic about your chances.
All rights reserved, Seth G. Derman, MD, 1996-2016