Depending on the plan we devised for you, you will begin one of these processes:
- Intrauterine Insemination (IUI)
- In Vitro Fertilization (IVF)
- Working with your surrogate or egg donor
WHAT TO EXPECT WITH IUI
If you will be using intrauterine insemination (IUI), we will start the process by tracking your ovulation to identify your most fertile periods. If ovulation is not occurring normally we may take some extra steps to ensure that there is an egg is produced that can be fertilized. After that, semen is collected, either from your partner or a donor. We will wash the semen, cleaning it of seminal fluid and leaving the healthiest, moving sperm. We do this to give the most motile sperm the best chance of reaching and fertilizing the egg and because inserting unwashed sperm directly into the uterus can cause cramping and pain. Before using donated sperm, we always recommend testing for any transmittable infectious diseases, so that the pregnancy can begin as healthy as possible.Find out more about the full IUI procedure HERE
WHAT TO EXPECT WITH IVF
Depending on your fertility needs, you may consider in vitro fertilization (IVF) rather than using IUI. IVF is one of the oldest and most frequently used fertility assistance procedures. The basic process of IVF involves:
- stimulating the ovaries to recruit and maintain more eggs than would occur in your
- regular cycle
- fertilizing the egg outside of the body
- selecting the best resulting embryo(s)
- transferring those embryos into the uterus for implantation.
Ovarian hyperstimulation and ovulation induction is produced by a combination of medication to encourage the maturation of multiple eggs at once, since in a normal cycle only one egg will be released. We will check to see that multiple eggs have been produced, and then harvest them in our offices. During this procedure you will be sedated under the supervision and care of an anesthesiologist and your eggs will them be transferred to our lab. We will then combine your eggs with the washed and prepared sperm (from either your partner or a donor) and this mixture will be closely monitored for 18-24 hours to make sure that embryos form.
This process also allows for the opportunity to perform pre-implantation genetic diagnosis (PGD) where we can screen for an identifiable genetic defect you or your partner may carry, as well as pre-implantation genetic screening (PGS) that may allow us to identify the healthiest embryos with the highest chance of success. Though there is a cost associated with genetic testing, we always recommend using it whenever possible – by only implanting healthy and viable embryos we can improve the chances of implantation and hopefully lessen the number of treatments required before a successful pregnancy. But don’t worry, we will discuss all of your options before beginning the IVF process.You can learn more details about the IVF procedure HERE
WHAT TO EXPECT WITH DONORS AND SURROGATES
If you will need a donor, of either sperm or eggs, there are several critical choices to make. While there are reasons to consider a known donor – a friend, acquaintance, or family member – before going this route there are certain important steps to complete.
There are kits available for at home insemination, also referred to as the “turkey baster method”, but this route comes with some added medical and legal risks. We always recommend running a full array of test for any unknown sexually transmitted infections (STIs) which could harm the mother or the fetus. Future parental claims and responsibilities are also complicated by choosing an at home donor insemination option. The legal rights of your donor depend on where the insemination takes place, as well as what you have established with a lawyer. In California, the legal claims of the sperm donor are released when the insemination takes place in the offices of your fertility care provider.
Similarly, if you are using both a surrogate and an egg donor, you may want to have the donated egg come from a different source than the person carrying the pregnancy. This distinction established the two types of surrogacy:
- Traditional surrogacy
- Gestational surrogacy
With traditional surrogacy, the surrogate uses her own eggs and is the biological mother of the baby. There are many different reasons to choose this type of surrogacy. One such situation is if you and your partner are both men and want to have a child that is biologically related to both of you. If either you or your partner has a female relative like a sister or a cousin – that is willing to act as your surrogate, the non-related partner will donate his sperm, and we can then process the semen and inseminate your surrogate using the intrauterine insemination (IUI) method.
There are barriers to traditional surrogacy in many states and potential legal implications. Many couples choose to use gestational surrogacy, where the woman carrying the pregnancy is not the biological mother of the fetus. For couples using a gestational surrogate, the process begins by selecting who that surrogate will be, often by working with one of many established and trusted agencies. Once a surrogate is chosen and the appropriate contracts have been drawn up with a lawyer, semen will be collected from the male partner and eggs harvested from the female partner. Once we’ve processed the eggs and sperm we will combine them in our lab to create embryos using in vitro fertilization (IVF). Those embryos will then be transferred to your surrogate.
Establishing your legal parenthood rights before any procedures take place is a crucial step to make sure there are no complications by the time your baby arrives.
WHAT TO EXPECT WITH EGG OR EMBRYO FREEZING
If you are not quite ready to start or expand your family but would like to prepare for the future, you may want to consider freezing your eggs or embryos. There are many reasons to plan for future pregnancies in this way:
- you are currently single and want to preserve your eggs while you are young
- you are facing a health care issue – such as cancer – that may damage your reproductive organs
- you have a genetic condition that may cause ovarian failure
The beginning of the egg freezing process is similar to the first steps of in vitro fertilization. We will use ovarian hyperstimulation and ovulation induction to collect multiple eggs in one cycle, and will then remove the eggs in our offices while you are mildly sedated. If you are just preserving your eggs they will then be frozen. If you are planning on freezing embryos, we will take your eggs and combine them with sperm from your partner or from a donor. After about 18-24 hours we will be able to determine if any embryos have formed which we will then freeze.You can find out more about the freezing process for eggs and embryos HERE
Whatever plan and course of treatment we build for you, we will always be available to answer your questions. Come to us at any time with questions or concerns. This process is intensely personal, and we are here to support you.