Egg retrieval process from donor's ovary
The aim is to retrieve maximum eggs during the egg retrieval process. The clinician administers a combination of hormonal medications to the donor for stimulating the multiple egg production within the ovary. Usually, the prescribed combination of hormonal therapy includes Human menopausal gonadotropin (hMG), recombinant follicle-stimulating hormone (r-FSH), or FSH (nonrecombinant) and the recommended regimen is termed as controlled ovarian stimulation.
The donor is kept under medical supervision after administering the therapy. Clinicians monitor the progress of egg development by ultrasound and testing the blood sample for checking the hormonal level in the blood.
Sometime doctors may recommend a gonadotropin-releasing hormone agonist (GnRH-a) or gonadotropin-releasing hormone antagonist (GnRH-ant) to prevent spontaneous ovulation and stops premature egg release.
For collecting the mature egg, follicle size and ovulation process are measured by conducting an ultrasound to check the appropriate stage of egg development. Then the medicine is injected for triggering the egg maturation process. Mature eggs are then retrieved.
The egg retrieval process is started approximately 34 to 36 hours of the administration of the medication to trigger the egg maturation process. A transvaginal ultrasound-guided oocyte aspiration process is followed to retrieve the egg from the ovary. The medical device used for this purpose is an ultrasound probe attached with a needle guide inserted into the vagina.
This device is placed into the ovary passing through the vaginal wall. The attached needle helps to puncture the ovarian follicle for the collection of eggs. Then the collected eggs are further tested in the laboratory for evaluating their maturity.
Then the mature eggs are inseminated with sperm (which may be collected from intended father or donor sperm) for fertilization in the laboratory set up. Then after a particular period formed embryo is transferred to the mother's womb for further development. This process is the step of the IVF.
Preparation of recipient for embryo transfer
It is important to prepare the recipient’s uterine lining to accept the transferred embryo. The clinician prepares the recipient in such a manner that the cycle of both donor and recipient is synchronized for the collection of eggs and transfer the embryo to follow the fresh cycle. In the fresh cycle, the cryopreservation technique is not followed. But in the case of cryopreservation, donor and recipient cycle need to be synchronized.
However, the recipient’s endometrium needs to prepare before embryo transfer by prescribing medication to improve the recipient acceptance of transferred embryo.
Depending on the individual patient's condition, the doctor recommended the appropriate process. Correction of the hormonal level is one of the principal requirements in the embryo transferring process. A GnRH hormonal therapy is recommended for women with functional ovaries to suppress their menstrual cycle.
Endometrium development treatment is concurrently started with ovarian stimulation of the donor cycle. Estradiol hormonal therapy is usually recommended to the recipient for endometrium development. There are many dosage forms like the oral pill, transdermal patch, or injection of estradiol available in the market.
The doctor has prescribed this dosage form depending on the treatment plan. The clinician observes the endometrium's developmental stages and its readiness to transfer the embryo through ultrasound and blood tests.
The recipient starts progesterone immediately the next day of the donor receives the ovulation trigger medication. Progesterone therapy smoothens embryo to implantation by favorable modulation within the endometrium. Vaginal gel, tablet, and intramuscular injection are different dosage forms of progesterone available in the market.
The embryo transfer process is usually conducted within three to five days of the embryo fertilization process. The embryo(s) are fixed within a small catheter which is then passed through the cervix and reached into the uterus to transfer the embryo(s). Currently, a single embryo transferred is preferred and extra embryos may cryopreserve for future use.
In the case of successful pregnancy both estradiol and progesterone therapy need to continue throughout the first trimester to support the early-stage pregnancy. In case of failure of the cycle, these medications need to stop.
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