Alta Bates IVF Program

510-649-0440 Info@ABivf.com

This is our second round at IVF following the successful birth of our first daughter, now age 4. I have nothing but praise and admiration for the venerable Dr. Chetkowski and his staff, and consider ourselves fortunate to have such expertise available in the East Bay.

Call Us: 510-649-0440 or Schedule an Appointment Online

Donor Eggs

Donor egg IVF is used in following situations:

  • Absent or non-functioning ovaries (Turner Syndrome, premature ovarian failure, surgery or chemotherapy)
  • Advanced maternal age
  • Reduced ovarian reserve (inability to produce multiple healthy eggs)
  • Absence of eggs as in gay couples and single men
  • Genetic abnormality
  • Repetitive failure to conceive with the standard IVF process with a woman’s own eggs

Ironically, donor egg IVF has turned out to be one of the most effective assisted reproductive technology and its high IVF success rates are largely independent of the recipient’s age. The mean age of our donor egg recipients has been 44 years.

Who are the egg donors?

Young, healthy, fertile women under the age of 33 years are recruited and rigorously screened by our office on an ongoing basis. The screening includes genetic, medical and psychological testing as well as multiple interviews with our staff, a consulting psychologist and a physician. Many donors are students but others are young mothers motivated not just by compensation but also by a desire to help infertile patients. If you do not find a satisfactory egg donor within our in-house pool, we can also work with a donor recruited by a reputable agency and will provide you with a list of agencies.

Our egg donation program has primarily followed the anonymous model which has been standard for sperm donation for decades. While no identifying information about the donor is revealed, detailed personal, medical and family profiles are provided to recipients in the process of selecting a donor. In most cases, anonymity best protects the privacy and interests of both parties. However, the majority of our donors are open to future contact with the child, should he or she desire such contact upon reaching maturity.

Some patients strongly prefer to conceive with eggs donated by a close relative who is their directed/known egg donor. While such donors are often older than ideal, they need to have reasonable ovarian reserve and pass the FDA screening. In-family egg donation can be a highly satisfactory solution but it can have lasting effects on the family dynamics. Therefore, assessment and counseling by an experienced mental health professional is required for optimal outcome.

How to select an egg donor?

Personalized medical guidance is of help to most patients facing the unfamiliar challenge of selecting an egg donor. You receive detailed personal, family, educational and medical information about several donors and the final selection is made by you. Our aim is to give you as much information as needed to make you entirely comfortable with your selection.

How much does the egg donor’s age matter?

There is widespread belief that the younger the egg donor the higher the success rate but this belief may not be accurate. The graph below, based upon national IVF data over 3 years, suggests that the age-related decline begins at 33 years. Up to the age of 32 years, the donor’s age has little effect on the recipient’s chance of a live birth.

 graph agedifference

Recipient’s treatment

The minimum pre-treatment evaluation of the recipient includes a semen analysis, an HSG (dye study of uterus & tubes) and a saline infusion sonohysterogram (SIS). If one or both tubes are closed at the end near the ovaries, forming a hydrosalpinx, removal or ligation of the damaged tubes is recommended before IVF, because such closed tubes lower pregnancy rates. Both partners have the STD panel (Hepatitis B Antigen, Hepatitis C Antibody, HIV Antibody, HTLV Antibody and RPR) and the Intended Mother also has a prenatal panel.

Since many of our recipients are beyond the usual childbearing age, a medical and obstetrical pre-conception evaluation is advisable to assess the safety of initiating an IVF pregnancy. A mammogram is recommended for all women above the age of 40. Above the age of 48 years a stress/exercise EKG or echocardiogram is done.

Preparation of the uterine lining for implantation (attachment of the fertilized dividing egg to the womb) is key to the success. Recipients receive natural estradiol to thicken the lining and progesterone to make it receptive. In some cases a trial hormone replacement cycle with an endometrial biopsy are recommended.

The hormone preparations, estradiol and progesterone are identical to the hormones which your body would naturally produce during a spontaneous pregnancy. Consequently, you need not worry about their possible adverse effects on the developing fetus because these hormones are the same as the ones produced in all human (and for that matter all mammalian) pregnancies.

What is the treatment plan for the egg donor?

The donors undergo the first two phases of in vitro fertilization: controlled ovarian stimulation and egg retrieval. They receive a series of daily injections of gonadotropins to stimulate their ovaries to produce multiple eggs over a period of 10 to 12 days. During that time they are closely monitored with blood tests and ultrasounds to determine the right day for egg retrieval. Egg retrieval is performed in an outpatient operating room and involves passing a long needle into the ovaries and removing the fluid containing the eggs from the ovarian follicles with conscious sedation anesthesia.

In Vitro Fertilization and Embryo Development

After eggs are retrieved, sperm are placed in the culture medium with the eggs or individual sperm are injected into some of the egg through ICSI. One day later the eggs are examined to confirm normal fertilization. Three days after insemination or ICSI, normally developing embryos contain about 8 cells.

eightcellembryothreedays

Eight-cell embryo 3 days after retrieval

Five days after retrieval, some embryos develop into blastocysts with 80-120 cells, an inner fluid-filled cavity, and a small cluster of cells called the inner cell mass.

 

blastocyst5day 
Blastocyst 5 days after retrieval

Many eggs and embryos are abnormal so the chance that a single developing embryo will produce a live birth is about 25-30% for day 3 embryos and 35-45% for blastocysts. When PGS is performed then the chance increases to 60-65%.

Untoward Events in the IVF Laboratory

In spite of reasonable precautions, any of the following may occur in the lab that would prevent the establishment of a pregnancy:

  • Normal fertilization of the egg(s) may fail to occur.
  • Normally fertilized eggs might fail to divide as expected.
  • Bacterial contamination might in loss of the embryos.
  • Laboratory equipment may fail.
  • Other unforeseen circumstances might interfere with the IVF process.

Embryo Transfer

While transfer of multiple embryos increases the chance of IVF pregnancy, it also increases the risk of multiple IVF pregnancy (The Dilemma of Twins). The decision regarding the number of embryos to transfer can be difficult. In making a recommendation we take into account the donor’s age, the appearance of the embryos, the couple’s prior history, the advisability of embryo freezing and the couple’s concern about multiple pregnancy and the potential need for multi-fetal pregnancy reduction. In general, we transfer two day 3 embryos or one day 5 blastocyst. The embryos not transferred are either frozen for future use or discarded.

The embryo transfer is done in a room adjacent to the laboratory. The transfer requires no anesthesia. If at all possible, we would like your partner to be present. We use an abdominal ultrasound to confirm that the catheter is within the uterine cavity. Therefore it is best if you drink extra fluid 1-2 hours and stop voiding about 1 hour before the transfer. In the usual position for a pelvic examination, a tiny catheter containing minute amount of fluid with the embryos is gently inserted into the uterus and the fluid is deposited. You then rest for 5-10 minutes before discharge. Following transfer you might notice light spotting for a couple of days.

Post-Transfer Care

Individualized luteal phase support schedule is provided to you in advance of the actual embryo transfer. We recommend that you refrain from vaginal intercourse and orgasm, both of which can be associated with strong uterine contractions, for five days after Day 3 transfer and for three days after blastocyst transfer. This allows embryo implantation (attachment of the embryo(s) to the womb) to be completed. Until that point, uterine contractions could expel the free-floating embryos from the uterine cavity. Otherwise, we leave it up to your discretion to what extent you may want to modify your usual activities. Bedrest after transfer does not improve IVF pregnancy rates.

Pregnancy Tests

We will tell you on which day to get a quantitative hCG blood test to determine if implantation has taken place. It is important to have the test done even if you are spotting or bleeding. If the test is negative, luteal supplementation with progesterone is stopped and a period follows within a few days. If the test is positive, it is repeated in a couple of days to determine whether there is normal growth. In the presence of pregnancy, progesterone is often continued for several weeks until a blood test indicates that the placenta is producing sufficient quantity of this hormone.

In some instances the first HCG test is higher than the second one which indicates a “biochemical” pregnancy which cease to evolve at an early stage. If your pregnancy progresses normally, you will be scheduled for an ultrasound examination about 4 weeks after retrieval. About 2-4% of pregnancies are ectopic, i.e. in the tube. This complication usually requires either medical treatment with methotrexate or a laparoscopic surgery.

Surrogacy

Surrogacy refers to a “third-party” reproductive technique in which the woman who carries the pregnancy is not the Intended Mother. The surrogate or carrier relinquishes the child to the Intended Parents at birth. There are two types of surrogacy depending on the source of the eggs: Gestational Surrogacy and “Traditional” Surrogacy. Gestational surrogate/carrier carries and delivers a pregnancy established with eggs either from the Intended Mother or from an egg donor with IVF.  Traditional surrogates become pregnant with their own egg and fertilization occurs in the surrogate’s body after intrauterine insemination with the Intended Father’s sperm.

Since common law presumes that the woman giving birth is the child(ren)’s mother, surrogacy requires extensive legal assistance so that the Intended Parents are recognized as such on the birth certificate and a drawn-out custody battle is avoided. Whereas the legal status of gestational surrogacy is well established in California and several other states, traditional surrogacy presents many more legal pitfalls because the surrogate’s claim to the child is much stronger since it is based upon both a genetic and gestational link. Thus, prudence favors gestational surrogacy and traditional surrogacy is rare.

The main reasons for using surrogacy are: 1. absence or dysfunction of the uterus (womb); 2. medical conditions in the Intended Mother which make pregnancy too risky for her. Gay couples and single men who desire children must perforce use a gestational surrogate in addition to an egg donor. Surrogates come either from the Intended Parents’ family or friends or are recruited through an agency.

The most important pre-requisite for a surrogate is to have at least one child from an uncomplicated pregnancy. Obviously, she must have a normal uterus and be free of medical illnesses likely to impact the pregnancy negatively. Unlike egg donors, the age of the surrogates is of less importance and women in their early 40’s can make excellent gestational carriers. The success rate of surrogacy is primarily determined by the age and ovarian reserve of the woman providing the eggs,

Treatment schedule for a gestational surrogate is similar to that of a recipient of donor eggs. She takes natural estradiol and progesterone to prepare the uterine lining for implantation of the embryos and for support of early pregnancy. The treatment schedule for the egg donor is similar to that of a woman undergoing IVF with ovarian stimulation, monitoring and egg retrieval. For successful implantation of fresh embryos the surrogate’s endometrium and the egg provider’s ovaries must be synchronized.

Currently, the approximate compensation for surrogates is US $20-30,000 which, together with legal, medical and agency fees, makes surrogacy the most expensive family-building approach. For appropriate candidates, surrogacy offers an excellent, and oftentimes the only, medical family-building option.

 

Our egg donation and surrogacy patients come to us from Oakland, Sacramento, San Francisco, the Bay Area, Berkeley and adjacent locations.                                                                                     

 

“If you’re reading this, you’re probably a woman struggling with infertility, and if you’re like, me it’s the hardest, saddest problem you’ve ever confronted.”

—A.F.

Read A.F.’s Story

“My husband and I decided to have a second child, but this time we weren’t so lucky.”

—S. and K.

Read S. and K.’s Story

 

 

Its All About Creating Families

"Patients are my partners. Together we have been making their dreams come true since 1984." ~Dr. Richard Chetkowski