There are a number of treatment options that can be considered with surrogacy when undergoing IVF (Egg Donor) and Frozen Embryo Transfer (Surrogate) in order to improve the chances of pregnancy. The choice of one particular procedure will depend on your egg donor’s/surrogate’s personal circumstances, medical condition, genetic factors, and previous care.
Some alternative options that your treating specialist might advise include:
Blastocyst Embryo Transfer is a specialised technique used in In Vitro Fertilisation (IVF) in which an embryo that has been cultured to the Blastocyst stage is transferred to the woman’s womb.
It is at the Blastocyst stage of development (five days after fertilisation) that an embryo would normally move out of the fallopian tube and into the uterus. Once in the uterus, the Blastocyst starts to attach to the uterine lining in a process known as implantation.
The advantage of attempting to grow embryos to the Blastocyst stage is that they should have a greater chance of implantation because the stage of embryo development matches the uterine environment. As a result, fewer embryos can be replaced, which will minimise the risk of a multiple pregnancy.
The disadvantage of attempting to grow embryos to the Blastocyst stage is that fewer embryos will “survive” or grow to this stage (probably about 30-50%). There is a possibility (up to 10%) that none will reach the blastocyst transfer stage and therefore, no embryos will be available for transfer. The availability of “extra” embryos for freezing is also significantly reduced.
Gay men or couples who have had unsuccessful prior attempts with IVF or IVF-ICSI despite having many good-quality eggs retrieved are being offered Blastocyst Culture as an alternative treatment. Gay men or couples with multiple good-quality embryos on day 3 are also good candidates for Blastocyst Culture. The ability to select the most viable embryos for transfer and implantation should improve their chance of achieving a pregnancy.
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Embryo Transfer Media involves a specialised embryo culture utilised in In Vitro Fertilisation (IVF) in which a Glycoprotein called Hyaluronan is used to assist the embryo to implant into the woman’s uterus.
For pregnancy to occur, the developing embryo must implant into the lining of the female’s uterus (endometrium). Research shows that Hyaluronan plays an important role in assisting embryos to implant. Hyaluronan is a naturally occurring substance found in the uterine cavity and fallopian tubes.
The embryos that are selected for transfer are placed in a small volume of Hyaluronan transfer medium. When the transfer procedure takes place the embryos are loaded into the transfer catheter along with a tiny volume of the transfer medium and released into the female’s uterus. Hyaluronan transfer medium does not guarantee implantation, but may assist it.
There is some evidence to suggest that females over the age of 38 years show the most benefit, with a significant increase in pregnancy rates, when a transfer medium with Hyaluronan is used (Balaban et el., 2004). There have also been studies that indicate frozen/thawed embryos may have increased pregnancy rates when transferred in a Hyaluronan transfer medium.
Assisted Hatching is a scientific technique used in In Vitro Fertilisation (IVF) that may improve the implantation of embryos into a woman’s uterine lining by creating an opening through which the embryonic cells can hatch out. Pregnancy cannot occur unless the embryo hatches.
Just prior to embryo implantation, the developing embryo must “hatch” out of its outer shell (Zona Pellucida). Some embryos seem to have a thicker shell that may decrease their ability to hatch, and therefore reduce the likelihood that they will implant. This may be due to the age of the woman or other, unknown reasons.
The unfertilised egg (oocyte) is surrounded by a membrane called the Zona Pellucida. The Zona Pellucida ensures that only one sperm cell enters and fertilises the egg. After fertilisation, the embryo begins to cleave into a two-cell, then a four-cell and so on. It is at this early Cleavage stage that Assisted Hatching can be performed on embryos.
It has been shown that women older than 37 years of age have a tendency to produce oocytes with a harder and/or thicker Zona Pellucida than younger women. The same goes for women with a high level of Follicle Stimulating Hormone (FSH).
The problem of a harder Zona Pellucida is that the embryo may not hatch and thus not attach to the woman’s womb. It has been reported that up to 75% of normal embryos may never hatch. Laboratory procedures involved in IVF may add to the hardening of the zona, as the embryo is not continually exposed to the enzymes present in the natural environment of the fallopian tubes.
There is also evidence to suggest that the process of freezing and thawing embryos may cause the zona to harden, and using assisted hatching can be beneficial.
We offer Laser-Assisted Hatching, which is a gentle and safe way to weaken a small section of the Zona Pellucida – allowing the embryo to hatch. Several studies have shown that using a laser is superior to chemical and manual hatching. Laser-assisted hatching has several advantages including minimal handling of the embryo and delivering fast and exact control over the drilling of the hole.
Laser-Assisted Hatching is performed by the scientists prior to the embryos being transferred back to the uterus.
The method of Genetic Screening used in In Vitro Fertilisation (IVF) is Pre-implantation Genetic Diagnosis (PGD).
PGD is generally used to detect anomalies in the number or structure of the chromosomes of embryos. PGD identifies affected embryos as they are developing in the laboratory prior to being transferred back to the patient’s uterus during the IVF cycle, in order to improve the chances of pregnancy. If you would like further information please talk to your treating specialist.
At Rainbow Fertility, our specialists have extensive experience in helping create LGBTI families. Feel free to contact our friendly team to learn more about the fertility treatment options available to you.
Current as at 01.02.2016