Understanding IVF Processes in Surrogacy
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1 Melvin H. Thornton II MD Medical Director CT Fertility Understanding IVF Processes in Surrogacy The Basics
2 Surrogacy involves multiple parties IVF CLINIC Egg donors screening and matching* Medical process of donor and surrogate In Vitro Fertilization Embryo transfer Embryo preservation Monitoring of pregnancy until week 13
3 Screening Autologous (Own Eggs) Egg Donor Anonymous Directed or Known Male Partner Surrogate
4 Autologous (own eggs) Screening FDA Checklist for intended Autologous Medical FDA Requirements Physical Examination Infectious disease risk factor questionnaire FDA Bloodwork within 30 days of egg retrieval Full Review of past records including FERTILITY TESTING Examinations and Consultations Consultation with CT Fertility Physician Physical Examination FDA Screening Questionnaire Genetic screening testing Baseline Ultrasound (cycle day 3) Bloodwork required by the FDA HIV-1 / HIV-2-NAT Hep B Surface Ag Hep B Core Ab Hepatitis C Antibody-NAT Syphilis IgG GC / Chlamydia-NAT West Nile Virus
5 EGG Donation Anonymous Meet in Person Video Conference Non Anonymous (known/directed donor) Require Legal Contracts
6 EGG Donor Screening Medical FDA Requirements Personal, Medical and Family History Physical Examination Infectious disease risk factor questionnaire FDA Bloodwork within 30 days of egg retrieval Full Review of past records including Prior Donations FDA Checklist for intended Egg Donors Examinations and Consultations Consultation with CT Fertility Physician Physical Examination FDA Screening Questionnaire Psychological counseling / MMPI Genetic Counseling and Testing Baseline Ultrasound (cycle day 3) Bloodwork required by the FDA HIV-1 / HIV-2-NAT Hep B Surface Ag Hep B Core Ab Hepatitis C Antibody-NAT Syphilis IgG GC / Chlamydia-NAT West Nile Virus
7 EGG Donor Initial Screening Application Full profile includes: Personal Essay Questions Motivation for donation Likes & Interests Physical characteristics Health and obstetrical history Family health history Childhood and adult photographs
8 EGG Donor Commonly Used Criteria AGE: y.o. BMI Non-smokers Adequate Psychological Evaluation Healthy Medical and Family History Normal Hormone & Ovarian Evaluation Negative drug screening Negative Infectious Diseases screening Negative Genetic Screening (with some exceptions) Cystic Fibrosis, SMA, Fragile X and ethnically
9 Egg Reserve Testing Baseline hormone levels Day 3 FSH AMH Baseline Ultrasound Antral follicle count
10 Egg Reserve Testing-AMH Best assessment of egg reserve Determines how well a person will respond to fertility medication
11 Egg Reserve Testing Antral Follicle Count Baseline Ultrasound Antral follicle count
12 Medical screening of SURROGATES Medical evaluation of a potential surrogate includes: Current medical and health status (age, BMI, smoking, etc.) General, reproductive and laboratory evaluation Review of all prior pregnancy outcomes
13 Male Testing FDA Checklist Sperm-7 days Initial semen analysis Physical Examination FDA Screening Questionnaire Genetic Counseling and Testing Sperm Freeze Bloodwork required by the FDA HIV-1 / HIV-2-NAT Hep B Surface Ag Hep B Core Ab Hepatitis C Antibody-NAT Syphilis IgG HTLV I and II CMV titers GC / Chlamydia-NAT
14 In Vitro Fertilization (IVF) Process Ovarian Stimulation: Local Fertility Center/U.S. U.S.
15 In Vitro Fertilization (IVF) Process
16 Sperm Prep
17
18 Intracytoplasmic Sperm Injection (ICSI) Sperm Issues Low Sperm Count Low Motility Abnormal Morphology Previous Failed or poor fertilization Frozen eggs Pre-implantation genetic screening
19 ICSI in the U.S. Fertilization Rates 85-90% with ICSI compared to 50-60% with routine inseminations Many U.S. use ICSI for all IVF cases to improve overall outcomes
20 Split Sperm Source
21 24 hours post insemination
22 Embryo Development
23 Blastocyst Day 5 or Day 6 Embryos
24 Blastocyst Day 5 or Day 6 Embryos: Grading
25 Preimplantation Genetic Screening (PGS) Incidence of genetically abnormal eggs increases with age 25% in Women < 30 y.o. 50% in Women y.o. 75% in Women >40 y.o. Leads to Chromosomally abnormal embryos Decreased implantation rate Increased miscarriage rate
26 Preimplantation Genetic Screening (PGS)
27
28 Preimplantation Genetic Screening (PGS) Best Embryo selected for transfer Reduce the likelihood of miscarriage Decrease the risk of abnormal pregnancy Reduce the amount of time and additional costs inferred with multiple IVF cycles Increase the likelihood of pregnancy with single embryo transfers (eset) Allows for family balancing if desires
29 PGS and Mitochondrial testing Above the threshold fewer euploid blastocysts implant. 30% of non-implanting euploid blastocysts had high levels of mtdna There was no association with blastocyst morphology mtdna quantification represents a new independent biomarker of embryo viability
30 In Vitro Fertilization (IVF) Process
31 Embryo Transfer Embryo Transfer
32 Autologous IVF Success Rates Success rate depends upon age of the age and not the age of surrogate
33 Donor Egg Success Rates
34 Single vs Dual Embryo Transfers 33% SART 2014 National Summary Report
35 Single vs Dual Embryo Transfers Multiple Gestation Risk Mother Hypertension Gestational Diabetes Bleeding issues in pregnancy Pregnancy Increased risk of miscarriage Premature labor and delivery Long-term complications-lungs, Gastrointestinal and Cerebral Palsy
36 Single vs Dual Embryo Transfers 1.1% 7.9% 4.9% 18.5% SART 2014 National Summary Report
37 Single vs Dual Embryo Transfers Primary goal of Elective Single Embryo Transfer (SET) Reduce the risk of multiple gestation Risk of twins with SET 1-2%
38 Fresh vs. Frozen Embryos Studies From around the world show that Frozen Embryo Transfers compared to Fresh transfers Increased Implantation rates Increased ongoing pregnancy rates Increased Live Birth Rates Decreased Miscarriage rates Lower risk of Pre-term Labor Healthier Babies
39 ZIKA Virus
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