Hold On To Your Dreams. Understanding IVF Process In Surrogacy The Basics

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1 Hold On To Your Dreams Understanding IVF Process In Surrogacy The Basics Dr. Said Daneshmand Dr. Sandy Chuan

2 Established in 1989 InternaBonal leader in ferblity treatment and care. ExcepBonal IVF success rates. Dedicated to Third Party IVF: Egg Donor & Surrogacy. Proud to have played a role in bringing more than 4,000 babies into the world.

3 Our Team of Dedicated FerBlity Dr. Sandy Chuan Dr. Susanna Park Dr. Brooke Friedman Specialists Dr. Michael KeUel Dr. Said Daneshmand Dr. Jeffrey Rakoff

4 San Diego

5 Del Mar

6 Mission Valley

7 Temecula Valley

8 State of the Art Embryology Lab Highly Skilled and Experienced Embryologists

9 Comprehensive Care In-Vitro FerBlizaBon (IVF) IVF with surrogacy Egg donor IVF cycle Egg donor IVF cycle with Surrogacy Embryo Banking Egg & Sperm Freezing PreimplantaBon GeneBc Screening & Diagnosis Family Balancing & Gender SelecBon

10 Embryologists

11 Our Team Compassionate care

12 1. THE BASICS OF IVF & EMBRYO DEVELOPMENT 2. GENETIC SCREENING 3. EMBRYO TRANSFER DECISIONS 4. EGG DONOR & SURROGATE

13 IN VITRO FERTILIZATION 1. Ovarian SBmulaBon 2. Egg Retrieval 3. Create Embryos 4. Transfer Embryos

14 Natural Menstrual Cycle Ovarian Reserve Small Antral Follicles Follicle SBmulaBng Hormone Brain SelecBon of the dominant follicle OvulaBon oocyte

15 Ovarian SBmulaBon Brain Ovarian Reserve Small Follicles Follicle SBmulaBng Hormone InjecBons of FSH 8 14 DAYS Egg Retrieval oocyte

16 ConvenBonal FerBlizaBon ICSI: Intracytoplasmic Sperm InjecBon FerBlizaBon DAY 1 EMBRYO

17 STAGES OF EMBRYO DEVELOPMENT Day 1: Zygote Day 3: MulB-celluar Day 3-4: CompacBng Day 4-5: Morula Blastocyst Hatching Blastocyst

18 Embryos can be graded on their appearance. Embryos with the best grade are more likely to implant than those with lesser grades. Many cribcal features of an embryo cannot be seen and are therefore not considered when grading the embryo. Among the invisible features are the chromosomes.

19 CHROMOSOMES

20 Incidence of GeneBcally Normal Embryos by Age 60 % of normal embryos % 21% 13% 0 Donor Egg < >42 Munne 2012 Years of Age

21 PGS Pre-implantation Genetic Screening 23 PAIRS OF CHROMOSOMES? GENDER XX OR XY Blastocyst biopsy

22 EMBRYO SELECTION Most human embryos are non-viable. Most do not implant in the uterine lining. Embryos are typically selected for transfer based on appearance alone.

23 Who would benefit from GeneBc Screening? PGS : PreimplantaBon genebc screening Women over age 37 years old Embryo selecbon to increase IVF success rates % of embryos from women years old have abnormal number of chromosomes. - Rate increases with female age. Up to 70-90% abnormal age >40 Family balancing

24 Percent Live Birth in IVF with and without PGS in Women >40 years old Untested Schoolcraft ASRM 2013 PGS

25 LiUle or no improvement in success rates with genebc screening when there is low aneuploidy risk: Young egg source (Age <35). Good quality sperm. Typical egg donabon cycles

26 Who Would Benefit from PGD? PreimplantaBon genebc diagnosis Family history of genebc disease that result from single gene mutabons History of posibve carrier screening for both sperm and egg provider.

27 Maximize success rates Blastocyst transfer PGS screening High implantabon rate Excellent cryopreservabon program Minimize risks Transfer only 1-2 embryos

28 How To Decide on Number to Transfer ESET: elecbve single embryo transfer DET: double embryo transfer

29 Success Rates

30 SelecBng Your Ideal Egg Donor In the United States, egg donabon is legal and confidenbal Ethnicity Appearance EducaBon Employment Family History Ovarian Reserve Donors are screened for: Family History GeneBc diseases & History InfecBous diseases Drug screen Ovarian Reserve

31 SelecBng the Ideal Surrogate: Social History Pregnancy History Medical History Life Style Uterine Health Surrogates are screened for: Obstetrical history Review InfecBous diseases (partner also) Drug screen Uterine Anatomy

32 Miracle Babies

33 Hold On To Your Dreams Steps to Success El Camino Real San Diego, CA Phone:

Hold On To Your Dreams

Hold On To Your Dreams Dr. Michael Kettel Dr. Sandy Chuan 1. THE BASICS OF IVF & EMBRYO DEVELOPMENT 2. IVF ADD-ONS - MYTH VS. SCIENCE IN VITRO FERTILIZATION 1. Ovarian Stimulation 2. Egg Retrieval 3. Create