Surrogacy: A ray of hope

Surrogacy is often the last option for many couples who are unable to conceive due to infertility. It is only available to locals, and it must be done altruistically because commercial surrogacy is illegal. (Please note that foreigners are not permitted to participate in a surrogacy programme in India at this time.)

Surrogacy allows genetic materials from both the mother and the father, as well as an egg donor or sperm donor, to be implanted into the surrogate mother’s womb. Surrogates have all been screened to ensure that they are healthy and capable of carrying a pregnancy to full term.

IVF Treatment

In vitro fertilization (IVF) is the laboratory process of fertilizing eggs. It’s a well-known type of assisted reproductive technology (ART). IVF works by combining medications and surgical procedures to help sperm fertilize an egg and the fertilized egg implant in the uterus.

You begin by taking medication that causes several of your eggs to mature and become fertile. IVF specialist doctor removes your eggs from your body and mixes them with sperm in a lab. After that, they implant one or more fertilized eggs (embryos) into your uterus. Any of the embryos can implant in the lining of your uterus, resulting in pregnancy.

IVF is a lengthy process with many steps that take several months to complete. IVF can sometimes work on the first try, but many people need more than one round to get pregnant. If you’re having fertility issues, IVF will almost certainly increase your chances of getting pregnant, but there’s no guarantee everyone’s body is different, and IVF isn’t effective for everyone.

IVF procedure includes:

1. Stimulation

Each time a woman has her period, she usually makes one egg. However, IVF needs a lot of eggs. Multiple eggs make it more likely to have a healthy embryo. You’ll get fertility drugs to make more eggs in your body. During this time, your doctor will do blood tests and ultrasounds to keep an eye on how many eggs are being made and when they should be removed.

2. Egg retrieval

This is called “follicular aspiration.” It’s when you get your eggs out. It’s a surgery that is done with anesthesia. Use an ultrasound wand to guide a needle into your vagina, through your ovary, and to a follicle that has eggs inside. In each follicle, the needle will take the eggs and fluid out with it.

3. Insemination

The male partner will now have to give a sample of his semen to the doctor. A technician will put the sperm and eggs in a petri dish and mix them. In case that doesn’t work, your doctor may use ICSI.

4. Embryo culture

Your doctor will keep an eye on the fertilized eggs to make sure they’re dividing and growing. Testing for genetic conditions may be done at this time.

5. Embryo Transfer

As soon as the embryos are big enough to the implant, they can be put in the womb Three to five days after fertilization, this is usually when the sperm starts coming out. This is how you get an implant in your body. A tube called a catheter is put in your vagina, through your cervix, and into your uterus. Once the embryo is in your uterus, your doctor will let it grow there.

The embryo attaches itself to the uterine wall, which leads to pregnancy. This could take from around 6 to 10 days. You can find out if you’re pregnant by having a blood test done.

Conclusion

Choosing whether or not to use in vitro fertilisation, and how to proceed if the first attempt fails, is a difficult decision. This process can be costly, physically demanding, and emotionally draining. Speak with your doctor to determine your best options and if IVF is right for you and your family.

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Once embryos are formed, some of them are transferred to the uterus for conception. But before this, embryo grading is done to choose the best quality of embryo for a successful IVF cycle. Embryo grading is a process that helps embryologists to determine, the best day of embryo transfer, the quality of embryo to transfer, and the suitable number of embryos to transfer.

Embryo grading is a subjective matter and depends on the discretion of the embryologist to judge the quality of the embryo. It is done on Day 3 (Cleavage stage) and Day 5 (Blastocyst stage) of the fertilization. Experts decide the grading of an embryo based on the appearance of the embryo, the patient’s age, fertility history, and medical history.

Why Embryo Grading is performed?

Dr Shivani Sachdev Gour – the top IVF Specialist Doctor in Delhi explains the following importance for performing embryo grading.

1. Embryo grading helps to identify the quality of embryo to transfer. Using the healthiest embryo for conception reduces the chances of IVF process failure.
2. It checks whether an embryo has the potential for development or not. For this, all the components of the embryo must examine to ensure successful pregnancy.

How Embryo Grading is done?

Grading is done by the embryologists in the following two stages of embryo development.

• Cleavage Stage: This stage is reached on day 3 of the fertilization. In this stage, the embryo starts dividing (cleaving) into cells. However, the embryo has not developed in the size. Embryologists determine grading by checking the grade of fragmentation along with the appearance and number of cells. The following grades are there for embryo assessment.

1. Grade A:The embryos with 6-8 equally sized cells. It must have no or less than 10% fragmentation.
2. Grade B: The embryos having cells of uneven or irregular shape with 25-50% fragmentation.
3. Grade C: The embryos having an unequal size with 50% or more fragmentation.
4. Grade D:It is the lowest grade and poor-quality embryo. It has less possibility to grow further.

Grade A and B have the highest potential to develop further.

Blastocyst Stage: This stage is reached on day 5 of the fertilization. In this stage, embryos start to enlarge to tightly confinethe zona pellucida (the membrane surrounding an ovum). Grading in this stage is more accurate. It depends on the degree of cavity expansion, the appearance of inner cell mass, and the trophectoderm that creates the placenta. The first part of this grading is a number from 1 to 6, where 6 is the most expanded cavity. The second part is letters from A to D, where A is tightly packed cells; while D has few cells. The third part is another letter that signifies the quality of the trophectoderm.

For successful IVF treatment, contact SCI IVF Hospital – the best IVF center in Delhi NCR.

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Step 1: Egg Donor Application and Screening

The interested egg donors need to first apply our egg donation program. An initial screening with one our clinical coordinators has been performed followed by two rounds of interviews with our physicians along with some testing. The donor applicants who passed all these screening and interviews are eligible for our egg donation program and can be further matched with a recipient couple. 

Step 2: Egg Donor Matching

The couple, who need to use donor eggs, can able to view and select the pre-screened pool of egg donors online and can able to select a desirable candidate from the pool. When a couple selected a specific donor, a tentative donor egg match needs to be done. To confirm the availability of the egg donor, our IVF coordinator will contact the donor. An official match is made, if the egg donor is available for the couple’s desired time frame, and passes the required round of testing. Some egg donor are selected and matched to a recipient soon after their application whether others need to wait for months or years before they are selected.        

Step 3: Suppression and Ovarian Stimulation for the Egg Donor

To synchronize the natural cycle of donor and the recipient, the egg donor are suggested to self-administer daily dose injections of a medication called Lupron to suppress her cycle. The egg donor are suggested to uses daily injections of gonadotropin to stimulate her ovaries during the ovarian stimulation phase. Generally in a natural cycle, only one egg matures but gonadotropins injections urge more than one egg to mature for eggs retrieval. The egg donors are monitored regularly through blood tests and ultrasound during ovarian stimulation in order to ensure that the ovaries are responding well and not going into hyperstimulation during the whole process. Egg donor requires to visit our IVF hospital in Delhi frequently during this phase. These testing and monitoring sessions are normally scheduled in early morning in order to avoid intervening with the donors’ daily schedule of their work.

Step 4: Endometrial Lining Development for the Donor Recipient

A favorable uterine environment, on the recipient’s side, particularly an endometrium of at least 7 mm is important in the success of a donor egg cycle. The egg donor is regularly monitored to develop eggs for retrieval and the recipient takes estrogen and progesterone to prepare her endometrial lining for successfully egg implantation. Developing the endometrium for embryo transfer is generally not a problem. In some cases but rather rare, some patients have difficulties in reaching minimal endometrial thickness and require special treatments. Fortunately, SCI IVF Hospital and IVF expert Dr Shivani has demonstrated special expertise in this area. Some patients with autoimmune abnormalities need to use additional medications to improve the chance of implantation. 

Step 5: Ovulation Triggering and Egg Retrieval for the Egg Donor

The egg donor will be instructed to trigger ovulation with an injection of hCG, when our IVF experts found with the help of various tests and ultrasound images that the donor’s eggs have sufficiently developed and ready for retrieval. Two days later, the donor eggs are retrieved in a short in-office procedure known as egg retrieval. In this process our IVF expert will use aspiration needle (guided by ultrasound) to transvaginally retrieve the eggs. The whole process has been performed when the donor is asleep under I.V. sedation.  After the successfully eggs retrieval, the donor suggested to take the rest of the day off to recover. 

Step 6: Egg Fertilization and Embryo Transfer for the Recipient

The retrieved eggs form the donor are then fertilized with partner’s or a donor’s sperm. If the fresh sperm need to be used, the partner will need to visit our IVF center to produce a sample of fresh sperm at this time. The embryos that obtained from this fertilization are incubated and graded in our specialized laboratory. Generally, embryos are transferred into the recipient’s uterus on day 3 after donor egg retrieval on in rare occasions it is transferred on day 5.  

Step 7: Post-Retrieval Checkup for the Donor and Pregnancy Tests for the Recipient

To make sure that the donor is recovering properly from both process the ovarian stimulation and retrieval, the donor need to visit our center for a post-retrieval checkup. In most cases, donors have no problem returning to normal and recover faster in a day or two after egg retrieval process. If the donor found it difficult to recover and found to be developed other complexity, our clinical team helped them to heal and closely monitor the donor’s progress and stay in touch with her until the donor fully recovers. From the application of the Lupron injections to egg retrieval for recipient, egg donation is a 3-5 week long process for most of the egg donors. Two weeks after the embryo transfer, the recipients will have a pregnancy test with a blood test that measures the level of hCG. After two normally rising hCG tests and an ultrasound test that demonstrate a successful pregnancy, recipients are discharged from the center to their obstetricians for prenatal care.

Frozen Donor Egg Program

IVF Hospital and Multispecialty Center under the supervision of best IVF specialist doctor in Delhi also offers a frozen donor egg program called Eco Donor Egg Program (EcoDEP), in which a recipient receives eggs from a donor who has already undergone ovarian stimulation and egg retrieval by the time the recipient selects her donor. Therefore Frozen Donor Egg Program has a different workflow from the standard egg donor program described here.

Dr Shivani Sachdev Gour Review is also very remarkable if we talk about egg donation program in Delhi.  The interested egg donor and donor recipient are recommended to visit our center for more information about this process.

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