Stage One: Selection/Screening

The first step is to complete a very detailed application, which serves as your introduction to the prospective parents. The application asks for you to relate in-depth your family health history, personal habits, hobbies, interests, education, employment and fertility information. It is important to obtain as much information as we can for the prospective parents because this is all that they will have to draw on in their child's future. Your anonymity is protected when we receive your application because we delete your identifying information in the application (name, address, etc.) and assign you a confidential number. If you are accepted into the program, a copy of the file is then placed in our Donor Registry for our prospective parents to review. Our program is set up to be anonymous between both parties so you may not ever meet or speak with the recipient couple. If you are amenable to meeting or having a confidential call (where only first names are exchanged) between parties you may so indicate on the application, however, please understand that both you and the recipient must be in mutual agreement on the matter.

Appointments are scheduled at our agency to allow prospective parents the opportunity to review the Donor Registry. In addition to the copy of your application, the couple will be able to see photographs of yourself and your children, which further helps them in making a selection -- especially in cases where a close physical resemblance is important to the prospective parents. In some instances, copies of your file will be sent to prospective parents outside of the United States as our client base extends worldwide. Your choice of photos is important and they should be of good clarity and ideally, will present you throughout the years. (Photos will be returned if you so indicate when you return your application, most usually after a cycle is completed or when you file is closed.)

Prior to your selection and inclusion in our Donor Registry, you will be required to have a preliminary phone consult with our licensed Clinical Counselor. This appointment will last approximately one hour. In some instances, you may be required to have your blood drawn to obtain an FSH and estradiol level. This test will help the doctor determine how responsive your ovaries may be to the medications and thus, he or she can better set what medication protocol you will be given. Please note that under no circumstances are we at liberty to reveal the reason or reasons that your application is turned down.

Once a Recipient selects you, the Program Coordinator will call you to confirm your selection and schedule you for the day of testing which will take place at the medical center, Pacific Fertility Center (PFC). Of course, we will arrange the necessary travel accommodations for you and there will be no cost to you -- just your time and efforts!

The testing will include an in-person psychological consult, a medical consult that includes a pelvic examination and ultrasound, and a consult with a Clinical Nurse Coordinator, as she is the person who will map out the cycle of treatment. (Basically the person who tells you the "who, what, when, where and why" of the cycle). And, finally, your blood will be drawn to test for HIV, Hepatitis, Syphilis and other sexually transmitted diseases (screening required by California law).

After 14 days injecting Lupron or using the nasal spray Synarel, you will begin a series of injections using a hormone called Gonal-f. At this time you will be using both Lupron or Synarel and Gonal-f. The active ingredient in Gonal-f is known as follicle stimulating hormone (FSH) because it works to increase the number of follicles developing in the ovaries. The follicles are the fluid filled sacs within the ovaries that contain the eggs. These hormones are injected directly under the skin of your abdominal wall or upper thighs (subcutaneous injections). You will be required to give the shots on a daily basis for a period of about 10 days. You will receive the necessary medical instruction from the clinic. Again, if you are unsure of dosage or process of how to give the shot, please contact the clinic directly. A missed injection can have disastrous effects on a cycle outcome. The dose of Gonal-f (or pergonal/repronex/humegon) may be adjusted during the cycle depending upon the response of the ovaries.

Gonal-f (or pergonal/repronex/humegon) has been used extensively for over twenty years and is not clearly associated with any type of cancer, birth defect, or increase in miscarriage. Side effects of Gonal-f are secondary to their action on the ovaries and are related to ovarian stimulation. If you are prone to premenstrual syndrome (PMS) you may feel some of the side effects attributed to the Gonal-f (or pergonal/repronex/humegon) injections. These effects are usually mild and may include allergic sensitivity, breast tenderness, abdominal bloat, headaches and/or mood swings. You may even gain a few pounds, which will only be a temporary weight gain as it is when you have PMS.

In rare cases, over stimulation of the ovaries may occur. Ovarian Hyperstimulation Syndrome (OHSS) generally causes enlargement of the ovaries accompanied by abdominal discomfort and/or pain. In severe cases it could lead to hospitalization. It is very expected that these symptoms will cease 1-2 weeks following the cycle of treatment. The physician at PFC will discuss any concerns you may have about OHSS at the time of your initial consult.

Monitoring

IVF-ET cycles are monitored in two ways: vaginal ultrasound and by blood hormone tests (blood draws). Monitoring is necessary in order to assess the growth and development of the follicles and to avoid the possibility of Ovarian Hyperstimulation Syndrome (OHSS). At the beginning of injections and after about seven days of Gonal-f, frequent ultrasound monitoring and blood tests begin.

Ultrasounds allow the physician to obtain an image of the follicles as they grow and develop in the ovaries. Both the number and size of the follicles can be determined by ultrasound, which is essentially a painless procedure. You may feel the pressure of the transducer on your abdomen or in your vagina; however, you cannot hear the sound waves nor have there been any harmful effects to the developing eggs.

As follicles develop, the ovaries secrete increasing amounts of the hormone, estradiol. The level of estradiol indicates the degree of ovarian stimulation and is used in conjunction with the ultrasound to adjust the dose of medication and to time the HCG injection (short for "human chorionic gonadotropins"). HCG is a natural hormone and works to stimulate ovulation as in a normal cycle and it has been used safely for many years.

HCG is your final injection and this initiates the final stage of maturation and timing of the egg retrieval.

The retrieval process takes approximately 15-30 minutes. Following the retrieval you are asked to remain at the clinic for one to two hours to recover from the anesthesia. You must plan on having someone available to drive you home as you have been under the effects of anesthesia and cannot (by law) drive yourself home or take public transportation. You must be accompanied home. When you are released from the clinic you may resume light daily activities. It is very common to experience some cramping and spotting following the process and the clinic will prescribe the appropriate pain medication. You will be scheduled for a care call with the nursing staff 3 days following the retrieval. You should be cautious of increased fertility for several days prior to the egg retrieval and for several days after the egg retrieval and should avoid sexual relations seven days prior to the egg retrieval and for two weeks after the retrieval (until you get your next menstrual period).

The donor fee is remitted following the egg retrieval. If the Program Coordinator is available to hand deliver the fee, you will receive it on the day of your retrieval and, if she is not able to personally deliver it to you, it will be sent via Fed Ex for prompt delivery.

The embryo transfers take place at the clinic and is a very simple procedure -- it requires no anesthesia and lasts only minutes. The embryos are placed in a thin catheter, which is then passed through the cervix into the uterine cavity, and it is there that the embryos are gently deposited. Following the transfer the recipient remains resting for about 15 minutes returns home to routine activity. We will not know the outcome for at least two weeks following the transfer. If you would like to know whether or not a pregnancy results, we can make those arrangements.