The Reproductive Science Center of the San Francisco Bay Area would like to introduce you to our IVF Gestational Carrier Program. We hope you will find this information helpful in learning more about our staff and about Gestational Carrier cycles. We invite you to become an active member of the IVF gestational carrier process!

The Nurse Case Managers coordinate the gestational carrier cycles. They all have specific training in Women’s Health and patient education. One of these case managers will be assigned to you individually.

You can reach any case manager between 8:00 a.m. and 5:00 p.m. If you call and leave a message on voice mail, please be sure to allow adequate time and opportunity to return your message. While each checks her messages frequently throughout the day and works hard at returning most calls the same day, some answers may require more time to research. If your call is of an urgent nature you may want to ask the receptionist to assist you in having your question answered more immediately.

Breaking Barriers, Building Families

Since 1983, we have pioneered fertility treatment for every kind of family. We want to help you achieve your dream of having a baby.

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ASRM guidelines for gestational carriers:

A gestational carrier may be a family member, friend, or chosen through an agency. RSC has adopted ASRM standards and requires that a gestational carrier be:

• Between the ages of 21 and 45.
• Maximum height/weight not to exceed a BMI of 30.
• Must have attained a high school diploma or received a GED.
• Must not currently smoke cigarettes or use recreational drugs.
• Must have had a prior full term delivery and experience with parenting.
• Must be free from major medical issues and diseases.

Psychological consultation:

All involved parties (the gestational carrier, her husband/partner, and the intended parents) must participate in psychological counseling. This is an extremely important meeting allowing everyone an opportunity to discuss vital and sensitive issues. A psychological clearance letter must be on file for everyone before the cycle can begin. We can refer you to individuals who can provide you with the necessary counseling. Two Psychological Consultations will need to occur: one with you and your husband/partner and one with the intended parents.

Legal representation:

You must also meet with legal counsel to draw up the necessary contracts. The gestational carrier and the intended parents will need to meet with separate attorneys for proper representation. A legal clearance letter must be sent to our office before the start of the cycle. We also can provide you with referrals.

Gestational carrier new patient appointment:

Next you will need to schedule an appointment with one of the physicians for testing and medical clearance. These appointments are scheduled individually. We will give you information about tests we will require for each person in the process.

IVF education and injection class:

There will also be a class for you to teach you about the IVF process, your role, the medicines, and allow time for questions. We will also teach you how to given yourself injections. Since your husband/partner will be giving the intramuscular injections, they should also be at this appointment.

Laboratory testing:

You and your husband will have blood drawn to ensure optimal medical health for the pregnancy and to make sure you do not have any infectious diseases. (The intended parents are also screened.) There will also be cervical cultures and a drug test for the gestational carrier. A recent report of a negative pap smear is required. A test of your uterus to ensure that we can do an embryo transfer and an evaluation of the inside of the uterus will also need to be scheduled. You may need to undergo a mock cycle to test your response to stimulation medication.

The cycle:

After our office has received all the appropriate clearance letters and test results, then we will make arrangements to begin the medication to synchronize the cycle between you and the intended mother or the egg donor.

The intended mother (or egg donor) undergoes the treatment for a routine IVF cycle. At the same time, your uterus is prepared to receive the embryos. In general, your cycle includes the following medications: Lupron injections, oral estrogen, vaginal progesterone and injectable progesterone.

We will give careful consideration to determine how many embryos will be transferred. Gestational carriers and intended parents logically have concerns about the risk of high order multiples (triplets, quadruplets, etc.) and need to be well informed about the high success rates of IVF with gestational carriers. We usually recommend limiting the number of embryos transferred to one or two, depending on the age of the intended mother/ egg donor, the quality of the embryos, and the preference of the intended parents and the gestational carrier. Any additional embryos of good quality can be frozen for use in a Frozen Embryo Transfer.

You will continue to take estrogen and progesterone, and approximately 9 days after the embryo transfer, you will have a pregnancy test. Estrogen and Progesterone medications will likely be continued for 7 weeks.

It is our goal to make all participants in our IVF Gestational Carrier Program feel involved and well-prepared, and to make this a positive experience in your journey helping others toward parenthood. We look forward to working with you. Please don’t hesitate to call our office for further information or assistance.

Remember:

• Provide us with a telephone number that identifies you in the phone greeting, so that we may leave you a message; otherwise, a message may not be left. If you use email, please give us an up to date email.
• Please review the consent forms. These will need to be signed during your IVF Education Session with your Nurse Case Manager.
• During your IVF Education Session an overview of schedules and medications will be reviewed. Please bring your packet to the appointment.
• Keep in touch with your Nurse Case Manager so that she knows when you want to start a GC cycle and what times you are not available.

Blastocyst embryo transfer

There is now abundant evidence that transferring Blastocyst (the embryonic stage just prior to hatching and implantation) embryos into the uterus 5 to 6 days after egg retrieval results in higher implantation rates per embryo transferred compared to embryos transferred after 3 days of in vitro development. Allowing the embryos to develop an additional 2 to 3 days in the laboratory gives us more discriminatory power to select the embryos with the highest developmental potential.

There is good evidence in the medical literature that Embryos that develop normally to Blastocyst are less likely to be genetically abnormal. In addition, replacing the embryos 5 to 6 days after fertilization allows the embryos to arrive in the uterus at a more physiologic time (with natural conception the embryo does not implant until about 6 days after fertilization).

Blastocyst transfer may be of particular benefit for:

2. Patients who develop many good quality embryos.

3. Patient’s who wish to limit their risk of multiple pregnancy.

4. Patient’s with past failed pregnancy with day 3 Embryo transfer.

5. Patient’s with poor quality Embryos (less than 5 cell) on Day 3.

Blastocyst Embryo transfer is performed on day 5 following egg retrieval. A possible risk with attempting a Blastocyst transfer is that none of the embryos may develop to the Blastocyst stage (an average of >40% of fertilized eggs develop to the Blastocyst stage); therefore, there would be no embryos to transfer. It is generally felt that if no embryos develop to the Blastocyst stage in the laboratory that they would most likely not have become a pregnancy if they were replaced into the uterus at an earlier time. Blastocyst transfers will be routinely anticipated in those patients having 3 – 4 or more good quality embryos on the third day after egg retrieval. Less than 5% of patients in this group will not have any embryos make it to the Blastocyst stage.

Candidates for Blastocyst transfer will be scheduled for an embryo transfer 5 days after their egg retrieval. Because going to the Blastocyst stage selects the best embryos, there will typically be fewer embryos available for freezing. Currently in our center, we only freeze embryos that make it to the Blastocyst stage. These Frozen Blastocyst embryos have a higher pregnancy rate in frozen embryo transfers than embryos that in the past were frozen after 3 days of development.

We feel that Blastocyst transfer is a good option to optimize pregnancy rates, while reducing the risk of multiple pregnancies.