Controlled Ovarian Stimulation of the Egg Provider
Controlled Ovarian Stimulation of the Egg Provider
COH is used to maximize the number of retrievable eggs for fertilization. The goal is to optimize the chances of a viable pregnancy. For women that do not have menstrual cycles (due to hysterectomy or endometrial resection), approximately 14 days after spontaneous ovulation occurs (as assessed by home ovulation test kit), she starts taking a birth control pill (BCP). About 8 to 20 days later a GnRHa is administered daily to prepare the ovaries. After 5 days of GnRHa, the BCP is stopped and the woman providing the eggs continues on the GnRHa for another few days, at which time daily blood estradiol (E2) measurements are done. Once the E2 is found to be less than 70pg/ml, the she is ready to receive gonadotropins. The exact timing is dependent upon when the surrogate (whose cycle has been synchronized) starts menstruating and reaches an E2 level of less than 70 pg/ml as well.
The female partner’s first day of gonadotropin injections is referred to as cycle day 2. On cycle day 9, the program would likely begin intensive daily monitoring by means of blood hormone measurements and ultrasound examinations. Usually, one-to-three additional days of gonadotropin therapy will be required. Once monitoring confirms that the female partner’s ovarian follicles have developed optimally, she is given an injection of the ovulatory trigger, hCG, at which time daily injections of GnRHa are discontinued. Her eggs are retrieved 34 to 36 hours after the HCG injection, by transvaginal ultrasound needle guided aspiration. This procedure is performed under anesthesia.
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