Using your eggs

USING YOUR FROZEN EGGS

Ready To Use Your Eggs?

Most women who bank their eggs are laser focused on Step 1, retrieval and freezing. The thought of Step 2, actually using these frozen eggs to conceive, can be too overwhelming to contemplate. Take one step at a time and one decision at a time – your frozen eggs are not going anywhere.
If you have decided you are ready for Step 2 – mazel tov! Many early egg freezing adopters are coming back to use their eggs. This section will be expanded as we learn from these women and their journeys to motherhood.
Using Frozen Eggs to get pregnant

Getting Pregnant With Frozen Eggs

Step 1: Clinic Consultation

The first step is to schedule an appointment with your clinic on Day 4-12 of your cycle.  Next make sure you have your medical records ready.  You’ll have to do a battery of test so get a head start and ask your clinic for a pre-work up checklist, which will typically include:
  • Pap smear
  • Mammogram
  • Communicable disease screening
  • APA (Antiphospholipid antibodies) panel
  • TSH and Free T4 (thyroid)
  • CBC  and chem panel
  • Varicella and Rubella (within five years)
On the day of your work up, your doctor will perform a baseline ultrasound and a hysteroscopy (HSC) and/or hysterosalpingogram (HSG).
What’s the difference between and HSC & HSG:
  • HSC assesses the health your womb. While under mild sedation, your Doctor will use a fiber-optic telescope to examine your uterus and remove, if necessary, any irregularities such as fibroids, polyps or scar tissues.
  • HSG assesses the health of your fallopian tubes. First, a radiopaque dye is inserted into your uterine cavity followed by an x-ray to determine a) if your fallopian tubes are blocked and b) pinpoint the location of the blockage.

A Note on Sperm Source

If you have a partner or recruited a sperm donor, then you are good to go. Otherwise, it’s time to start sperm shopping. There are many factors to consider – everything from race and genetics to height and eye color – so do not rush this decision.
First, you need to find a sperm bank that provides the level of service you need. Some women are comfortable choosing their sperm donors online (oddly very similiar to a match.com search), while others will opt for more hands-on personalized service. Once you have selected your donor, the sperm bank will ship the frozen sample directly to your clinic.

Step 2: Preparing Your Body

When your Doctor gives you the green light, it’s time to start preparing your body for your FET (Frozen Embryo Transfer). You’ll start by taking estrogen (orally) and progesterone (vaginally or via injections) to prepare your uterine lining (endometrium) for the transfer. Dosage and timing will vary, but plan on about a 2-3 week protocol. During this period, you will be monitored via blood draws to assess the development of your endometrium. Based on your blood work, your doctor will perform a final ultrasound to ensure you’re ready for the embryo transfer. If your body did not responded well to the medication, the cycle will be cancel. It’s critical that your body is as healthy and prepared as possible for the ensuing transfer.

How many eggs should I fertilize?

Do you want to fertilize all or just a portion of your frozen eggs? If you have not already made this decision, now is the time to finalize your plan of attack. Reserving some of your frozen eggs will give you the option to change your sperm source later, while fertilizing all of your eggs will enable you to genetically test the embryos. There are pros and cons to both scenarios, however if you want to keep your options open keep some of your eggs on ice.

Step 3: Thawing & Fertilizing

Your frozen eggs will be removed from the storage vat and quickly rehydrated or warmed. If you are using fresh sperm, your partner or identified donor will provide their sample on the day of the thaw. Otherwise, your frozen sperm will be thawed or brought to room temperature in about 30 minutes.
Time to fertilize. Because the outer wall (or zona pellucida) hardens when eggs are frozen, ICSI (intracytoplasmic sperm injection) is used to fertilize frozen eggs. This technique involves directly injecting a single sperm into a single egg with a needle instead of allowing sperm to penetrate the egg naturally in a Petri dish.
Within 24 hours: your clinic will let you know your embryo (fertilized egg) count

Step 4: Genetic Testing

The more you know about the health of an embryo prior to implantation the better the odds of a successful pregnancy. Advances and innovations in the preimplantation genetic testing field have significantly impacted transfer and subsequent live birth rates. The decision to use preimplantation genetic testing of any kind is up to you. The tests are not cheap, however the information they provide can have a significant impact on the success of your transfer.
Deciphering Genetic Test
PGD (Preimplantation genetic diagnosis): testing for a single gene defect such as Tay-Sachs, cystic fibrosis, etc. The acronym PGD has become a blanket term for any type of chromosomal testing.
PGS (Preimplantation genetic screening): PGS, or aneuploidy screening, goes one step further than PGD and assesses embryos for chromosomal abnormalities.
CCS (Comprehensive Chromosome Screening): A subset of PGS, CCS is the newest and more comprehensive chromosomal test around. CCS is performed on Day 5 at blastocyst stage when multiple cells (about 5-10) have developed making it possible to evaluate all 23 chromosomes.

Step 5: FET (Frozen Embryo Transfer)

FET is a fast (about 15 minute), non-surgical procedure whereby embryos are implanted directly into the uterus. Post procedure, it is recommended that you lay low for a couple days.
How many embryos should you transfer? You will need to make this call with your Doctor taking into account several factors, most importantly your embryo quality and age. Although the ASRM has published guidelines, the decision is ultimately based on your specific situation.
How many embryos should you transfer? You will need to make this call with your Doctor taking into account several factors, most importantly your embryo quality and age. Although the ASRM has published guidelines, the decision is ultimately based on your specific situation.

Step 6: Pregnancy Test

Post transfer, you will continue to take the hormone medication (progesterone and estradiol) to boost implantation success. So, when will you know if you are pregnant? Approximately 2 weeks post FET, you’ll take a blood test and have your answer! If you are pregnant, you will continue hormone medication until the placenta is viable (about week 10-12).

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