Shared Motherhood
(ROPA)

One of the first steps is to perform tests and exams. Your physician needs them to assess your clinical status. The exams may include a gynaecological ultrasound, hormone tests or infectious disease screening.

If the chosen MAR treatment is Shared Motherhood (ROPA) it will involve the two members of the couple and a sperm donor.

Treatments using donated gametes, whether it’s sperm or eggs, require the couple to attend a psychological counselling appointment at our clinic. Although it is compulsory, it is just a counselling session to discuss the legal, emotional and social implications of this type of treatment.

In this phase of your treatment, you will be contacted by a member of our team of embryologists for the selection of the most appropriate sperm donor for your treatment. In addition to its own sperm bank, AVA Clinic also has agreements with international sperm banks that meet all the quality and safety standards required by our own National Medically Assisted Procreation Council (CNPMA). This offers a wide range of possibilities for anyone wishing to use donated sperm.

After the sperm donor has been selected we will be able to start your treatment at any time suitable to you. You should expect your treatment to take about four to five weeks from the starting day to the pregnancy testing day.

The treatment begins with ovarian stimulation of the genetic mother (egg donor) to make her ovaries produce more than one egg.

Without medication, a woman’s ovary releases one egg in each cycle. In this type of treatment, the goal is to retrieve several eggs in the same cycle so that more embryos can be created in the lab. The ovaries, therefore, need to be stimulated and this is done with hormone injections. There are different protocols for ovarian stimulation and your physician will decide which one is best for you.

During ovarian stimulation (lasting an average of 10 days) we will need you to visit our clinic two or three times so that the growth of your follicles (small sacs where your eggs grow) can be monitored by ultrasound. Your protocol may be adjusted at any time and your hormone dosages may be changed. This ultrasound monitoring is therefore essential to the success of your treatment.

While the genetic mother is undergoing ovarian stimulation, the gestational carrier mother’s uterus will have to be prepared to receive the embryo(s) generated in the lab. This preparation is done with hormone medication.

As soon as your follicles reach the ideal size, we will schedule your egg collection and all the eggs that are sufficiently mature for in vitro fertilisation will be retrieved. This procedure is performed in an operating theatre under anaesthesia and is therefore not painful.

The retrieved eggs are then taken to the lab where they will be stored under conditions similar to those of the human body. These conditions are perfect for fertilisation and subsequent development of the resulting embryos.

On the day of the egg collection, it takes around three hours to recover from the procedure and you can go back to your usual routine as soon as you leave the clinic (with any exceptions indicated by your physician).

On the same day as the egg collection, we will thaw the selected donor’s sperm so that your eggs can be joined with it. After assessing the thawed sperm, our embryologists will use lab techniques to select the ones with the best motility and morphology. There are a number of techniques to improve sperm samples and our embryologists make sure that they choose the most appropriate one for each case.

The eggs will be fertilised with the selected sperm in the lab on the same day that the eggs are retrieved and the sperm is thawed. We will use one of two techniques to fertilise your eggs:

• In vitro fertilisation (IVF)

  In this technique, we simply put your eggs together with the right quantity of selected sperm so that fertilisation can take place. This is the classic, physiologically most natural fertilisation method as it involves little handling of the cells. The sperm will be responsible for finding and penetrating the eggs to fertilise them.

• Intracytoplasmic sperm injection (ICSI)

  In certain cases in which it is not possible to perform IVF, the chosen technique is ICSI. One sperm per egg is selected and injected into it. We use special, high-precision equipment (microscopes, microinjectors and microneedles) for this procedure to ensure that we achieve good fertilisation rates.

ICSI is the technique of choice if there is a suspicion or certainty that fertilisation may be low or non-existent with IVF.

The choice of technique for your treatment will be made on the basis of a number of criteria to ensure the best possible results. The fertilisation rates are similar for both techniques but neither of them will guarantee fertilisation of 100% of your eggs.

The day after egg collection, one of our embryologists will contact you with news about your treatment. This is when you will find out how many embryos will be developing over the next few days. During this culture period, which may vary from two to five days, your embryos will be safe in our lab and our embryologists will ensure that they have the ideal conditions for their development.

The embryologists will decide on the best day to schedule the transfer of your embryo(s) to the uterus. This decision will depend not only on the quantity but also the quality of the embryos. The embryologists will conduct a careful assessment of each embryo every day to ensure that the best ones are chosen on the day of your embryo transfer.

On the day of the embryo transfer, our embryologists will let you know how many good-quality developing embryos you have. If there are more good-quality embryos than you want to transfer, our lab team will cryopreserve them for future use (vitrification freezing method). Cryopreserved embryos remain intact and at the same stage of development until they are thawed. Around 95% of embryos are totally unaffected by this freezing and thawing process.

At AVA Clinic you will be given the choice of transferring one or two embryos. However, we will probably advise you on the ideal number to transfer in order to achieve a healthy pregnancy and delivery.

The transfer procedure is performed in the operating theatre. No anaesthesia is a necessity in this case, as it is practically pain-free, much like a gynaecological examination. The embryos are transferred to the gestational carrier mother’s uterus through the cervix with a very thin catheter. An ultrasound probe is used to place the embryo(s) directly in the place where it should implant to result in a pregnancy.

Today’s the day! After what we know is a difficult wait, it’s time to do the long-awaited pregnancy test. The test is normally conducted about two weeks after egg collection. You will have to take a blood test to confirm your pregnancy. You can take the test in the comfort of the AVA Clinic though, if this is not convenient, you can do it at any lab testing facility.

The AVA Clinic team wishes you the best of luck with your treatment. And don’t forget that you can contact us at any time if you have any questions.