Share motherhood is an assisted fertility process for same sex female couples. One of the women will be “the donor” providing the eggs, and the other will be “the recipient” becoming pregnant and giving birth.
The ROPA method can be summarized in the following stages:
1. Ovarian stimulation:
Injectable hormones (gonadotropins), which are hormones naturally produced by women but administered at higher doses, are started on the first or second day of menstruation. The administration lasts between 8 and 10 days. Doses are calculated based on age, weight, height, and follicular endowment to achieve multiple ovulation (about 6 to 10 follicles). In our center, we have standardized mild stimulations that are better tolerated by patients, as it has not been shown that stimulations with high hormonal doses improve pregnancy rates and instead may increase the risk of potential complications.
2. Follicular monitoring.
Between the 3rd and 5th day of medication administration, the first ultrasound control is carried out, and based on this, hormonal determination is performed depending on follicular development. It is not always necessary to determine serum estradiol. From this first control, the patient will be scheduled every 24-48 hours for monitoring of follicular development and adjustment of medication if necessary. Another hormone we measure before concluding the treatment is serum Progesterone, in case the endometrial characteristics are not optimal or in case of suspected premature ovulation which could create unfavorable conditions for embryonic implantation.
3. Egg Retrieval – Follicular Puncture.
The maturation of the eggs concludes with a final injection, which aids the ovulation process, also known as the "trigger shot." Follicular puncture is scheduled 36 hours after this injection. On the day of egg retrieval, the woman must arrive at the center fasting for at least 8 hours, without makeup, perfume, antiperspirant, or any other substance that emits odors. Before starting the procedure, a vein in the arm is cannulated with a solution, and the patient is prepared for a short and superficial anesthesia to perform the follicular puncture without the patient experiencing any discomfort. The duration of the puncture is approximately 15 to 20 minutes. The doctor uses a fine needle guided by ultrasound to penetrate the vaginal wall and reach the ovary. In each ovary, the content of the follicles is aspirated, thus obtaining the eggs. This procedure is performed in the operating room.
4. Fecundación In Vitro.
After the follicular puncture, the IVF laboratory proceeds to fertilize the eggs with sperm from an anonymous donor (the donated semen samples at our center come from CEIFER BIOBANCO GRANADA). Fertilization can be done in two ways:
a) Conventional: the eggs and the previously prepared sperm are placed in a glass container for fertilization to occur.
b) ICSI (Intracytoplasmic Sperm Injection): This technique involves injecting a spermatozoon into the egg using a micro needle, to facilitate fertilization. It is used when the number of motile and normal sperm is too low to ensure fertilization, in cases of insemination failure, or at the slightest suspicion that fertilization could be difficult. In more than 90% of our patients, ICSI is performed. Conventional IVF is usually used in very selected cases and combined with ICSI (50% of the oocytes are allocated to each technique). Once fertilization occurs, the development of the obtained embryos is observed. The gynecologist or embryologist will inform daily about the evolution of the embryos until the transfer.
5. Embryo transfer.
Embryo transfer involves placing one or two embryos into the uterus of the recipient woman through the vagina using a specially designed cannula. This procedure generally takes place 3 to 6 days after egg retrieval, depending on the development of the embryos. The embryo transfer is performed after endometrial preparation of the recipient woman, which can be through a SUBSTITUTE cycle (using estrogens) or a NATURAL cycle (without medication). The advantage of the NATURAL cycle over the SUBSTITUTE cycle is that it is more physiological, but the disadvantage is that in most cases, the embryo transfer cannot be performed with fresh embryos, and vitrification is required. It is important that no chemical substances emitting odors or potentially harmful to the embryos, such as makeup or antiperspirant, are applied. This process does not require anesthesia and lasts approximately 5-15 minutes.
6. Pregnancy Test
It is carried out 10-12 days after the embryo transfer, through a quantitative determination of the pregnancy hormone (hCG - human chorionic gonadotropin).