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Optimizing IVF for Black Patients

Course / Optimizing IVF for Black Patients

Hyperstimulation and Protocols

The goal of ovarian stimulation is to mature multiple competent oocytes (eggs) in a single cycle, providing the best foundation for creating viable embryos. A “one-size-fits-all” approach is obsolete; modern care is defined by personalized protocols.

  • Antagonist Protocol: This is the most commonly used protocol today due to its safety and efficacy. It involves administering medications (FSH/LH) to stimulate follicle growth, with the addition of a GnRH antagonist mid-cycle to prevent premature ovulation. Its benefits include a shorter treatment duration and a significantly lower risk of Severe Ovarian Hyperstimulation Syndrome (OHSS).
  • Agonist (Long/Lupron) Protocol: This classic protocol begins with a GnRH agonist to suppress the pituitary gland, followed by stimulation medications. It offers excellent cycle control and is often preferred for patients with specific conditions like endometriosis, though it may have a slightly longer duration.
  • Microdose Flare Protocol: This protocol uses a low, continuous dose of a GnRH agonist to stimulate rather than suppress the ovaries at the cycle’s start. It is typically reserved for patients with a low ovarian reserve or those who have had a poor response to other protocols, as it can help recruit a stronger cohort of follicles.
  • Personalization is Key: The choice of protocol is based on a patient’s age, Antral Follicle Count (AFC), Anti-Müllerian Hormone (AMH) level, and previous IVF response. The use of preimplantation genetic testing for aneuploidy (PGT-A) is often recommended to identify chromosomally normal embryos, especially for intended parents using their own gametes.

Fresh or Frozen Embryo Transfer

A critical decision in any IVF cycle is whether to perform a fresh embryo transfer or to freeze all embryos for a later frozen embryo transfer (FET).

  • Fresh Embryo Transfer:
    • Process: Embryo transfer occurs 3-5 days after the egg retrieval, within the same stimulated cycle.
    • Considerations: While logistically straightforward, a fresh transfer takes place in a hormonally altered environment. The elevated estrogen levels from stimulation can adversely affect endometrial receptivity, potentially leading to lower implantation rates in some patients.
  • Frozen Embryo Transfer (FET):
    • Process: All viable embryos are cryopreserved via vitrification. The surrogate undergoes a separate, prepared cycle where her endometrial lining is optimized with estrogen and progesterone, creating a more controlled and physiologically receptive environment for implantation.
    • Advantages:
      • Better Endometrial Synchronization: Allows the surrogate’s cycle to be perfectly timed with the embryo’s development stage.
      • Eliminates OHSS Risk: Removing the risk of ovarian hyperstimulation in the carrier is a significant safety benefit.
      • Allows for PGT-A: Freezing embryos provides the time needed for PGT-A biopsy and results, enabling the transfer of a known euploid embryo.
      • Higher Success Rates: In many clinical scenarios, particularly with PGT-A, FET cycles demonstrate higher live birth rates than fresh transfers.
  • Clinical Recommendation: For surrogacy arrangements, Freeze-All cycles with a subsequent FET are the gold standard. This approach prioritizes the surrogate’s safety and maximizes the chance of a successful singleton pregnancy by allowing for optimal embryo selection and endometrial preparation.

Single Embryo Transfer

The practice of transferring multiple embryos is a legacy of older, less efficient IVF technology. Today, with vastly improved lab conditions and genetic testing, Elective Single Embryo Transfer (eSET) is the unequivocal standard of care for good-prognosis patients.

  • The Goal: One Healthy Baby at a Time
    • The primary objective of a surrogacy journey is the safe delivery of a healthy child. Twin and higher-order pregnancies are considered high-risk for both the carrier and the babies.
    • Risks of Multiple Gestation Pregnancies: These include dramatically increased rates of preterm birth, low birth weight, preeclampsia, gestational diabetes, and cesarean section.
  • How eSET is Safely Achieved:
    • Advanced Embryo Selection: Through morphokinetic grading (time-lapse imaging) and especially PGT-A, we can identify the single embryo with the highest potential for implantation and live birth.
    • Equivalent Success Rates: For patients with a good-quality, euploid embryo, the cumulative live birth rate from one eSET is equivalent to—or even higher than—that of a double embryo transfer, but without the devastating risks of a multiple pregnancy.
  • Our Commitment: Surrogacy4All strongly advocates for eSET in collaboration with our partner clinics. This evidence-based practice is the most responsible path, safeguarding the health of the surrogate and the intended parents’ long-awaited child(ren).
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