Module 9: Surrogate Endometrium Preparation

Questions and Answers

When should a surrogate start taking Oral Contraceptives (OCP)?

Two weeks prior to her ultrasound scan

On the first day of her period

One week before embryo transfer preparation

After selection/approval by the doctor and on second or third day of her period (correct)

What is the purpose of the Decapeptil or Diferin lin 3.75 shot given to the surrogate?

To suppress dominant follicle development (correct)

To promote menstruation

To prepare the endometrium for transfer

To induce ovulation

On which day of her period does the surrogate start preparing for embryo transfer?

Day 1

Day 14

Day 2 or 3 (correct)

Day 7

What hormone level is required for Estradiol on the day of embryo transfer?

More than 150 pg/ml Signup and view all the answers

When should progesterone and estradiol tests be conducted after starting estrogen?

12-14 days after starting estrogen Signup and view all the answers

What additional medication is added if the first transfer plan does not work?

Vaginal progesterone 400 mg the night before transfer Signup and view all the answers

How long should progesterone be taken after receiving the estradiol and progesterone test results indicating good hormone levels?

For 5 days by injection and vaginally Signup and view all the answers

What should the progesterone level be on the day of embryo transfer?

More than 10-15 ng/ml Signup and view all the answers

What should be ensured about hormone testing results on the day of embryo transfer?

They should be sent immediately after testing Signup and view all the answers

When is it necessary to stop OCP after Decapeptil Shot?

In 7 days Signup and view all the answers

What should the estradiol level be after embryo transfer?

More than 150 pg/ml Signup and view all the answers

How many days should progesterone be administered before embryo transfer?

5 days Signup and view all the answers

What is the recommended progesterone level after embryo transfer?

15-20 ng/ml Signup and view all the answers

What is the role of video calls in the medication administration process for surrogates?

To ensure all medications are taken properly Signup and view all the answers

When should the surrogate begin taking progesterone in before embryo transfer?

Five days before embryo transfer Signup and view all the answers

Why should the surrogate not know in advance when tests will be performed?

To ensure accountability for medication compliance Signup and view all the answers

What should coordinators do if lab test results are out of normal range?

Inform the medical team, have recommendations, ensure the surrogate follows new recommendations, and then inform intended parents of the adjustments made Signup and view all the answers

What is the subject line required for emails sent by coordinators about surrogates?

Name of the surrogate/Intended parent Signup and view all the answers

What email should be included in the CC of all coordinator emails?

<a href="mailto:[email protected]">[email protected]</a> Signup and view all the answers

What should happen if there is a mismatch in test results on the specified days?

Immediate adjustments should be made Signup and view all the answers

Study Notes

Surrogate Endometrium Preparation for Embryo Transfer

Surrogate selection followed by immediate initiation of Oral Contraceptives (OCP).
OCP starts on the 2nd or 3rd day of the menstrual cycle for progesterone regulation.
An ultrasound is scheduled for days 14-15 of OCP; if no dominant follicle, administer Decapeptil or Diferin injection (3.75 mg).
After the injection, discontinue OCP after 7 days and prepare for embryo transfer from day 2 or 3 of the next period.

Preparation Steps for Embryo Transfer

Begin estradiol administration daily starting on day 2 or 3 of the menstrual cycle.
Perform an ultrasound scan on days 12-14 after initiating estrogen.
Surrogate visits clinic at 9 AM for progesterone and estradiol testing.
If tests are within normal ranges, commence progesterone administration on the same day, vaginally and via injection for 5 days.

Hormone Testing Requirements

On testing day, ensure progesterone levels are below 1-1.5 ng/ml, estradiol exceeds 150 pg/ml, and endometrial thickness is 8 mm or more.
Results must be communicated on the same day; any necessary adjustments should be made immediately.

Testing Protocol on Day of Embryo Transfer

Repeat progesterone and estradiol tests on the morning of embryo transfer.
Normal ranges required: estradiol above 150 pg/ml, progesterone between 10-15 ng/ml.
Communicate lab results promptly; adjustments must be addressed quickly, leading to embryo transfer.

Post-Transfer Monitoring

Monitor estradiol and progesterone levels on days 2, 5, 7, and 10 post-embryo transfer without advanced notice to the surrogate.
Medication continues through weeks 12-14 of pregnancy and is gradually reduced.
Target levels post-transfer: estradiol >150 pg/ml and progesterone >15-20 ng/ml, and increasing.

Dosage Requirements for Progesterone

Administer 800-900 mg of micronized progesterone vaginally three times a day and additionally inject 2.5% progesterone daily.
Maintain progesterone levels ideally between 15-20 ng/ml; no less than 10 ng/ml.

Communication Guidelines

Emails must include mandatory CC recipients and maintain subject format with surrogate/intended parent's name.
Maintain communication chains without starting new emails for each lab test.
Initial email sent when surrogate begins preparation, followed by significant dates (ultrasound, embryo transfer, and post-transfer monitoring).

Coordinator Responsibilities

Collect and organize all laboratory tests and ultrasound reports in designated folders with appropriate titles.
Ensure compliance with medical recommendations; follow up with doctors within 12 hours if there are delays.
Relay lab results to intended parents and adjust dosages as necessary based on lab test outcomes.
Repeat infection screening tests if more than three months have elapsed since last tests prior to transfer preparation.

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Description

This quiz covers the critical steps involved in preparing the surrogate endometrium for embryo transfer and the necessary follow-up procedures. It emphasizes the significance of oral contraceptives, the timing of progesterone regulations, and the ultrasound scan to monitor follicle development. Test your understanding of the process and its timelines.