WHEN FERTILITY TREATMENT DEPENDS ON SOME ONE ELSE
Sometimes, in the process of seeking solution to infertility problems, couples may find themselves having to decide on whether they should consider the use of either donor eggs or sperm (which may come from anonymous persons or relatives/ family friends). As remote as this may sound, many couples find that deciding on donors, may significantly determine their ability to achieve pregnancy with assisted reproductive Technique.
The society of Assisted Reproductive Technique (SAPT) a regularly body based in Alabama, USA, recently, reported the fact that the highest live birth rates were found amongst women, who have IVF, using donated eggs, sperm or embryos. The SART data further indicated that the overall delivery rate per person following use of donor eggs was as high as 41.2% compared to 31.1% following IVF with the woman’s own egg.
(As earlier stated, may be known persons i.e. A relative or anonymous persons).
The woman who will require the donations of eggs will usually fall into one of these categories:
• Women With Premature Ovarian Failure:his means women who have stopped menstruating and ovulating
• Women With Premature Menopause.
• Women who were born with under developed ovaries, which cannot function normally.
• Women with ovaries which have been damaged by radiotherapy (or chemotherapy in the process of cancer treatment).
• Women with previously failed IVF treatments due to poor egg numbers or quality and failure to achieve pregnancy after repeated attempts.
• Women with age consideration, who wish to have IVF treatment- (women over 40 years are very likely to have poor quality eggs).
• Women with high risk of passing genetics disorders to their off-spring.
• Women past the age of menopause, who desire child bearing.
Criteteria For Qualification As An Egg Donor
Female donor, who wishes to donate her eggs to assist another woman who requires donor egg for IVF, needs to meet the following criteria.
• Be aged between 21 and 34.
• Weight less than 85kg
• Have regular menstrual cycles ( between 24 and 35 days cycle)
• Have 2 ovaries
• Had not more than G2 (a culture media that supports the in-vitro development of the fertilized oocyte, the zygote, from 8-cells to blastocyst). failed attempts at IVF if she has had IVF treatment
• Should have suitable hormonal levels for FSH and LH.
(may also be known persons or anonymous persons)
Men, who require donor sperm, will usually fall into one of these categories.
(a) Those who have no sperm at all (Azoospermic), with which to carry out either IVF or ICSI ( intra cytoplasm sperm injection), in whom surgical sperm retrieval has failed
(b) Men who also have a high risk of passing inherited disease to their offspring may opt to use donor sperm.
(c) Severe Rhesus incompatibility, where the female partner is RH sensitized and the male partner is RH positive.
(d) When the male partner has an incurable sexual disease such as HIV.
Donors’ sperm can be useful in two ways:
1. IVF 2. Intra uterine insemination. (IUI)
Criteteria For Qualification As A Sperm Donor
Sperms donors should also fulfill the following criteria:
• They should be healthy men of normal intelligence and fertility (preferably high sperm counts).
• Be between 21 and 35 years.
• Have no history of mental disorders or genetic inherited diseases.
• Have no STDs.
(It is imperative to state that, not all volunteers are however suitable as donors, as IVF centers
have strict screening criteria. For ethical reasons especially, a brother should not donate sperm to assist a sister who is married to a man with azoospermia. A father may also not be suitable as a donor to a married azoospermic son for (sexually transmitted diseases) Hepatitis B or HIV seropositivity)
This is a situation in which the couples seeking IVF treatment opt to receive the donation of fertilized egg (eggs and sperm) from another couple. This may be indicated when partners, (men and women) have neither eggs nor sperm. The woman for instance may have reached early menopause, and the man may be azoospermic; Couples who have a high risk of passing genetics disorders to their offspring; and sometimes, the couple may have poor quality eggs and sperm which has manifested as current IVF failures.
Couples, who decide to use (embryo) donors, will need counseling prior to treatment, so that all ethnical or moral issues may be properly addressed. Both donors and recipients also need to give a recent Consent. For many couples donor IUI or Donor IVF may just be the solution to their problem of infertility or failed treatments. For this reasons, it may be worth considering as a means of achieving your much desired goal.
There is no doubt that the success of ART is directly dependent on the quality of eggs used and this is directly related to the age of the female partner in couples seeking ART treatment. The lower success rate achieved in older women is mainly due to lower quality of eggs encountered in this group of women.
In order to make IVF more beneficial to the older couple and at the same time increase accessibility to couple with financial constraints, the concept of Egg SHARING was introduced in Europe and America. Now fully acceptable in many countries worldwide, EGG SHARING SCHEME has evolved to meet both the reproductive and financial needs of an increasingly enlightened population. In essence, couples facing of eggs. The development and maturation of the egg will then be monitored by serial ultrasound scan. When all the eggs are ripe, all the eggs collected from her ovaries will be shared equally between herself and the recipient.
The inherent disadvantage in this is that there will logically be a lower predicted outcome of oval success, if for example she produces only a few eggs or only a few eggs fertilize. Both women may end up with fewer numbers of fertilized eggs each. Those with the challenge of infertility who cannot afford the cost of IVF treatment can have their treatment paid for by an “egg recipients” couples, egg sharing therefore involve the voluntary sharing of eggs between two couples who remain anonymous throughout the procedure.
At Nordica fertility Centre, Lagos, we also have modified egg sharing scheme which takes care of the inherent problems in the classical egg sharing scheme. This will be introduced in this article. Usually, the egg recipient is an older woman who has no eggs of her own (i.e. premenopausal or menopausal) or has poor quality eggs, which has resulted in repeated miscarriages or previous cancelled/ failed IVF cycles.
Couples sharing their eggs (donor couple) should be fit, healthy and under the age of 35. Prospective couples who wish to take advantage of the Egg Sharing Scheme will need to undergo an initial screening for hormonal imbalances, genetics and infectious diseases. The donor couples only pay for the cost of this screening and practically have their treatment free! ‘The donor couple’ will also have a detailed assessment of past medical and gynecological pelvic examination along with virginal ultrasound scan for the woman. The presence of ovarian cysts, polycystic ovarian diseases, malpostioned ovaries, endometriosis or fibroids, may disqualify prospective ‘donor couples’. Egg recipient (women) may be in their early or late 40’s, in some instance, women in the 50’s may benefit from the Egg Sharing SCHEME. This means that it is not necessary for the egg recipients to be having regular period. She may be having regular or irregular periods. Her periods may even cease. She may already be on hormone replacement therapy.
Egg Sharing Procedure
With simple egg sharing, the woman sharing her eggs will undergo a course of stimulation drugs, which work on the ovaries to induce a large number.
Modified Egg Sharing Procedure
With the modified Egg Sharing Scheme, the donor will undergo 2 cycles of stimulation. All the eggs collected from her first cycle will be donated to recipient couple. After one or two months of a resting phase, she will have her own treatment cycle. Like the first, all the eggs that are collected will be made available for her own use, to be fertilized by her partner. The Modified Egg Sharing Scheme potentially ensures a higher success rate as both couple will have the maximum number of eggs each. The egg receiver will need to be available for treatment at the same time as the Egg ‘donor’ undergoes her stimulation cycles. Recipients who are not menstruating at all may not need the same course of drugs as those who have at least irregular periods.
At an appropriate time, estrogen tablets are commenced to build up the lining of the womb towards the transfer of the eggs which would have been fertilized by sperm from the recipient’s partner. Then those participating in the Eggs sharing or modified egg sharing schemes, will generally be anonymous to each other, although in certain circumstances, known donation will be permitted. Consent forms will need to be signed by all participating couples and counseling will be recommended from both parties, so that all relevant legal, ethical and moral issues may be properly addressed. Couples who participate in this Modified Scheme also pay for their screening along.
In few instances, couples desiring to achieve pregnancy through Assisted Reproductive Techniques (ART) may be faced with the option of surrogacy. Surrogacy is a situation in which a third party (usually woman) agrees to carry a pregnancy to term on behalf of an infertile couple.
There are basically two types of surrogates: (1)Natural or Traditional surrogates or (2)IVF surrogate mother otherwise known as gestation carriers.
A natural surrogate mother is genetically related to the child, apart from carrying the child she has also gone through the procedure of insemination, with the use or her own eggs.
An IVF surrogate on the other hand is not genetically related to the child. She is a woman who carries a pregnancy, created by the egg and sperm of the commissioning couple. ideally the surrogate should be under the age of 38 years, married or in a stable relationship. She should also preferably at least have previous live birth without complications.
Prospective surrogate should not have medical disorders, such as diabetes for blood group incompatibilities. In additions, they should not smoke, drink or abuse drugs. Normally prospective surrogate are thoroughly screened (medical history and full physical and radiological (ultrasound scan) examination). They would also need to go through counseling, as many surrogates; both natural and gestational may eventually find it difficult to part with the baby after delivery.
Couples requiring IVF surrogacy is usually those in which the woman’s ovaries are producing eggs, both her womb has been surgically removed. This can occur in stances whereby a woman had uterine cancer, severe hemorrhage for some reasons, or a ruptured womb from previous pregnancy.
Sometimes the woman was born without a womb.
She may also have a scarred womb, which will make it difficult for her to carry a pregnancy to term (Asherman’s syndrome)
In some cases she may not be able to carry a pregnancy because her womb has an abnormal shape or size.
In addition, sometimes women who suffer from medical problems such as severe diabetes, heart and kidney diseases put themselves at risk if they were to carry a pregnancy to term.
For others, surrogacy may be indicated because there is history of repeated miscarriage, due to some immunological incompatibilities i.e. Rhesus blood group incompatibility between mother and fetus.
Surrogate mothers are usually unrelated person, but in rare cases parents (especially mothers) have been known to act as the gestational surrogates for infertile daughters. In 1989, for example, a South African woman was highly publicized for acting as a gestational or IVF surrogate for her daughter. She was carrying triplets.
Traditional surrogacy is indicated in women who have no functional ovaries as a result of premature menopause. This means that she has no eggs in her ovaries. It may also be their offspring or who for health reasons, may be unable to carry a pregnancy to term.
Many women who agree to become surrogate may do so for compassionate reasons, to help siblings (sisters), offspring (daughter) or a friend. In many countries women are not permitted to become surrogate for financial gain. For a woman to qualify as a surrogate, she must fulfill some specific requirements: release the babies after birth. Such a breakdown in surrogacy arrangement can be extremely traumatic for the infertile couple. By law the woman who carries the child remains the mother of the child.
Procedure for IVF Surrogacy
The prospective surrogates will need to undergo blood tests for blood group Rhesus status, HIV and Hepatitis B and C. The fertile female partner will undergo IVF treatment, including ovarian stimulation, using fertility drugs. She will also have cycle monitoring by ultrasound scan. This helps to check the development of the eggs in her ovaries. When her eggs are mature, she will be given an injection of HCG, and the eggs will be collected 36 hours later. Following fertilization, the embryo, will be transferred into the womb of the surrogate.
Procedure For The Traditional Surrogate
The traditional surrogate is usually inseminated with the sperm of the fertile woman’s husband (Intra Uterine Insemination). No IVF is necessary, since the surrogate provides the eggs. Pregnancy tests are carried out 2-3 weeks after either procedure.
Success rates for traditional surrogacy are approximately 5-15% per cycle. For IVF surrogacy, live birth rates are as 20-30% per cycle. The live birth rate per treatment cycle in 1999 as reported by SAPT (Society of Assisted Reproductive Technology) was 29.8%