Fertility
EGG DONATION
While most women are born with a lifetime’s supply of healthy eggs, an unfortunate few may find that their eggs are defective in some way that prevents them from being able to conceive a child or carry it to term. In the past, this meant that such women would be unable to experience the joys of pregnancy and childbirth. With modern technology, however, there is hope for women with poor quality eggs in the form of in vitro fertilisation (IVF) using donated eggs. This procedure, which was groundbreaking when it was first introduced in the 1970s, has changed many women’s lives for the better, and remains highly popular and remarkably successful today.
Egg donation is recommended for women who fall into several categories, including those who are menopausal, who have not responded well to repeated IVF treatments, or who have dysfunctional ovaries due to a disorder, illness, or injury. All these issues can lead to defective eggs, leaving egg donation as the main recourse for such women to become pregnant themselves.
The process of receiving an egg donation is relatively straightforward in theory. Eggs are harvested from a healthy young donor, and can be preserved indefinitely or used right away. The eggs are then fertilised before being implanted in the uterus of the recipient. This process is much like a routine gynaecological examination, and involves the use of a very fine plastic tube that is inserted into the uterus to deliver the embryo. If the procedure is successful, the now-pregnant mother will then carry the baby to term.
Young donors are usually chosen due to the higher success rates of the IVF process that this can achieve – up to 70% pregnancy rates are currently possible with modern technology and good, healthy eggs. Fortunately, the recipient’s age does not have a serious effect on the success rate, although many clinics do put an age limit on the procedure itself (usually around fifty years).
Egg donors can be sourced privately or through egg donation agencies. Egg donation recipients (as well as the donors themselves) must undergo a rigorous series of medical tests to ensure that the chance of a successful procedure is sufficiently high. Where a male partner is involved, he too must undergo tests to assess the potential for successful fertilisation. Certain medications and hormone treatments are also required for each individual recipient before, during, and after the procedure.
EGG FREEZING
While women are born with between one and two million eggs, this number decreases relatively quickly over the lifespan (at a rate of approximately 750 per month). Furthermore, the quality of the remaining eggs (in terms of their ability to result in successful fertilisation and pregnancy) also diminishes over the lifespan. This is one of the main reasons for the decrease in pregnancy rates that is found as age increases, with the chances of pregnancy becoming very small after the age of around forty-five.
As a result of this biological trend, the popularity of egg or embryo freezing has steadily increased over the years since the technology became viable. Since 1986, when the first successful frozen egg birth was reported, the techniques involved have become more and more refined, and the overall success rates have increased considerably. This allows young women who are uncertain about whether or not they will want children at a future date to freeze their most viable eggs for use at a later date, instead of compromising their chances of successful pregnancy by relying on the lower-quality eggs they may be left with as their age increases. Women who are concerned about their future fertility due to medical reasons (such as chemotherapy treatment) may also benefit from egg or embryo freezing.
Until recent years, the freezing process left many eggs vulnerable to damage due to ice crystal formation, but recent scientific breakthroughs (including the dehydration and subsequent rehydration of the egg, as well as ultra-rapid freezing) have been able to overcome these problems, bringing the procedure into the medical mainstream and guaranteeing the success of most frozen egg births. Fertilised eggs (or embryos) can also be stored in a similar way and implanted into the womb at a later date.
The process of egg or embryo freezing is relatively straightforward and begins with an assessment of the ovarian reserve of the woman in question. By using a combination of ultrasound and measurement of hormonal levels, the number of viable eggs in a woman’s ovaries can be estimated. If this number is acceptable, hormone therapy follows to create an optimal environment for egg retrieval. At the correct time, the procedure of egg retrieval is performed under sedation. This process is painless, requires no hospitalisation, and lasts only a few hours, requiring only a day of recovery time. Once retrieved, the eggs or embryos are inspected, prepared, and frozen by a qualified embryologist. Under proper storage conditions, the frozen eggs/embryos can last for up to ten years.
BLASTOCYST TRANSFER
The process of in vitro fertilisation (IVF) procedures can be complex, and needs to be customised to suit each individual patient depending on the many factors that may influence her chances of a successful pregnancy by this method. One of the additional procedures that may be required as part of the IVF process is that of blastocyst embryo transfer. This procedure has become a highly popular addition to the IVF process due to the increases that have been noted in rates of successful pregnancy as a result (around 45% with blastocyst embryo transfer, compared to around 27% when this process is not included in the overall IVF procedure).
Blastocyst embryo transfer involves the implantation of a fertilised egg into a recipient’s womb after a period of five to six days following fertilisation, instead of the usual two- to three-day period that is most often used in standard IVF procedures. This longer waiting period allows for the fertilised egg to take in a special culture fluid that increases the chances of its development into a ball of around 120 cells known as a blastocyst (the first stage of embryo development). Once this development is stable, implantation into the womb is recommended for the highest chance of successful pregnancy.
A fertilised egg can develop multiple blastocysts (as in the case of twins). In this event, the prospective mother can choose the number of embryos she wishes to carry. Successfully formed blastocysts can also be frozen for use at a later date, using the same IVF process.
ARTIFICIAL INSEMINATION
One of the most popular and effective procedures available to partners experiencing difficulties with conception is artificial insemination. This procedure is used throughout the world, particularly where cases of mild male infertility, endometriosis (a disorder of the uterus), or other less serious infertility issues. Artificial insemination has proven to be highly successful across a broad range of patients, is non-invasive, and is one of the most cost-effective procedures available, making it an obvious choice for many hopeful mothers.
Artificial insemination is most commonly performed using the partner’s sperm (assuming it is healthy), and can be performed with minimal discomfort in any doctor’s examination room, usually in the late morning once the provided sperm sample has been improved. The procedure is conducted using a very small flexible plastic tube that is inserted into the uterine cavity, and feels very similar to a pap smear (if it is felt at all). The woman’s ovulation cycle is monitored to determine the optimal time for insemination as well as developments thereafter.
Artificial insemination can also be performed using a donor sperm sample, often from a sperm bank. This is most often required in the case of men who suffer from more serious infertility issues of their own (although there are many treatments that can help those with all but the most serious cases to have their own biological child), or in the case of single women or same-sex couples who wish to have a child. The insemination procedure is conducted in much the same manner as above, and can be completed in just a few hours.
IVF
Unfortunately for many prospective parents, biological difficulties can make it impossible to have a child by natural means, and this kind of fertility problem is on the rise throughout the world. Fortunately, however, the medical field as well as its technological capabilities has risen to the challenge of solving this complex problem using a number of innovative techniques. Among the most successful and popular of these is the process of in vitro fertilisation (often abbreviated to IVF). This procedure has proven highly effective in overcoming both male and female infertility issues, such as damaged or blocked fallopian tubes, severe endometriosis, severe male infertility, advanced age, decreased ovarian function, or other types of unexplained infertility.
Since Louise Brown was born in the UK as the first ‘test tube baby’ in 1978, thousands of women all over the world have experienced the joys of becoming a mother through the scientific miracle of the IVF procedure. The procedure’s popularity is largely due to its largely pain-free nature. This process begins with medical treatment during the first two to three days of a woman’s menstrual cycle, including hormone therapy that is designed to stimulate egg growth. These medications can be taken either orally or by easily self-injectable methods, and result in few side effects other than the potential for mild abdominal pain.
Throughout the preparation phase, the production of eggs is monitored using a combination of ultrasound and blood tests, while medication is also given to suppress ovulation until the appropriate time. This ensures that the eggs are in the optimal location for retrieval when this time comes. At the time of the procedure, which can be performed in any equipped procedure room, an anaesthetist will administer a sedative and remain on hand to ensure that the patient does not feel anything of the procedure. A fine needle with attached ultrasound is used to extract the eggs from the ovaries with minimal physical damage to the patient. The entire procedure generally lasts no more than two hours, and requires only a day of recovery in most cases.
A sperm sample is obtained at the same time as egg retrieval, and is used to fertilise the eggs shortly after this process is completed. The embryos are then allowed to develop for around three to five days in the laboratory before being implanted into the womb of the prospective mother. This process is also quick and pain-free, can be done in the consulting room of any gynaecologist, and involves the use of a very thin plastic tube to transfer the eggs to the uterus. Once implantation is complete, an ultrasound will be conducted and further medication administered to ensure successful acceptance of the embryo into the womb.
In Vitro Maturation (IVM)
While in vitro fertilisation (IVF) procedures are most often used in cases where fertility issues such as damaged or blocked fallopian tubes, severe endometriosis, severe male infertility, advanced age, decreased ovarian function, or other types of unexplained infertility prevent successful pregnancy by natural means, other treatments are also available to address this problem. In vitro maturation is one such procedure that is similar in nature to IVF, but has a number of key differences that make it more suitable for certain patients.
Unlike in IVF procedures, where fully developed eggs are collected from the ovaries of a prospective mother, in vitro maturation (often abbreviated to IVM) involves the collection of eggs before they have reached full maturity. The advantage of this arrangement is that the woman does not need to take as much medication as she would in the case of IVF treatments. This is particularly important for women who are highly susceptible to the side effects of these drugs, such as ovarian hyper-stimulation syndrome (OHSS) or those who suffer from polycystic ovarian syndrome (PCOS).
In the IVM process, immature eggs that are collected are allowed to mature in the laboratory with the help of an incubator before being fertilised. The eggs are collected and implanted in much the same way as used in IVF processes. Collection is performed under sedation with the use of a small needle, and eggs are implanted into the uterus with the use of a very thin plastic tube. Both procedures are monitored by ultrasound, are completely painless, and last no more than two hours with no more than a day’s recovery time. While a very new process, IVM has proven to be highly successful.
ASSISTED HATCHING FERTILITY TREATMENT
Within the process of in vitro fertilisation, different procedures often need to take place to ensure a successful result. Many of these are necessary due to the fact that fertilisation takes place outside of the mother’s body, without the many helpful factors that the this body provides. One such procedure that is often required in fertility treatments is assisted hatching (often abbreviated to AH).
In the natural process, fertilisation of an egg by a sperm cell results in the outer shell of the egg quickly hardening to prevent other sperm cells from getting in (which would result in an overload of DNA and the potential failure of the embryo).This process takes place as the egg is travelling towards the uterus.Once it reaches thee uterus, this hardened outer shell (called the zona pellucida) breaks down to allow the egg to attach itself to the lining of the uterus and begin to develop into a fetus. When this takes place, the process is known as ‘hatching’.
In the case of in vitro fertilisation, the egg’s outer shell often does not break down as readily once the egg is implanted into the uterus of the woman who is to carry the pregnancy to term.This can result in complications with the pregnancy (or failure of the embryo to develop). In order to assist the egg in breaking down its outer shell, assisted hatching is performed, either with the use of a mild acidic solution, or by using a laser or microscopic needle to create a small hole in the shell before implantation. This greatly increases the chances that the shell will break down as normal once in the uterus, allowing for normal development to proceed from there.
INTRACYTOPLASMIC SPERM INJECTION
While a common perception is that the majority of fertility problems affect women exclusively, the truth is that many men suffer from problems of their own that can make it difficult for a couple to conceive a child.
Some of the main fertility issues that men can experience include:
- Low sperm count in the semen – this leads to a reduced chance of an egg being successfully fertilised. Sometimes, even when there is a complete absence of sperms in semen, a sample can be collected via advanced sperm retrieval methods.
- Problems with ejaculation – retrograde ejaculation makes the semen drain into the bladder instead of making its way out through the penis. In this situation, sperm cells can be collected from a urine sample or even directly from the testes.
- Problems with sperm mobility – these can cause the sperm to be unable to reach the egg for fertilisation, but a normal ejaculation is sufficient to collect a sample.
- Permanent vasectomy prevents sperm cells from exiting the testes.
- Cancer treatment can also cause infertility in men – in this case sperm samples are often taken prior to treatment and stored for later use.
In all the above cases, a procedure that is often prescribed is that of Intracytoplasmic Sperm Injection (often abbreviated to ICSI). This procedure entails the collection of both a sperm sample as well as several eggs from the prospective parents. Each egg is then gently injected with a single sperm cell under laboratory conditions, which are then kept in a culture fluid for a few days. Once healthy embryos begin form, the best of these are then implanted into the woman’s uterus. The entire process is thus very similar to that of in vitro fertilisation (IVF).
INTRAUTERINE INSEMINATION
While many common fertility treatments can be complex (and often expensive), there are a number of simpler and cheaper options that, while less certain of success, are less invasive and are often recommended for those whose fertility problems are not too severe. One of the most popular of these is the procedure known as intrauterine insemination (often abbreviated to IUI).This process is certainly cheaper than in vitro fertilisation (IVF) and often results in successful pregnancy without the need for further treatments.
The process of intrauterine insemination begins with the collection of a sperm sample, which is often improved by the addition of nutritive fluid that increases the sperm cells’ activity. The sperm is then released directly into the uterus of the prospective mother through the vagina by means of a long thin tube (a similar method to that used in in vitro fertilisation procedures). With the aid of the nutritive fluid, the sperm cells are then much more likely to reach the fallopian tube and fertilise the eggs that are released there, resulting in successful pregnancy.
Stimulated intrauterine insemination is a variation of this procedure in which the woman’s menstrual cycle is monitored by means of ultrasound scans, blood/urine tests, and other methods, in order to determine the optimum point at which the sperm should be introduced. In some cases, ovulation is triggered at the desired time by means of hormone treatments or fertility drugs. Examples of these drugs include clomid and metformin, both of which are safe and have very few known side effects.
SURROGACY
Despite the advancement of medical science and the many treatment options on offer for women suffering from fertility issues, there are unfortunately some cases in which it becomes impossible for a woman to carry a pregnancy to term. These circumstances might arise from illness, injury, or may be present from birth.For same-sex couples, there are also obvious issues that prevent a natural pregnancy from occurring.
In all the above situations, surrogacy, is a commonly used option for such couples to have a child that is genetically their own, and involves a woman agreeing to carry and deliver the child for the couple in question. In traditional surrogacy, this woman might be the genetic mother of the child (but has agreed to consider the child as belonging to the original couple), and may be conceived naturally or through artificial insemination.
Another method by which surrogacy can take place is through the transfer of a previously created embryo. In this case (known as gestational surrogacy) the original mother may be able to conceive, but is unable to carry a pregnancy to term. Alternatively, her eggs may be used to conceive a child through in vitro fertilisation (IVF) procedures. Once an embryo is created, it can them be implanted into the uterus of the surrogate mother to be carried and delivered naturally from that point on. In this situation, the child remains the genetic offspring of the original parents, but is carried by a third party (the surrogate mother).
