Artificial insemination first made surrogacy possible. A traditional surrogate is a third party woman who is artificially inseminated with the man’s sperm or receives the fertilized embryo from the couple. She then carries the baby and delivers it for the parents to raise.
Many couples are not able to have their own children, regardless of having a normal sperm or ovarian function due to congenital absence of the uterus or malformations of the reproductive tract. In some instances, a pregnancy may be contraindicated due to other health issues that jeopardize the life of the mother, or because the medical treatment will expose the fetus to the teratogenic effect of medicines taken during pregnancy.
Therefore, it is feasible to transfer the embryo into another woman who will carry the baby to term. The uterus of the gestational carrier will be synchronized with the ovulation induction of the biological mother in order to create the best possible environment for the embryo.
A complete psychological evaluation and numerous blood screening tests are required, as well as a signed legal agreement among all involved parties.
This programme offers hope to a large number of women who previously would never become pregnant. Such women include:
- Women who have a uterus but whose ovaries do not produce eggs due to premature menopause (affects 1-2% women before the age of 40)
- Women who have their ovaries removed as a treatment for cancer, pelvic infection or endometriosis
- Women whose ovaries are damaged by radiotherapy and chemotherapy.
- Women who were born without functioning ovaries (Turner’s syndrome).
- Women whose ovaries are resistant to stimulation by fertility drugs and women who had poor ovarian response to hormonal stimulation.
- Women with recurrent IVF failures linked to poor egg quality and those whose apparently normal eggs failed to fertilize repeatedly.
- Women with high risk of passing genetic disorders to their off-springs e.g presence of sex-linked diseases like haemophilia, Duchenne’s muscular dystrophy and Huntington’s chorea. Couples with recurrent pregnancy loss due to chromosomal abnormalities.
At Green-Onyx Fertility Center, we take time to make both the donor and the recipient couples to be aware of the psychological, moral and legal implications of egg donation and ensure that they are also adequately counseled and screened. Screening includes HIV, Hepatitis B and C and Syphilis, Genetic diseases like sickle cell, blood group and Rhesus status. Physical characteristics are also taken into consideration.
Selection criteria for egg donors
- Egg donor may be or may not be known to the recipient couples
- Healthy, between the ages of 18 and 30 years with no known history of mental disorders.
- No family history of genetic or inheritable diseases.
- Preferably, should have had healthy children of their own.
Women who have produced a large number of oocytes for an ART procedure may be asked if they are willing to donate unused oocytes. In egg donation, the donor must be ready to renounce all rights to the donated eggs.
The donated eggs are fertilized with sperm from the recipient’s partner. Following fertilization, the embryos are then transferred into the uterus of the recipient. Alternatively, the option of freezing and quarantining embryos derived from donor egg for six months, with the use of the embryos after retesting the donor may be considered. When this is chosen the possibility of lower success rate should be discussed with the couple. The donor undergoes a similar stimulation protocol for an IVF cycle with egg collection performed vaginally.
In this program, infertile couples that cannot afford the cost of IVF treatment have their treatment paid by an egg recipient couple. The egg sharer couple must be fit, healthy and under the age of 30 . The potential egg sharing donors are carefully assessed and screened for infectious and genetic diseases like we do for altruistic egg donors. The egg sharer donor undergoes stimulation protocol for IVF, after the eggs are collected, they are shared between the donor and recipient couples. The donated eggs are then inseminated with sperm from the recipient’s partner while the other eggs will be inseminated with sperm from the donor’s partner. Each couple will have their embryos transferred. This program may sometimes be the only source of hope for the older women. However, since it involves a third party, we usually recommend a trial of Assisted Hatching except in cases where there is no response to hormonal stimulation or when fertilization fails to occur.
Seminal Fluid Analysis
Semen analysis: What is it?
Approximately one in six couples have difficulty in conceiving and in approximately 20-25% of these it appears to be due to a male factor. Sperm problems can range from the complete absence of sperm, to having low numbers or simply poor quality and currently the only reliable method we have for detecting these is by a semen analysis. Semen analysis is basically the microscopic examination of the semen to see how many sperm there are and whether they function correctly. The results of all the semen analysis tests will indicate whether or not a male factor is involved and so aid decisions about appropriate treatment.
What does the man have to do?
Put quite simply and crudely the man has to masturbate into a small sterile container. Although we recognise that this can be quite embarrassing for some, useful information can be gained from just one semen sample and quite often no further tests are required. Specimen collection is usually done at home, however for those living more than an hour away we recommend that it is done on site using our private facility. The results will help us decide whether or not treatment is necessary and what type of treatment will be most appropriate.
To provide the best sample, patients should:
- Ensure they have booked an appointment. Occasionally, the laboratory will close for training or attendance of meetings and cannot be held responsible if a patient arrives without an appointment only to find that it is closed
- Provide a complete sample. The first part of the sample contains most of the sperm so if some is lost it will affect the overall test.
- Abstain from ANY sexual activity for 2-5 days before hand.
- Deliver the sample in a container provided or recommended by the laboratory
- Label the sample container clearly with full name and date of birth
- Deliver the sample within 1 hour of its production and keep the sample close to the body whilst travelling in (as sperm are sensitive to extremes of temperature)
- Arrive with their request card
- Be hygienic, washing their hands and genital area beforehand
Fertility Hormonal Assays
A woman’s fertility is not perceived merely in terms of mucus, or tubes or ovaries. The complex relationship between the brain, pituitary gland and the ovaries also needs to be studied. It is often essential to measure the levels of the various hormones in the body, which may play a part in the control of ovulation.
Why are hormone assays required?
Infertility treatment takes a holistic approach. A woman’s fertility is not perceived merely in terms of mucus, or tubes or ovaries. The complex relationship between the brain, pituitary gland and the ovaries also needs to be studied. It is often essential to measure the levels of the various hormones in the body, which may play a part in the control of ovulation.
What will hormone assays tell the doctor?
There are certain key hormones that are involved in the whole process of ovulation. These are follicle stimulating hormone (F.S.H.), luteinizing hormone (LH), estrogen and progesterone. In addition, another pituitary hormone called prolactin can interfere with the normal pituitary secretion of F.S.H. Disorders of the thyroid gland can also adversely affect fertility.
If, for example, your periods are very infrequent or have even stopped altogether (and you are not pregnant!), assays of prolactin. F.S.H., estrogen and thyroid hormone levels can be very useful in indicating the cause of your problem and thereby suggest a particular line of further investigation or treatment.
How is the normal production of these hormones determined?
Your progesterone level should be at the maximum level at the mid-point of the luteal phase of the cycle, between ovulation and the next period. This is a sign that ovulation had taken place. A low progesterone level at this time of the cycle (about day 21 of a 28 day cycle) indicates that normal ovulation in this cycle has not occurred. This, in turn, may be linked to an inadequate release of both F.S.H. and L.H. from the pituitary gland. A basal body temperature chart with a short luteal phase of less than 11 days may also indicate inadequate progesterone production.
Follicular Monitoring is the process of serial ultrasonic monitoring of the ovarian follicles used to identify maturation status of eggs. It is useful for assessing the size of the follicle that supports the growing egg and for determining the thickness of the uterine lining.
In women taking fertility medication, follicle monitoring is essential to assess her response to treatment. In order to safely proceed, it is important to know how many eggs will ovulate and how high the estradiol level is. Each mature egg should produce between 150 and 200 pg/ml of estradiol. Therefore, by using the hormone levels in conjunction with the ultrasound exam, a more accurate determination of a woman’s response to treatment can be made.
Additionally, the dose of the fertility medication can be adjusted during treatment if there is an inadequate response or if too many eggs start to mature. If the estradiol level gets very high, a woman may be at an increased risk for developing ovarian hyperstimulation syndrome.
The goal of follicle monitoring is to provide information about the number of mature eggs that will ovulate and to ensure that this is accomplished safely.
When the eggs are mature, patients are advised to have planned relations, or Intrauterine Insemination or proceed with egg collection in case of an In-Vitro Fertilization Cycle.
Ultrasound Monitoring enables the Doctor to understand present status of the uterus, endometrium and ovaries. Abnormalities in these findings could help to explain why a woman may have difficulty conceiving. It also identifies ovarian cysts, pelvic collection, hydrosalpinx etc.
We do all follicular monitoring at Green-Onyx Fertility Centre, starting from baseline scan on day 2 followed by Day 6 & Day 9 after which patient is ready for further management. Thus patient needs to come to the clinic for a maximum of 3-4 visits.