Fertility Program: Third Party Reproduction Options
For many of our patients and couples, not being able to conceive is a challenging obstacle. At Wright State Physicians Obstetrics & Gynecology, we offer “third party reproduction” solutions for those individuals and couples who may benefit from donor assistance.
“Third Party Reproduction,” according to the American Society for Reproductive Medicine, refers to the use of eggs, sperm or embryos that have been donated by a third person (donor) to enable an infertile individual or couple to become parents. The use of donor eggs, sperm or embryos can then be used in ART (assisted reproductive technology) procedures such as IUI and IVF. “Third Party Reproduction” also includes surrogacy with a gestational carrier.
Sperm donation is when a male voluntarily gives his sperm in the hopes of helping a woman or couple to become pregnant by way of IUI or IVF. Just as in egg donation, sperm donation can be done anonymously or as a directed (known) donor.
Anonymous Sperm Donation
Wright State Physicians Obstetrics & Gynecology assists couples with selecting anonymous donor sperm from sperm banks that are accredited by the American Association of Tissue Banks (AATB). Such accreditation assures us that these banks meet specific minimal standards for disease screening and semen quality.
Known Sperm Donation:
Known or directed sperm donation is reserved for those individuals or couples selecting a family member or friend to be their sperm donor. We follow the guidelines of the American Society of Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology (SART) as well as FDA regulations for directed sperm donation. We select only those men as donors who have passed appropriate physical, genetic and psychological screening.
Embryo donation involves using another individual’s or couple’s embryo(s) that were produced from previous IVF cycle(s) in order to conceive. For many patients and couples undergoing IVF, more embryo(s) are oftentimes created and cryopreserved (frozen) than are used to successfully complete one’s family. These remaining embryo(s) are often donated, providing a unique opportunity to help other individuals or couples experience pregnancy and childbirth.
We follow the guidelines of the American Society of Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology (SART) as well as FDA regulations for embryo donation. We select donated embryos from individuals and couples who have passed appropriate physical, genetic and psychological screening.
A surrogate is a woman who agrees to carry a pregnancy for another woman or couple.
One of the most generous gifts a woman can give to another is to carry a baby for 9 months. With the onset of new advances in reproductive medicine this is now possible. For a woman without a healthy uterus, she can now have her own genetic child.
When is Surrogacy needed?
The most common reason is that a woman does not have a healthy uterus. There can be many reasons for this including: infection, small size, scar tissue and poor endometrial development. Additionally, there are certain women who are born with ovaries but no uterus.
How successful is Surrogacy?
The success of surrogacy depends on many factors. However, by far and away the most important factor is the age of the egg provider. For women or donors below age 32, the success is above 60% per cycle.
Who becomes a Surrogate?
There are many educated women who very much enjoy being pregnant. In addition, they enjoy helping another woman have a child. There are a number of requirements before a woman can become a surrogate including having a child of her own and being at least 21 years old.
How are Surrogates chosen?
The surrogate agencies provide a great deal of information on prospective surrogates including pictures and personal information. The surrogate/egg provider relationship is often non-anonymous but that is decided by each case.
When a surrogate is selected then medical and psychological screening tests are done to ensure the surrogate is satisfactory from the general health, hormonal and psychological perspectives. The medical tests include a careful medical history, a pelvic examination (including a pelvic ultrasound), blood tests to look for infectious diseases (HIV, hepatitis B, hepatitis C, syphilis and HTLV-1), cervical cultures for Gonorrhea and Chlamydia. The psychological screening includes an interview with a therapist experienced in this area.
How is Surrogacy accomplished?
Surrogacy is an IVF cycle split between two women. Both women take birth control pills for a few weeks and then start the medication, Lupron. This serves to synchronize the menstrual cycles of the women and get both of them to the “starting gate” at the same time.
The surrogate then begins receiving estrogen in the form of estradiol valerate injection twice a week. This estradiol is the same main estrogen normally produced by the ovaries. Meanwhile, the egg provider receives daily injections of fertility drugs (such as Gonal-F, Follistim, Menopur and Repronex) which helps mature a group of eggs in her ovaries. Usually 8-12 days of fertility hormones are required before the eggs mature. Soon after this point the recipient begins progesterone, the other hormone necessary to maintain pregnancy. This can be in the form of a vaginal gel or a daily injection. It has long been our custom to teach a spouse, relative, friend or neighbor to give injections so frequent trips to our office are not needed.
The eggs are gathered at the egg retrieval. The eggs are usually inseminated a few hours after retrieval with sperm from the recipient’s husband. This is done by our embryologist. He will culture the fertilized eggs (now called embryos) until the time of transfer to the recipient’s uterus. The embryo transfer is usually done 3-5 days after the egg retrieval.
What are the risks of being a Surrogate?
The primary risk is that of being pregnant. Pregnancy itself is a risk. While it is beyond the scope of this information to discuss the risks of a singleton pregnancy, we strive to limit the number of multiple pregnancies. Multiple pregnancies increase the risk of complications to the surrogate and the unborn babies. This includes premature delivery and the respiratory, infectious and other complications that often follow. We therefore limit the number of embryos we transfer while still maximizing success rates.
Can Surrogacy reduce the future fertility of the Surrogate?
It is not thought that surrogacy reduces the future fertility of the surrogate. This is unless there is a complication with the pregnancy or the delivery.
Gestational surrogacy (also known as a Gestational Carrier) is the most common type of surrogacy and refers to a woman who agrees to have another individual’s or couple’s embryo(s) transferred into her uterus as discussed in the above IVF process. The surrogate has no genetic link to the pregnancy she carries.
Traditional surrogacy refers to a woman who is artificially inseminated with sperm (typically from the male partner of a couple seeking a surrogate) for the purpose of conceiving. The surrogate’s eggs are fertilized with the sperm during this process and therefore the surrogate has both a genetic and biological link to the pregnancy she carries. At this time, traditional surrogacy is not offered at Wright State Physicians Obstetrics & Gynecology.