Wednesday, February 17, 2010

Why embryo adoption is more useful than surrogacy

There is still a lot of confusion amongst patients about the difference between embryo adoption and surrogacy.

Surrogacy gets a lot more media coverage, but in reality, it is applicable for a much smaller group of patients . This is because surrogacy is best reserved for women with no uterus ; or those with an irreparably damaged uterus. Unfortunately, it is often misused and overused for patients with : multiple failed IVF cycles; recurrent miscarriages; older women. Actually, none of these patients need surrogacy at all.

Let me explain.

The commonest reason for IVF failure is failed embryo implantation. This means most women who fail an IVF cycle will produce beautiful embryos, but these will not implant, even though the embryos are good quality ; the uterine lining is thick and trilaminar; and the embryo transfer was easy.

Why healthy good looking embryos do not implant is still one of those things we do not control
However, we do know that the vast majority of the time this is because of an intrinsic genetic defect in the embryos which we cannot detect because our technology is not yet good enough. Similarly, the commonest reason for a miscarriage is a genetic abnormality in the fetus, and this is Nature's defense mechanism, to prevent the birth of an abnormal baby. While these defects are often random, they are commoner in older women. This is because the eggs of older women have more genetically abnormalities, because they have "aged" and have genetic defects, which cannot be screened for.

However, when an infertile woman fails an IVF cycle or has a miscarriage, she usually "blames" her uterus . Infertile women have low self-esteem - and when the cycle fails, they feel it is their body which is flawed and defective. This is why they believe that using a healthy woman's uterus will help them to have a baby. However, this is flawed reasoning. If your uterus is healthy, then using a surrogate's uterus will not help at all ! Not only is doing surrogacy illogical, it's also much more expensive and complex because of the numerous ethical and legal challenges surrogacy creates. Unfortunately, few doctors bother to explain these facts, simply because surrogacy is so much more profitable for them to offer , as compared to enbryo adoption !

From a medical point of view, embryo adoption is a much better solution for most of these patients which a much higher success rate. After all, if the problem is with the embryo ( even though we cannot detect it), then it makes much more sense to replace the embryo , rather than the uterus.

Of course, just because solution is logical does not mean it is easy to accept. Most people are very strongly attached to their genes, and want to be able to hand these over to their offspring ! This is the major problem with embryo adoption for many couples - it is difficult for them to accept that their child will not have their genes. This comes down to the Nature versus Nurture argument - and what is more important in being a parent - biology or love ? Embryo adoption is not the right solution for everyone, but it's a very good option for couples who are comfortable with the idea of adopting a child they can bring up as their own.

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