Thursday, April 15, 2010
Embryo adoption versus surrogacy
We get lots of requests for surrogacy treatment . India is now acknowledged to be a global leader in IVF technology; and because surrogates are easily available and IVF treatment is much less expensive than in other parts of the world, many couples travel to India for surrogacy treatment.
While this is good news, because they can get cost effective treatment, the downside is that surrogacy gets very overused. Because it is very profitable, many doctors offer it to patients who do not need it - and even worse, those who will not benefit from it !
Typically, women who ask for surrogacy are older women, or women who have failed many IVF cycles. They are desperate and emotionally vulnerable and feel that the best solution to their problem of repeated failed embryo implantation is to use a surrogate. They have low self-esteem, and believe that fact that their embryos do not implant means that their uterus is defective. This is why they feel that using a surrogate is a logical answer which will help them to solve this problem ! They have very unrealistic expectations of surrogacy success rates - and a flawed understanding of reproductive biology
The commonest reason for failed embryo implantation is NOT a defective uterus, but rather genetically abnormal embryos. 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.
This is why if there is a problem with embryo implantation, changing the embryos is a better option than changing the uterus, which is why embryo adoption is often a much better option than surrogacy for these patients.
The reason is simple ! 9 times out of 10, the problem in patients with repeated failed IVF cycles is not with the uterus but with the eggs !
I think this fact needs to be emphasised. As women get older, they know their fertility declines. Most assume that this is because their reproductive system is aging - and for most women their reproductive system consists of their uterus. If menopause = no periods = nonfunctioning uterus, it is quite logical to conclude that increased age = reduce fertility = poorly functioning uterus. Seen from this perspective, changing the uterus to improve fertility by doing surrogacy treatment is very logical !
However, this logic is flawed. Hundreds of medical studies have proven that as a woman gets older and enters the menopause , even though her uterus stops functioning, this is only because of the absence of ovarian hormonal stimulation. If the uterus is exposed to estrogen and progesterone, it starts working one again - even if she is 72 years old !
I feel an effective solution to prevent the misuse of surrogacy is that this treatment option should be endorsed by two independent IVF specialists, before a patient is signed up for an IVF program. This should help to prevent the overuse and misuse of surrogacy treatment !