Monday, September 22, 2014

The abuse , misuse and overuse of surrogacy


 I was counseling a patient who had failed many IVF cycles . She was completely fed up and wanted me to do surrogacy for her. We have an active surrogacy program , and it's very profitable for me to offer surrogacy because it’s far more expensive than a regular IVF cycle . However, it’s my personal opinion than surrogacy is a treatment which is best reserved for patients whose uterus is absent or damaged .

For most women with the distressing problem of repeated failed implantation , the probability that there is a problem with their uterine receptivity is very low , especially when we have checked that their uterus is normal ( with the help of a transvaginal ultrasound scan which shows they have a thick, trilaminar endometrium).

This is why the uterus using a gestational surrogate makes no logical sense because it cannot increase pregnancy rates .

To use an agricultural metaphor, the seed has a far more active role to play as compared to the soil. We know based on extensive research that the reason for failed IVF cycles and recurrent miscarriages is far more likely to be a defective embryo because of a lethal genetic defect, rather than an endometrial problem.  Sadly, we still don’t have the technological ability to be able to document these genetic defects, and this leads to a lot of confusion. Thus, if an embryo fails to implant after PGS/CCS has shown it to be normal, patients jump to the flawed conclusion that the problem is with their uterus, which is “rejecting” the embryo. The reason this is erroneous is that PGS/CCS only allows us to count the number of chromosomes – it cannot test the normality of all the genes !

However, most doctors are quite happy to offer surrogacy as a solution , and this makes a lot of logical of sense to the patient. They feel that if the doctor transferred good looking embryos into my uterus and they still failed to get pregnant, this proves that their uterus is defective and is rejecting the embryos.

Their belief is strengthened by all the rubbish which floats around on the internet about immunological dysfunction causing recurrent implantation failure .

It’s often hard for me to explain to them why surrogacy's actually not the right solution for them , and why they would actually be better off considering donor egg IVF or embryo adoption . Patients come to doctors with preconceived notions , and they don't really want to engage in a debate with the doctor. Most would much rather find a doctor who was happy to do whatever they wanted . After all, they are willing to pay for the treatment , so why should the doctor object ?

The problem with surrogacy is that it deprives the patient the joy of experiencing pregnancy herself. The unfortunate women who are born without a uterus don’t have a choice in the matter, but it’s sad that they deprive themselves of this unique experience simply because of preconceived misconceptions.

I think my role is not merely just that of being a technician . I am a professional , so that I need to offer my personal opinion . I may not always agree with the patient, and some of them get upset when I do this. They would rather find another clinic who accedes to their requests . Of course, it’s much easier for me to do this as well, and by educating my patients , I am aware that I'm actually turning away income ! However, I think that it’s in their best long-term interests that they understand their alternatives , and then choose the option which is correct for them .

Sadly , I find a lot of patients want to do surrogacy simply because they are fed up of going through the ups and downs of IVF cycles. They can no longer emotionally cope with this kind of roller coaster ride , and would much rather just outsource the entire pregnancy to someone else.

What they fail to realize is that the implantation rate in a surrogate is not 100% either – and just because they are an arm’s length away does not  make the IVF treatment for them any easier . In fact, it can sometimes be scarier, because they are never sure what the surrogate is doing, and whether she is taking as good care of their baby as they would !  The fact that they have unrealistic expectations of the success rate of the surrogacy treatment cycle causes lots of heartburn when the cycle fails , especially when they have spent so much money , and done it with such high hopes and expectations.

Is your doctor pushing you to do surrogacy ? Please send me your medical details by filling in the form at http://www.drmalpani.com/free-second-opinion so I can guide you sensibly ?






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