Monday, March 18, 2013

Why donor egg IVF is a better option than surrogacy

Women are much more attached to their embryos than to their uterus. This makes perfect sense. After all , the high point of an IVF cycle is you get a chance to see your embryos. There is no question that embryos are  beautiful , and because they represent potential future babies, many women refer to them fondly as their embies ! The uterus , on the other hand , is not very glamorous. Most women think of it as just a passive container - and one which has often caused them considerable grief during their menstrual periods !
This is why when the IVF cycle fails , women are much more likely to blame the uterus rather than the embryos. They feel that the uterus is defective or damaged and has rejected the embryos. This is why so many of them jump to the conclusion that surrogacy would be their best option , if they have had many failed implantation cycles. Sadly , this is flawed thinking.

We know that most embryos do not implant , not because there is a problem with the uterus , but rather because there is a genetic problem the embryo, which causes the embryos to arrest . Some embryos which are genetically abnormal may continue to develop further , and even implant , but nature will not allow these embryos to grow further , in order to prevent the birth of genetically abnormal babies with birth defects. These will present as first trimester miscarriages. However, from an emotional point of view, a miscarriage after IVF will just reinforce the patient's flawed belief that the fact that the embryo implanted means that the embryo was fine - and that it was her uterus or her body’s immune system  which did not allow the embryo to grow further. This is especially true for women who have failed implantation after comprehensive chromosomal screening or CCS. While CCS will allow us to check the embryos for aneuploidy, and will ensure that we transfer only embryos which have the normal number of chromosomes , it will not allow us to test for all possible lethal genetic defects.

If women were mice , this would be an easy problem to solve scientifically. We could put the woman's embryos into another woman's uterus; and we could cross test by putting donor embryos into her uterus. Unfortunately it's not possible to do this in real life, which is why we have to depend on our clinical experience. It has been shown time and again that the success rate with transferring good-looking embryos into a surrogate’s uterus is no better than with transferring the same embryos into the patient's uterus. This is hardly surprising , since the defect is not with the uterus , but with the embryos. However, it can be hard to think logically , when your heart is breaking. Also, since most of us are quite fond of our personal DNA, and have a completely understandable urge to want to propagate our genes, it's quite easy to understand why women who have failed multiple IVF cycles want to explore surrogacy, rather than using donor eggs, which would have a much higher success rate.

Doctors are also quite happy to comply with the patient’s request. After all,  the customer is always right – and surrogacy is much more profitable than any other IVF treatment , so why spurn the patient’s request, when it’s so remunerative to keep her happy ?

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1 comment:

  1. Nice Informative blog providing a basic concept on IVF and surrogacy.
    Donor Egg program


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