Tuesday, September 20, 2022

Is Surrogacy the right treatment option for recurrent pregnancy loss ?

Many women who've been unfortunate enough to have experienced recurrent pregnancy loss, recurrent miscarriages, or habitual abortion often believe that surrogacy is the right treatment for them. The logic is very clear and, in fact, a lot of doctors believe this too. The fact that they're getting pregnant means they don't have a fertility issue, which means the eggs are okay, the sperm is okay, and the tubes are okay. The embryo is implanted in the uterus, but the uterus is not able to hold on to that embryo.

It cannot sustain or support the pregnancy. This means if there's a problem with the uterus, it's just common sense to find another woman (it's called a surrogate) who's had a pregnancy in the past and whose uterus is normal. And if you then put that intended parent's embryo in this surrogate's uterus, that embryo will continue growing and they'll be able to have a healthy baby because she will have a healthy pregnancy. Actually, this reasoning is completely flawed, and let me explain why. It's like the soil. It's the seed or the embryo which is active.

It's the seed that actually does all the work. The uterus doesn't have to do anything at all. This is in fact, why older women who, let's say 60, even though she hadn't had a period for 20 years, were absolutely fine once you started treating her with hormones and she could carry a baby all the way to nine months. Now remember, if this woman can carry at the age of 72, she's not going to have a problem carrying at a younger age and that's exactly the point; the uterus does not have a biological clock.

The problem is that they are not able to carry the pregnancy because the embryo is genetically abnormal. It's difficult to diagnose a genetically abnormal embryo, but research has shown that the most common cause of a first-trimester miscarriage is a genetically abnormal embryo, and the most common reason for a genetically abnormal embryo is genetically abnormal eggs, which usually occur in older women because their eggs have aged and accumulated a lot of genetic defects that we can't diagnose, treat, prevent, or predict.

Now, Interestingly, because the uterus is passive, therefore, what they really need to do is not worry about changing the uterus. What they need to do is change the embryo. Again, this sounds very counter-intuitive, but it's the truth and the reason for this is that it's the embryo that determines the fate of the pregnancy at the end of the day. In fact, a woman who's had recurrent miscarriages most of the time has a completely healthy uterus. After all, if a uterus hadn't been healthy, the embryo wouldn't have been implanted in the first place.

The fact that the embryo is implanted means a uterus is working fine. This embryo can't continue to grow because it's genetically abnormal, which is why nature terminates that pregnancy at either eight weeks or ten weeks or what have you, and this is why these women do not need surrogacy. Because even if they did a surrogate with their own eggs and sperm, that surrogate would end up miscarrying again because the underlying problem is the genetically abnormal embryo. Because the genetically abnormal eggs are not going away, what these women require to have a healthy baby is donor eggs. which doesn't sound intuitive I get that, but that is the one treatment option that will maximize their chance of having a healthy baby because once they use a younger woman's eggs, those eggs are much more likely to be genetically normal as compared to using their own eggs, which have a much higher risk of being genetically abnormal because they are older.

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