My heart goes out to this Australian couple who have just had their babies through surrogacy in Ukraine. Unfortunately, the babies have been born very prematurely and the parents are now trying to manage the care of their twins in a foreign country, negotiating in a language they don’t understand and with medical insurance that apparently hasn’t really covered their current needs. This is probably the worst possible outcome of cross-border surrogacy I could imagine. https://www.facebook.com/7NewsBrisbane/videos/264865640843154/UzpfSTEzMDczNjM3NjkzOTIyMzoyMjEzMTExOTc1MzY4MzA5/
If you are going through fertility treatment, you have probably heard the phrase PGD, PGS or PGT (pre-implantation genetic diagnosis/screening/testing, respectively). But what does this offer you if you are undertaking IVF? Does it really help reduce miscarriage? What genetic abnormalities can be discovered? Does it protect the future baby from further testing?
This article from The Conversation provides a pretty simple but clear description of what PGT can… and can’t do.http://theconversation.com/genetically-testing-human-embryos-what-you-need-to-know-about-the-debate-98057
If you have been struggling to conceive, you may be starting to explore fertility treatment options. Many people who start exploring assisted reproduction end up feeling overwhelmed and confused by all of the different assisted reproduction treatment (ART) options, and have lots of questions swirling through their mind:
“What do all of the options mean?”
“How are they different?”
“Which one is right for me?”
” Have I chosen the best doctor?”
“How am I supposed to know the difference?”
I can strongly recommend the information contained on https://www.varta.org.au/information-support/assisted-reproductive-treatment/types-assisted-reproductive-treatment It is simple and straightforward information, and completely impartial of any of the big clinics or pharmaceutical companies, so you don’t need to feel like VARTA has something to “sell” you. I have clipped some of the information they provide on ART options here:
Traditionally, Australian IVF clinics have been reluctant to transfer embryos which have a known chromosomal mosaicism. To explain, we need a quick lesson in genetics… Usually, conception occurs when a single egg is fertilised by a single sperm, and an embryo develops containing 46 chromosomes. Occasionally, a fertilized egg with contain 47 chromosomes. This occurs as a result of trisomy, in which there is an extra copy of a chromosome in a cell. When trisomy occurs, the result is usually that all cells in the individual have the extra chromosome. The most common type of trisomy is trisomy of chromosome 21, which causes Down syndrome.
So what is mosaicism? In some cases, only some of the cells have the extra chromosome. As the embryo develops into a fetus, cells that initially acquired the extra chromosome give rise to new and larger populations of cells with the extra chromosome. All cells produced from the initial abnormal cell have the trisomy, but cells produced from the normal cells have the usual 46 chromosomes.
In IVF, it is possible to test embryos prior to transfer back to the carrying woman, through a process known as preimplantation genetic screening, or P.G.S., which involves a biopsy of a small number of cells from the developing embryo. PGS can help determine whether an embryo is chromosomally normal or not.
Recently, clinics have also been able to use high-resolution, next-generation sequencing of embryos, and this technology has given far better information about mosaic presentations.
Importantly, researchers are finding something surprising: About 20 percent of embryos are mosaic (have both normal and abnormal cells), and the percentage of embryos that present in this way increases with maternal age. Mosaic embryos have long been known, but they have been detectable during an active IVF cycle only in the last year. And we understand that at least some of these embryos seem to mature into healthy children.
As a result, there is increasing controversy among fertility experts about what to do if mosaics are the only viable embryos a couple has left after IVF. Should would-be parents discard them because they contain abnormalities? Or transfer them in the hopes of achieving a normal pregnancy? A recent article in the Nw York Times examined this further https://mobile.nytimes.com/2016/04/19/health/ivf-in-vitro-fertilization-pregnancy-abnormal-embryos-mosaic.html?smid=fb-share&referer=http%3A%2F%2Fm.facebook.com
“Every research program is fearful of throwing away a healthy embryo, but on the other hand, mosaicism is not always a benign thing,” said Richard Scott, founder and laboratory director at Reproductive Medicine Associates of New Jersey. “Now we are paying attention to these mosaics, but we don’t know exactly what to do with them.”
“A mosaic embryo does have potential for reproduction,” he said, “but it could be anywhere on the spectrum from a healthy to a damaged baby, and we don’t know where.”
Some time ago, I blogged about court proceedings that had been launched in the USA
against Xytec, a significant provider of donor sperm in the United States, and also importing here to Australia.
The case has finally come to a conclusion, but details of the matter will never be disclosed as the applicants eventually decided to settle out of court. The original lawsuits filed claimed that Xytex had failed to properly vet a donor who donated sperm for nearly 14 years. Over that 14 year period, the donor spent time in jail on a burglary charge, and also spent time in and out of mental hospitals. Unfortunately, Xytex appears to have been unaware of this, and continued to make his semen available to recipients.
Xytex tried to get the lawsuits dismissed, but federal courts in Florida and California allowed the cases to move forward, stating “Xytex surely knew that it failed to screen up to the standard it advertised.” The company now runs a criminal background check on new donors. Xytex now also claims to verify a donor’s education claims. The donor in question had claimed to be working toward a Ph.D. at the University of Georgia, when at the time, he’d yet to earn a bachelor and wasn’t even enrolled when he initially donated the sperm.
The settlement only impacts Xytex. There is still no industry requirement to verify the accuracy of a donor’s application. http://www.11alive.com/news/investigations/sperm-bank-settles-negligence-lawsuits/481397639
If you value the blogs here, perhaps you would like to visit my Facebook pages containing even more posts and insights related to everything psychology and perinatal https://www.facebook.com/familyandfertilitysupport/
and more specifically, information related to receiving a diagnosis of abnormality during pregnancy https://www.facebook.com/Abnormal-Pregnancy-Decision-Support-Australia-1929996853937509/
Implications of the recent interpretation of who is a “parent” by the Australian Family Court in cross border surrogacy matters are starting to become more clear. For this family, who were living in the USA at the time that they engaged in a surrogacy arrangement, the parents are Australian citizens (and therefore can only live in the USA for a limited period) but their children were born as US citizens (and therefore can only enter Australia on tourist visas).
We are bound to see more and more of these beuqacratic disasters in the coming months, and it only reinforces the importance of really seriously considering the implications of heading overseas for surrogacy. It also really reinforces the importance of the Australian government revisiting the structure under which surrogacy can be done at home For the full storyhttp://mobile.abc.net.au/news/2017-10-21/australian-surrogacy-laws-leave-6-month-old-twins-in-legal-limbo/9047246?pfmredir=sm
VARTA is a wonderful resource for families undertaking fertility treatment (including donor and surrogacy). One of the great things they do is generate a whole load of really helpful information booklets and online information sources about everything fertility related. Their website include information for families and friends of people going through fertility treatment – it might really help you if you just “aren’t sure what to say”. Check out the website here https://www.varta.org.au/information-support/assisted-reproductive-treatment-art/how-family-and-friends-can-help
”I think often people, when they have a loved one going through IVF, want to fix it and often they do care. But the person who’s experiencing infertility can sometimes feel as if that person doesn’t care because those responses don’t quite hit the mark… but I think what I wanted was for people just to listen and not judge and not offer solutions… just to listen.” Anne
An increasing number of women are now exploring the option of egg freezing as fertility “insurance”. But does it really stack up to “ensure” that wanted baby in years to come? This article does a good job at exploring the pros and cons of egg freezing. http://www.abc.net.au/news/2017-07-31/egg-freezing-helping-women-delay-motherhood-but-risk-missing-out/8737308?sf102297805=1
Consultant Simone Campbell from the City Fertility Centre in Brisbane said many women visited the clinic purely to discuss their options. She said the best age to start thinking about egg freezing was early 30s.
“Unfortunately a lot of the women who come and see me in their late 30s to discuss it — that’s not the best time to freeze eggs,” Dr Campbell said.
“If we can have people thinking about it earlier, they can at least assess the situation and make an informed decision.”
Dr Campbell said success rates of conception using frozen eggs was under-researched, but collecting 20 healthy eggs from a 32-year-old may result in a 70 to 80 per cent chance of “taking home a baby”. “We need to see generations of people until we can really gauge that.
“It’s a mini insurance policy that has no definite pay off at the end.” Dr Campbell said it was important for women to understand there were medical risks associated with the egg collection procedure.
“It’s a safe process, but we know that there is a risk of bleeding from ovaries [for example].”
Although this story is from an American site (so the information is not completely relevant to the Australian context) I still feel that it gives a good perspective on some of the unexpected reactions that may occur for a woman who decides to become an egg donor. Remember that in Australia, there is NO paid/compensated donation (altruistic only) and there is no genuinely anonymous donation – donor conceived people (conceived after 2003) have the right to learn their biological identity after they reach adulthood. Still, for some donors, they will never receive information about the children born from their donation, as the children may not necessarily seek the donor out. https://www.romper.com/p/11-things-that-surprised-me-the-day-i-became-egg-donor-67583