IVF with Gestational Surrogacy
IVF with Gestational Surrogacy occurs when the surrogate carries embryos that are formed through in vitro fertilization (IVF) using the eggs and sperm of the intended parents. No egg donor is needed. In this instance, the gestational carrier has no genetic relationship to the baby. Women who can produce healthy eggs but cannot carry a pregnancy for medical reasons often use this approach to have children to whom they are genetically related.
Donor Egg with Gestational Surrogacy
Gestational Surrogacy with Egg Donation is the treatment of choice for single men or gay male couples, older women, or other situations in which eggs must first be provided by a donor, and then fertilized to produce embryos which are transferred into and carried by the surrogate. CT Fertility offers a wide choice of egg donors whose donor profiles are available for on-line viewing, and are available for immediate matching. We also allow parents to provide known donors or donors they have found from outside agencies, provided those agencies follow the same strict standards which we do.
In some instances CT Fertility may be able to provide you with one of our gestational carriers, but more often we partner with surrogacy agencies and attorneys who will match you to the carrier that is right for you; negotiate whatever contracts are necessary; provide ongoing support throughout the pregnancy; and assist you in finalizing court-mediated adoption arrangements.
Who should consider fertility consultation?
1. Women or couple not able to conceive after two years (female age <35 years), one year (female age >35 years) or 6 months (female age >40 years) especially after repeated unsuccessful attempts at timed intercourse or simple treatment (e.g., clomid)
2. Women with known fertility factor (no ovulation, endometriosis or tubal disease / pelvic scarring, fibroids.)
3. Men with known fertility factor (decrease count, motility or morphology of sperm, difficulty with ejaculation or erection)
4. Women or men who are at risk for reduced fertility due to disease or disease treatment (e.g., cancer, cancer treatment, chemotherapy, lupus, prior surgery, irregular menses or absence of menstruation)
5. Recurrent pregnancy loss in the first or second trimester of pregnancy
Fertility treatment especially assisted reproductive technology-IVF enabled many women to achieve pregnancy even those with the most difficult cases of infertility. Advances include ICSI-injection of a single sperm into an egg, PGD-biopsy of embryos and polar bodies for genetic diagnosis, of specific genetic diseases, prolonged culture of embryos to blastocyst stage-day 5 to 7 and TESE-surgical sperm retrieval.
Meanwhile, a new host of fertility treatments emerged in the past 10 or so years that were not thoroughly studied including egg freezing, ovarian tissue freezing and transplantation, IVM-in vitro maturation of oocytes, PGS-preimplantation genetic screening for chromosomal abnormalities in the embryo or oocyte and generation of ‘artificial’ eggs or sperm. These procedures carry great promise to advance reproductive options for men and women and can be tailored to their medical or social circumstances.
Not suitable for all patients based on their ovarian reserve. No large studies comparing the efficiency of egg freezing in comparison to the established technology of embryo freezing. No long term follows up data for children conceived using thawed oocytes.
Ovarian stimulation in estrogen sensitive cancers
Using conventional protocols for ovarian stimulation in breast cancer and other estrogen sensitive cancers was not studied in terms of its effects on cancer recurrence. Using special protocols to reduce estrogen exposure during stimulation was not studied long enough. In short and intermediate terms, however, it does not appear to increase recurrence.
Ovarian Tissue Freezing
This is the most investigational technique for fertility preservation. Ovarian tissue is harvested and frozen for later transplantation. Only sporadic case reports were published. It is considered in women with very high risk for ovarian failure e.g., after chemotherapy. There is also the risk for transmission of malignant cells within the graft at the time of transplantation. The outcomes of children conceived after transplantation is unknown.
Immature eggs are not suitable for fertilization with sperm. Immature eggs can be harvested, matured in the lab then fertilized or frozen. ‘Cultivating’ very immature eggs from primordial follicles in the lab is experimental and was not done in humans yet. Immature eggs obtained after short period of ovarian stimulation can produce a viable child. This procedure is more applicable to women with very good ovarian reserve. The long-term safety of the procedure is not known yet.
Pre-implantation genetic screening for aneuploidy
Many eggs in every woman are not chromosomally normal-having an extra or missing chromosome-egg quality. Fertilization of these eggs result in chromosomally abnormal embryos. The majority of abnormal embryos do not implant or are miscarried. Testing of embryos to select the normal ones was suggested as a method to increase the pregnancy rate. This is yet to be proven in a peer-reviewed scientific publication. The exact embryo stage to test and the method of testing are still debated.
The concept that eggs and sperm can be generated from human embryonic stem cells was shown in mice. The function of the resulting gametes is unknown. This was never accomplished in humans. If functional gametes can be produced from other cells, likely applying this technology in medicine will require another decade or more.
Beware of what you read
Many new reproductive technologies are available to address one or more medical or social issues related to reproduction. Some of these technologies are experimental, not efficient or their outcomes not studied long enough to ensure its safety. They may be applied in limited or monitored settings e.g., research or for those that at risk for losing their fertility and have no other options. Detailed discussion with woman / couple is essential to ensure that the they have realistic expectations concerning their outcomes and that uncertainty about their safety is clearly explained.