On most occasions surrogacy is done with the intended parents own eggs and sperm. This usually happens when the lady does not have a uterus (genetic or surgical removal) or has a defective uterus (septum, bicornuate, arcuate, or due to infection like Tuberculosis). Another reason we use surrogacy is when the couple has had numerous failed IVF cycles.
The intended parents first decide to proceed with self-cycle surrogacy at our centre, they sign the contract and the tentative dates are decided. The lady is put on pills to be able to synchronize with the surrogate’s menstrual cycles. The surrogate is also prepared to build the endometrium. Once the intended parent (lady) periods start, hormones are injected to make multiple eggs. This usually goes on for 10-12 days. The lady needs to stay in the city for minimum of 7 days provided she takes a few of these injections at home. All this is discussed and explained to the couple beforehand. There is regular communication through e-mail and telephone.
The eggs are retrieved under anesthesia, they are fertilized with the husband’s sperm, it is to be noted here that if time does not permit the husband may leave his semen sample in his earlier visits and the same can be frozen.
After fertilization of the eggs and sperm, the embryos take 2-3 days to develop. We are doing both cleavage and blastocyst transfer depending on the total no. of eggs retrieved, no. of grade A embryos formed and previous history. The embryos are then transferred into the surrogate under the ultrasound guidance. The decision regarding the no. of embryos depends on the age of the intended lady and previous treatment history. We usually transfer 2-3 cleavage stage embryos or 1-2 Blastocysts.
Following embryo transfer the surrogate is given hormonal supplements like estrogen and progesterone. She is asked to take rest and the pregnancy test is done 2 weeks later. Both her co-ordinator and the centre co-ordinator pay regular visit to ensure that the instructions are being followed.
About 10% of all couples trying to conceive face difficulty. This could be because of many reasons like infrequent inter course, stressful lifestyle or medical factors. About 50% of these causes are because of male factor and half due to female factor. Male factor includes absent or poor sperm. Female factor includes tubal uterine or ovarian problems. We describe two cases of successful pregnancy in a couple where a problem was identified in a man. Both these men had nil sperm count.
Absence of sperm in the ejaculate can be because of pre testicular, testicular or post testicular issues. Pre testicular cause involves defective hormonal signals to the testis to create the sperm. Testicular cause involves absence or defective progenital cells which synthesis the sperm cells. Post-testicular causes include those cases where the sperm is produced; however it is unable to come out in the ejaculate because of blockage in the ducts. The cause can be identified by measuring the hormonal levels, assessing testicular volume and doing certain radiological tests like ultrasound and Doppler.
Both of the above cases had problems in the post testicular stage. Amira (name changed) was a patient from Iraq being directed by another patient who had successfully conceived after IVF treatment under Dr. Banerjee. A biopsy of the testis done at Iraq failed to show any mature sperms. We performed multiple testicular biopsy at the Max IVF centre. This was done by a small nick in the scrotal skin and was done under complete anesthesia. Multiple tissue biopsy was taken in order to ensure that no normal focus of sperm synthesis was excluded. Testicular sperm was retrieved after finally dissecting the tissue and was kept in special media under specific laboratory conditions. The eggs of the lady were harvested on the same day. This was done by subjecting the lady to multiple Gonadotropin injections which cause the woman to produce many eggs. These eggs were then collected by using ultrasound guided needle aspiration. This was done under general anesthesia. The testicular sperm was then injected into the egg using a micro manipulator. This is highly specialized equipment and the procedure is called intra cytoplasmic sperm injection (ICSI). The fertilized eggs were kept under special laboratory conditions for two days where they divide and grow. The best embryos were transferred two days after fertilization. This was done without anesthesia under ultrasound guidance. The lady was then prescribed certain medications for two weeks and a pregnancy test performed. The pregnancy test was positive with a beta HCG of 205 miu/ ml.
Another couple had a similar problem. The first IVF cycle had failed and we went ahead with second cycle using frozen testicular tissue which was collected in the first IVF attempt. The same procedure described above was carried out. This time it led to a positive pregnancy test.
Being able to father your own genetic child with nil sperm count is a miracle. Says Amira (name changed) “This is nothing but a dream come true for me”. My friend in Iraq who had a successful treatment under Dr. Banerjee referred me to her at the Max IVF centre. My husband and I are so happy that we finally have conceived our own child.
For men with nil sperm count donor sperm insemination is also an option. However, this may not be acceptable to all. Testicular sperm extraction with Intra-cytoplasmic sperm injection is an advanced method to help our patients realize their dreams.
The age of woman has a major impact on IVF success rates, if age of woman is less than 35 years, the success rate is higher. The possibility of success falls dramatically after 40 years. Other factors that determine success rate are:
Eggs and sperm quality
Condition of endometrium
Ease of embryo transfer
The major complication is risk of multiple births, this may lead to:
Potential for long term damage
The other major complication is ovarian hyperstimulation syndrome. In this condition fluid accumulates inside the abdomen and lungs. Usually it settles on its own with proper fluid management. In rare cases hospital admission and intensive care is required.