Artificial insemination by husband (AIH) is useful in the following cases :
1. The woman has a cervical mucus problem. For example, the mucus may be scanty or hostile to the sperm. With an intrauterine insemination (IUI), the sperm can bypass her cervix and enter the uterine cavity directly.
2. The man has antibodies to this own sperm. The ‘good’ sperm which have not been affected by the antibodies are separated in the laboratory and used for IUI.
3. If the man cannot ejaculate into his partner’s vagina. This situation arises because of psychological problems such as impotence (inability to get and maintain an erection) and vaginismus (an involuntary spasm of the vaginal muscles so that vaginal penetration is not possible); or because of anatomic problems of the penis, such as uncorrected hypospadias; or if the man is paraplegic.
4. The man suffers from retrograde ejaculation in which the semen goes backward into the bladder instead of coming out of the penis.
5. For unexplained infertility, since the technique of IUI increases the chances of the eggs and sperm meeting.
6. As an inexpensive alternative to GIFT, IUI is a reasonable first choice (especially for younger couples) since it is so much cheaper and less intrusive.
7. If the husband is away from the wife for long stretches of time (for example, husband who work on ships or work aboard), his sperm can be frozen and stored in a sperm bank and used to inseminate his wife even in his absence.
8. For male factor infertility, though this is a controversial area, especially for the common problem of oligospermia (a low sperm count). What is the rationale behind using IUI for treating this problem? Remember that infertility is a problem of the couple’s, not just the oligospermic male’s. Whether a given couple will conceive or not depends on the sum of their fertility potential of the wife is improved by superovulating her, so that instead of producing just one egg per cycle, she produced 2-4 eggs per cycle. In addition, the husband’s sperm are processed in the laboratory, and the best sperm are used for IUI. This increases the chances of the best sperm being able to reach and fertilize the egg.
Test Tube Babies—ivf and gift IVF
IVF is a method of assisted reproduction’ in which the man’s sperm and the woman’s egg are combined in a laboratory dish, where fertilization occurs. The resulting embryo is transferred to the woman’s uterus. The basic steps in an IVF treatment cycle are ovulation enhancement (stimulating the development of more than one egg in a cycle), egg harvest, fertilization, embryo culture and embryo transfer.
IVF can be a reasonable treatment choice for couples with various types of infertility. Initially, it was only used when the woman had blocked, damaged, or absent fallopian tubes (tubal factor infertility). IVF is now also used to circumvent infertility caused by endometroiosis, immunological problems, unexplained infertility, and male factor infertility.
Gift
GIFT stands for gamete intrafallopian transfer. A gamete is a male or female sex cell- a sperm or an egg. During GIFT, sperm and eggs are mixed and injected into one or both fallopian tubes. After the gametes have been transferred, fertilization can take place in the fallopian tube as it does in natural, unassisted reproduction. Once fertilized, the embryo travels to the uterus by natural processes.
As in IVF, a GIFT treatment cycle begins with ovulation enhancement which is followed by egg harvest, usually by means of laparoscopy. But the similarity to IVF ends here. In IVF, an embryo is transferred. In GIFT, only gametes are transferred.
Only patients who have at least one normal, healthy fallopian tube are candidates for GIFT. Such patients include women who have unexplained infertility or mild endometrosis and couples whose infertility results from male, cervical, or immunological factors. Some doctors recommend that couples with male factor infertility proceed with GIFT only if it has been proven that the man’s sperm can fertilize the woman’s egg either by in vitro fertilization or by past pregnancies.
Surrogate Mothering
The word ‘SURROGATE’ means substitute or replacement and a surrogate mother is one who lends her uterus to another couple so that they can have a baby. In the west where fewer and fewer babies are offered for adoption, surrogacy is gaining popularity, despite controversial legal and ethical hassles.
Which kinds of women need surrogates? The commonest reason is a woman who has no uterus. The uterus may be absent from birth (Mullerian agencies); or may have been removed surgically (hysterectomy for life-saving reasons, such as excessive bleeding during a Caesarean section operation). Other women have suffered to explore surrogacy include those who have suffered multiple miscarriages or who have failed to conceive despite repeated attempts at IVF for unexplained reasons.
Women who agree to become surrogates may do so for compassionate reasons. Such women could include a sister, mother or a close friend of the couple. They may also do so for financial remuneration, and this could be a woman, with or without children, known or unknown to the couple, who ‘rents’ out her womb for a fee.
There are two main kinds of surrogacy :
1. The surrogate mother provides the egg. In this case, the surrogate is inseminated artificially by the husband’s sperm. Thus, the infertile woman has no genetic relationship to the baby.
2. More commonly, the infertile woman provides the eggs, which are then either transferred along with her husband’s sperm to the surrogate mother’s fallopian tubes by GIFT, or they are fertilized in vitro by IVF with her husband’s sperm and the resulting embryos are then transferred to the surrogate’s uterus, which then acts as an incubator for the next nine months.
Certain guidelines have been laid down in order to try to minimize misuse of the surrogacy technique and a surrogate motherhood contract needs to be drawn up, which should specify that the child will become the legitimate adopted child of the infertile couple, i.e., the intended parents. This contract needs to be signed by the couple, the surrogate, and her husband (if any), but cannot be held to the legally binding.
The ‘legal waters’ of surrogate motherhood will continue to be murky, and, at present, now laws or guidelines exist in India. This is why the element of trust between the couple and the surrogate mother is so important.
It is vital that the surrogate and the couple consider the future of the child. The receiving mother should ideally be present at the birth and care for the baby in hospital. She can even be prepared for breast feeding by hormone treatment (induced lactation).
Surrogacy has spawned a host of legal and emotional questions to which there are no right answers.
For example :
- What will you do if the surrogate insists on keeping the child?
- How much should you pay the surrogate?
- If the surrogate becomes seriously ill as a result of the pregnancy, who will pay the medical costs?
- Is it possible to put the receiving mother’s name as the ‘mother’on the child’s birth certificate?
- Will you steel the child about the surrogacy?
- Will surrogates undertake pregnancy merely for profit?
- What happens if the child is handicapped and is unwated by the couple and the surrogate mother?
- What happens if the surrogate dies during child birth?
Many people are worried about the possibility of the surrogacy technique being misused. They feel it may allow the exploitation of poor women who may be used as ‘mother machines’ to bear babies, much like the wet nurses of yester years.
Surrogacy has received quite a lot of adverse press publicity recently, especially when the contract goes sour and there is a dispute over the baby between the commissioning parents and the surrogate mother. Such a situation makes headline news. The courts then need to have the wisdom of Solomon to assign the rights of the ‘genetic’ mother; the ‘birth’ mother; and the ‘social or rearing’ mother.
Nevertheless, we must remember that surrogacy does offer one method of achieving parenthood to a few couples who could never possibly have a baby by any other means.
