More Nigerians opt for egg/sperm donation

by UCHE AKOLISA

More Nigerian couples who are unable to naturally conceive and have their children because of one medical challenge or the other, are now opting for egg or sperm donation from either relations, friends or anonymous donor linked by fertility clinics, in a bid to realize their dream of having their own children.  This development, according to fertility experts, is the result of the growing awareness and advancement in technology in the field of fertility management which has made it possible for hitherto impossible cases of infertility to be resolved medically.

With newer technologies such as ICSI (Intra Cytoplasmic Sperm Injection), PGD (Pre-Implantation Genetic Diagnosis), PESA (Percutaneous Epididymal Sperm Aspiration), TESA (Testicular Sperm Aspiration) and MESA (Microsurgical Epididymal Sperm Aspiration) or a combination of two or more of the afore-mentioned, otherwise hopeless cases have been turned to success stories.

ICSI , the injection of a sperm directly into the egg to fertilize, is a technique used for treating men with severe low sperm count or sperm of very poor quality. PGD, usually used with IVF or ICSI, is a technology used to analyze the genes in the embryo to isolate genetic disorders. PESA is the retrieval of sperm from the epididymis by insertion of a micro needle. TESA, the retrieval of sperm from the testes using a micro-needle, is a technique used to help men who do not have sperm in their semen but have some in their testes. MESA is used mostly for men with congenital abnormalities such as congenital bilateral absence of the vas deferens(CBAVD).

Confirming the growing demand for egg/sperm donation in the few years, a fertility expert and consultant gynaecologist at Trucare Fertility Centre, Lagos, Dr. Sola Akinniyi, MD said, “Yes, awareness and acceptance are higher. When the woman cannot produce eggs and also fails to produce eggs using other protocols or method of stimulating the ovaries, then we resort to egg donation from young women. For males that do not have sperm, the couple opts for sperm from a young donor who has been screened and certified fit.”

Egg donation offers a leeway for women who infertile as a result of conditions such as premature ovarian failure, hypothalamus-related menstrual irregularities or who suffer age or chronic-disease related infertility and consequently could not conceive with their own eggs due to poor egg quality or limited number of egg  to conceive using donor eggs.

In a similar vein, men with severe case of azoospermia (absence of sperm) now resort to sperm donation either from a close friend or relative or an unknown donor.

As a woman grows older, her eggs become fewer and less healthy than when she was young.  Conception becomes difficult and even when she succeeds in getting pregnant; the risk of miscarriage or birth defects or genetic disease is higher. Where drugs for ovary-stimulation are not tenable, the next option is egg donation. For men, where surgical retrieval of sperm falls, as in severe cases of azoospermia, a couple may have torelyon sperm donation from a willing donor to parent their own child.

FACTORS TO CONSIDER BEFORE RECEIVING DONATED SPERM/EGG
Even when people are willing to help an infertile couple, not every person is qualified to donate his or her 'seed of life.' There are factors to consider when choosing an egg donor. They include the age of the donor, general/reproductive health, need for secrecy and legal implications among other issues:

Age of donor
Age is a crucial factor to consider when looking for an egg or sperm donor. For a woman to qualify to donate egg, she has to have a good ovarian reserve (enough number of eggs in the ovary) to spare without affecting her own reproductive ability. However, studies have shown that the quality of a woman's egg diminishes with age. Older women suffer reduced fertility. On the other hand, older men may not suffer a decline in fertility, but sperms from older men pose higher risks of birth defects or miscarriage. Consequently, the younger the donor is, the better the outcome of fertility treatment. According to medical authorities, the best age for egg donation is between 20 and 35 depending on the fertility center.

Dr. Sola Akinniyi, while confirming this, pegged the age limit of donors at 37 though he disclosed that at his facility the age limit for age donation is 27 years. “The best time for reproduction is between 20 and 29 years so we play around that age bracket. The donor should not be more than 37 years.”

Akinniyi explained why: “The quality and quantity of eggs go down after 35 years. A woman has the opportunity to menstruate for about 300 times in her lifetime.  She will take from her own stock of egg each time she menstruates. She is picking from the bank and not making new eggs,” he said.

The Center for Disease Control (CDC)  threw more light on the donor-IVF success  in a report that showed that the likelihood  of a successful pregnancy depends on the age of the woman who produced the egg. “The likelihood of a fertilized egg implanting is related to the age of the woman who produced the egg. Thus, the percentage of transfers resulting in live births for cycles using embryos from women's own eggs declines as women get older. In contrast, since egg donors are typically in their 20s or early 30s, the percentage of transfers that resulted in live births for cycles using embryos from donor eggs remained consistently high at above 50% among most women of different ages,” the center stated in its 2009 report.

Health status of donor
The general and reproductive health of the donor is of utmost importance. Apart from being physically fit, medical screening of the donor to isolate communicable diseases such as sexually transmitted infections such as gonorrhea, syphilis and HIV is crucial. Dr Niels Lauersen who co-authored, Getting Pregnant: What You Need to Know Now, with Collette Bouchez stated that, “In order to become a donor, a woman must undergo specific medical testing, including a pap smear, cervical exam, and numerous blood tests.”

“She must be screened of all communicable diseases; HIV, Hepatitis B and C, syphilis,” contributed Dr. Akinniyi.

The American Society for Reproductive Medicine recommends that donor sperm (except in the case of close relative) be frozen for six months before using them for fertilization to give room for retesting for HIV.

Genetic screening too
Experts also stress the need to run blood test for blood group, blood type to make sure they match with those of the intending parents. It is also important to screen for genetic diseases.  Some genetic diseases that may be detrimental to the baby's health such as cystic fibrosis, mental retardation, sickle cell anaemia, klinefelter syndrome and some type of cancers may be passed on in the absence of in-depth genetic screening. Quoting some studies conducted at the Genetic and IVF Institute in Fairfax, Virginia, Dr. Lauersen revealed that a number of serious genetic-related diseases including several types of cancer, may silently pass from one generation to the next and activate when certain environmental or biological conditions come into play.

Like father, like son?
Matching physical characteristics of the donor such as colour of skin, height, hair color, stature with the host is imperative, otherwise the outcome would raise social questions for the couple and their child in the future. Expatiating on that, Dr Akinniyi said, “If you are slender, it will be wrong for me to bring an obese woman to donate egg for you because that will raise some social problems in future. You are a little fair-skinned, I cannot go and pick a dark woman to donate for you. So, we try to match the donor's physical characteristics."
For this reason, some couple opt to choose relatives as donors, however, experts acknowledged that even among relatives, resemblance may be absent as obtains in some instances of natural conception where siblings do not look alike.

Need for secrecy
Due to socio-cultural orientation, in this part of the world issues around IVF are shrouded in secrecy. While some couple may use to use close relatives, so that apart from the genetic similarities, it would be a family best kept secret, many couples would not want anybody including close relations to know how they came about their baby, so they may choose to use egg from anonymous donor.

Need for Legal representation
Whether, the donors are known or anonymous, there are legal implications, experts said. Egg donation involves signing of contracts to forestall controversies about the parentage of a child in the future. Therefore, an intending couple may need to engage a lawyer in the process of signing documents between them and the donor on the legal ownership of the baby produced from the donor egg or sperm. “Whether known or unknown donor, there is a legal implication that you must read and understand and sign so that in future there can be no controversy like 'I donated for my sister and the son is now a professor,' noted Dr Akinniyi.

In more developed societies, there are existing legal framework for fertility treatment unlike Nigeria where this specialty is still unregulated. Most Nigerian fertility doctors only fall back on Western protocols which do not take into consideration the peculiarities of Nigeria society. While acknowledging this shortfall, Dr Akinniyi said: “On the issue of regulation, yes, it is true that we don't have regulation of ART (Assisted Reproductive Technology) practices in Nigeria, but good enough, the practice of IVF is not African, it is Western. For a clinic to do well, it is very important that you follow the guidelines from that part of the world, especially the Human Fertilization and Embryology Authority which has guidelines for all the issues you have raised. That points to the standard of procedures and protocols. If you have a standard of procedures (the way you do things and document things) then you are on the part of best practice to ensure that what you are doing in Nigeria is comparable to what an IVF expert will be doing in US.”

The original article appears on Uche Akolisa's blog.

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