“And if the embryo is stolen?”: 12 wacky questions to the fertility specialist
Medicine does not stand still and last but not least, it concerns the issues of infertility treatment: in vitro fertilization procedures (IVF) are no longer a rarity, and couples who want, but cannot have a child, can use donor sperm, eggs and even embryos. We have already told you how and why they do IVF and how they “edit” the human genome, and now we have decided to ask strange and non-obvious questions. With the help of the gynecologist-reproductologist of the Mother and Child Clinic in St. Petersburg Vladimir Alekseevich Kazantsev, we will understand what will happen to frozen embryos, if the couple dies, whether embryos are confused with IVF, and other problems.
Who comes to the fertility specialist? Can a single person turn?
In Russia, only a woman has the right to have a child with assisted reproductive technologies alone - this is spelled out in the main order regulating the use of such methods. So a lonely man can not do this. It happens that such people turn, but we have to refuse them.
Lonely women also come. There are two possible options: if she has a reserve of ovaries, that is, there are a sufficient number of eggs, we use the sperm of the donor or someone of her friends who are not an anonymous donor. It happens that the ovarian reserve is reduced so that we can not get a woman's own egg. In this case, she is offered both a donor egg cell, and donor sperm, or a donor embryo immediately. If the patient has a partner who agrees to fertilize the eggs, but does not have its own biological material, then she will buy more donor eggs, which we fertilize.
Can I find a donor with certain parameters?
We select donors so that they look like patients. We have more than one hundred and twenty female donors in our database - as a rule, we manage to find similar ones. When only an oocyte donor is selected (ova. - Approx. ed.), and the cell is fertilized by the partner's sperm, half of the genetic material comes from the father - in this situation, the chance that the child will be like both parents is higher.
But there are other patients. For example, now more and more clients from China come to us, because surrogate and donor programs are prohibited there. For them, we picked up certain donors and were faced with the fact that they wanted a different appearance for their children, closer to the European one - this turned out to be very important for them. We go to meet, it is their right.
How to become a donor?
There are two types of egg donation programs. This may be a "fresh" program, when in parallel with the stimulation (hormonal drugs. - Approx. ed.) donor girls, prepare endometrium (inner layer of the body of the uterus. - Approx. ed.) patient, which will carry the embryo. In this case, we select a donor, synchronize her menstrual cycle with the patient's cycle and prepare them in parallel.
There is another type of program when we use frozen donor cells that are stored in a cryobank. This situation is simpler: we can thaw the oocytes at any time. When the clinic needs to update the egg bank, it causes donors, stimulates and just freezes the eggs. For example, now we have accumulated enough material in the storage and we don’t take "fresh" donors, but six months ago we had five to ten requests per month.
The question is when a woman wants to become a donor - now or later. All that needs to be done is to come to the clinic: to undergo a special examination, after which the person enters the database; then it remains to wait, or when the clinic will need to update the bank, or specific patients. We do not have our own sperm donors: as practice shows, in large cities it is very difficult to maintain an up-to-date base - this may be the case in an ecological situation, but the exact reasons are unknown. One way or another, the majority of men who turn are not perfect enough. (The concentration, mobility and morphology of spermatozoa are estimated - that is, their structure, shape, size, how they look under a microscope. - Ed.). We buy samples of frozen semen from a company from another city.
How carefully are donors checked?
Donors are carefully checked, all surveys are strictly prescribed by law. Be sure to check the karyotype, that is, whether the person is a carrier of some genetic abnormalities; conduct standard blood tests; donor examines the therapist, they do an electrocardiogram, fluorography and so on. This allows you to exclude many diseases.
How much do donors pay and how much do fertility specialist services cost?
An egg donor receives an average of about sixty thousand per puncture (in about two weeks of stimulation and puncture). A sperm donor gets about two or three thousand for one surrender. In the second, it all depends on the spermograms: they can change even during the day, so first they look at the material they received from the donor, and the payment depends on it. At the first, the amount is fixed, regardless of how many eggs the clinic receives.
A donor program for patients is always somewhere a hundred thousand rubles more expensive. This includes donor services (sixty thousand rubles) plus stimulation drugs (about thirty to forty thousand rubles). One sample of donor sperm costs about twelve or thirteen thousand rubles.
Can I get to know a sperm or egg donor?
In our clinic there is only an anonymous donation of both the eggs and the sperm - only the clinic knows the full information. This is a gray area in terms of the law; we have made such a choice so as not to face legal problems in the future. I know that in Russia there are organizations that provide non-anonymous donation services, they are much more expensive. These companies declare that they show photos of donors and it seems they can even get acquainted with them (people, naturally, give their consent to this). It is impossible with us: we provide only information about external data of donors (height, weight, incision and eye color, length and hair color, length and shape of the nose, shape of the forehead), their blood type and education. Most donors are selected by external data and blood type.
What happens to embryos and biological material if someone from the processors dies?
Biological material is sperm or eggs. An embryo is formed after connecting the female and male cells, it is a separate organism. Only donors can dispose of frozen sperm or eggs. Nevertheless, they can insure themselves legally - and prescribe the transfer of rights to biological material in the event of their death.
With embryos, everything is more complicated: they consist of male and female biological material, so the couple disposes of them together. If one of the participants in the process eventually changed his mind, then no further manipulations with the embryo are possible - without new agreements or a court decision. If a woman changes her mind, then everything is simple: the resulting embryo will not be planted in another woman. If a man changed his mind, he should write the appropriate statement in the clinic.
In the contract, which is made in the clinic, there is a clause about who controls the embryos in the event of the death of one or both partners. In this field it can be entered that the embryos must be destroyed or that one of the partners entrusts the other to dispose of them. If both people die, the embryos can destroy or sacrifice the clinic. In this case, a dead couple has the possibility of genetic immortality through donation: from the frozen embryos their children are born, just from another couple.
If the couple had a preliminary agreement, and then they quarreled, there is another sharp point. The number of eggs in a woman is limited, and in men the ability to synthesize spermatozoa persists throughout life. It happens that a woman has a marginal reserve of eggs; we get her eggs, fertilize them with her husband's sperm, and we have the necessary number of embryos to achieve the desired pregnancy. But it takes several years, the couple diverges, remain frozen embryos. At the same time, the reserve - the number of eggs in the ovaries - does not allow obtaining new cells of their own, or they are no longer of such good quality. Then the consent of the former partner is necessary for her to give birth to a child thanks to these embryos. There are situations when a woman is not sure of a partner - then we fertilize a part of the eggs to get embryos, and freeze a part so that we can later unfreeze them and fertilize other male spermatozoa.
How are embryos and eggs stored? Can they unfreeze?
The storage itself is a locked room with large blue "cans" in which there is liquid nitrogen. Inside the "cans" there are special clusters where the embryos are located - they take up little space and many embryos fit into each one.
The worst thing for the center is the power outage. We have a special floor in the clinic under the provision of uninterrupted work, where there is a generator. It takes three to five minutes to turn it on; for this time, uninterruptible power supplies are included, which are installed in the laboratory itself and can provide it with electricity for a day or two, such double insurance.
As soon as the electricity disappears, the clinic management receives a message on the phone. Most of them live fifteen or twenty minutes on foot from the clinic: even if we assume that something did not turn on (although everything is fine-tuned and works), within fifteen or twenty minutes people will be in the clinic. In addition, there are standard checks that are in any clinic: medical, fire and others.
Is it possible to use someone else's biological material? Are they trying to steal embryos?
Although a man can produce sperm for life, sperm is also stored for storage - usually in the case when a man goes on business trips or if patients live in different cities. The man agrees, and we can use his biological material. But as soon as he comes to the clinic and asks to defrost and destroy biological material or no longer give anyone access to it, from this moment no one can use it anymore.
It is impossible to steal materials: they are in a cryostorage and only the embryologist knows where everything lies. To transport them is also not easy, we need special conditions. However, sometimes patients are asked to bring material from home (we often communicate with patients). It happens, men can not pass the material in the clinic: someone can not purely physically, someone simply refuses. We meet them and give out the tube. At this stage, a woman can theoretically bring the biological material of another man - but no one will know about this before the birth of the child and the paternity test. We can not verify that "inside", it is technically impossible.
Can I choose from multiple embryos for IVF?
There is a classification of embryos, depending on the day of development and the number and quality of cells. Standardly, embryos, while they grow, are evaluated three times. The first is the day after fertilization: the embryologist looks at whether everything has happened correctly. On the third day, they look at how many cells are in the embryo and what quality they are. Another check takes place on the fifth day, and if the cell is a little late, it is looked at the sixth: if it “straightens”, it can be transferred or frozen. The cells are evaluated under a microscope, the embryologist writes an abbreviation of letters and numbers (for example, 4A or 8B) —the number of cells and their quality (A, B, C, D). The patient is also shown this information: for example, there were ten cells, six of them fertilized correctly, they all grew to the third day, but only four embryos grew to the fifth; two of them are of perfect quality, two of them are of good quality. At this stage, you can choose: transfer one embryo or two, transfer the best or the worst, and the best freeze. But no one ever knows what is "inside" the embryo until we have done a genetic study. He may be the most "beautiful", and pregnancy will not come - and maybe so-so in quality, but a great pregnancy will come, and a healthy baby will be born.
Sex selection is prohibited by law. But there is an exception: if a pair confirms a genetic disease that is inherited either by boys only or by girls, they have the right to choose the gender - this is also spelled out in the law. If, for example, we carry out genetic analysis of embryos (there are indications by age, a couple of this wants or there are genetic indications), in this situation we usually know the sex of the embryo, it comes as a result of research.
So theoretically we have the opportunity to find out. But, for example, if a woman is young, it will be quite difficult to do this, because there is no evidence for this. By the age of forty or more, there is evidence for additional research - but we do not go for it in order to select the gender, but to exclude genetic abnormalities in a particular embryo.
What are patients most afraid of?
Patients are afraid of stimulation with hormonal drugs, ask whether it is harmful to the health of women. Today we use highly purified modern stimulants - it is clear that any treatment has a risk of complications, but, fortunately, we do not see them.
People often ask: "Will our embryos be confused?" The laboratory has very strict control, at a time the embryologist works only with the material of a particular pair - there is nothing else on the desktop. When he begins to work with the following material, the table is completely removed, new tubes and cups are taken. Plus now there is the practice of double control: the second embryologist observes the actions of one embryologist, he puts a signature confirming that there were no mistakes.
When we freeze embryos, patients sometimes ask if the children will not be “frozen”. Now they use vitrification - the method of the so-called shock freezing. The main problem during cell freezing has always been the fact that ice microcrystals were formed, which traumatized the cell membrane, and because of this the cell was destroyed. Her vitrification decided: freezing occurs faster than ice microcrystals have time to form. The process is similar to the blowing of glass: the liquid inside seems to glaze. Efficiency is almost one hundred percent: in our experience, one or two or three of the thousands of cells can not be defrosted, but, as a rule, they are not of very good quality - they could have stopped in development without freezing.
Periodically, patients want to postpone some of the stages of the IVF program. For example, when ovaries are stimulated and follicles grow, we are very dependent on time. When the follicles are ready, the woman is prescribed a drug that causes the maturation of the eggs - a trigger - and a puncture (procedure when the eggs are removed. - Approx. Ed.). Some patients are asked to make a puncture in the evening. From puncture to the moment when the embryologists finish their work, it takes six to seven hours: we receive the cells, transfer them to the embryologists, and they work with them further. Therefore, the procedure is always prescribed in the morning - so that embryologists do not engage in the patient all night.
They also ask if embryos will mix up after they are thawed. This is controlled by the lab. If patients are very worried, we say that we give a guarantee, but they can do a genetic test - but, as a rule, they don’t get it. Foreign patients sometimes use it, they come to another country and worry. But, as a rule, everyone understands that the process is serious and everything is under control.
What is done with embryos left after IVF?
As a rule, embryos are stored for many years. Firstly, patients may not be sure that they will not want more children, and if there are embryos, why not preserve them - this is not so expensive today. If they understand that they do not want more children, they can sign a document asking the clinic to dispose of embryos. In this case, they are simply thawed and, shall we say, thrown away. Either embryos are donated - this is an analogue of the situation when a couple dies and the embryos remain, and they are “presented” to the clinic. If a couple still has embryos after she underwent an IVF procedure and had a child (or children), they can write a statement that they do not plan to have more children, do not want to extend the storage of embryos, and ask the clinic to use them for other patients.
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