Tag Archives: Gestational Surrogacy

ESHRE Endorses Egg Freezing : ASRM Lifts Experimental Label From Egg Freezing

The American Society of Reproductive Medicine (ASRM) and the European Society of Human Reproduction and Embryology (ESHRE) have endorsed oocyte freezing as a standard and safe procedure in  2012. ASRM  issued a new report on 22 October, 2012 stating that in young patients egg freezing techniques have been shown to produce pregnancy rates, leading to the birth of healthy babies, comparable to IVF cycles using fresh eggs. After much work and deliberation by fertility experts, who reviewed the world literature on the effectiveness and safety of egg freezing and, most importantly, on the desired outcome: healthy babies, egg freezing is can now be used in routine practice. More studies are being published regarding this age range, and all is reassuring.

 

APPLICATION:

Egg freezing could provide a viable alternative source for couples needing donor eggs to build their families. In addition, among the medical indications for its use are fertility preservation for patients who may be left infertile following medical treatments for other diseases  (viz., cancer),  some genetic conditions, or IVF treatment interrupted by the unexpected inability to obtain sperm.Cryotec

 

REASON FOR CAUTION:

The Committee points out that the age of the woman at the time of egg freezing is a very important factor. “Success rates with oocyte cryopreservation appear to decline with maternal age consistent with the clinical experience with fresh oocytes.”  ASRM did not encourage egg freezing for “social reasons,” such as a delay in childbearing as, although the technical procedure of egg freezing is safe, we do not have enough long-term data about babies born to women using eggs frozen when they are older than 35. Cryotec VitrificationCiting a lack of data on safety, efficacy, cost-effectiveness, and potential emotional risks, the report states, “Marketing this technology for the purpose of deferring childbearing may give women false hope and encourage women to delay childbearing. Patients who wish to pursue this technology should be carefully counseled.”

 

ROTUNDA EGG FREEZING PROGRAM:

Rotunda is now offering oocyte cryopreservation as part of its ART services  using the latest cutting edge Cryotec vitrification technique. We also have initiated donor egg bank. We have achieved comparable success rates with frozen donor oocytes  to fresh donor oocytes.

Rotunda Egg Freezing ProgramThe excellent survival rates, embryo development and pregnancy rates have given a tremendous new hope to young cancer women. These young cancer patients can now dream of becoming a mother one day in future when they are cured of their disease.

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” If you imagine it, you can achieve it. If you dream it, you can become it.” – William Arthur Ward. One of our patient’s sucess story in his own words

My fatherhood story

From the age of 20 I know I will become a parent, but time past faster than I felt and I was over 40 still a single man with no clue how I am making my biggest dream come true. And it happened a few years ago I came to read in a local newspaper about a gay couple becoming parents to a child getting help by a surrogate via Rotunda.

 It took me more than 2 years before I got the courage to send a mail to Rotunda and on the second mail my angel on earth wrote me. It was Dr Goral who later I understood is going to be the most meaningful person ever for me. She personally was the doctor and embryologist who got my embryos created through egg donation and she personally was the doctor who selected and put back the perfect embryos in my surrogate’s womb.

But this I will tell later. Before I want to tell about how afraid I was to begin the path. I am a single man, living alone in Israel. I don’t have any will changing my status. The only thing ever I wanted was a family! My family! and at the age of 43 I finally said to myself that I can’t wait no more and I sent the first mail to Rotunda. Till that stage it was the most difficult thing I did. No one can understand how much courage I needed and if not the feeling that this is what GOD has wishing for me I would not have become a father. My first try did not succeed. It took me 6 more months and good words from Dr Goral to start 1 more time. Got 1 more flight to Mumbai and again sat in Rotunda while the egg donation and 2 days later getting  embryos back in my surrogate.12 days later Dr Goral sent me the best mail till then telling me there is a pregrancy.

8 months later I became the happiest man living on earth! I am a father of a daughter and a son.

 My twins are 1 year and almost 4 months now. The boy is running for almost 2 month and the girl is making her first steps now. There is no happiness bigger than my happiness! No argument about it. Thank God for allowing me to be a father to my twins and thank Gods angel on earth (Dr Goral).

For anyone reading this blog I wish to explain: You need to stand on your legs and want the impossible! It is possible, just decide you want it. Rotunda knows how to make our biggest dream come true. God is great. Thank you Rotunda and more than anyone thank you Dr Goral & Dr Allahbadia.

Oriah (meaning the light of God) – my daughter

Yehonathan (meaning God gave) –  my son &

 Me- Yehoshua / Joshua (meaning God will save)

Email: joshua40@walla.com

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Dr Shantabai Gulabchand Oration on Cross-Border Reproductive Tourism at the ET2010, Lavasa

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Breaking News: Surrogacy not for married couples only – singles and gays will have legal rights to have surrogate babies

Single men, single women, gays and lesbians may soon get the legal sanction to undergo surrogacy in India.

The draft bill legalizing the surrogacy process in India has provided for Single parenthood by allowing “Unmarried Couples” and “Single Persons” from India and abroad to have children in India using ART procedures and surrogate mothers.

By conferring the right to have children on unmarried couples and single persons, the bill attempts to achieve several historic feats – legalizing commercial surrogacy, single parenthood, live-in relationships and entitling gays and lesbians to start families using surrogate mothers – at one go.

The bill proposes to set up a mechanism to regulate and supervise surrogacy in India.

The bill, with potential to rewrite the social landscape, may be tabled in the monsoon session of Parliament if the Union Cabinet clears it.

Read more about this on http://epaper.hindustantimes.com//artMailDisp.aspx?article=21_06_2010_001_020&typ=1&pub=264

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Indian IVF bill may stop gay couple surrogacy

In the name of the fathers ... John Allen-Drury, left, and his partner, Darren, nurse their son, Noah, who was born in India using a surrogate mother. Photo: Graham Crouch

If the parents of newborn Noah Allen-Drury are lucky, their son will sleep through the noise as their flight from India lands in Sydney this morning.

Noah’s gay parents, however, are aware of legal turbulence that could prohibit the surrogacy arrangements that fulfilled their wish for a child.

A growing number of male couples from Australia and other Western countries are hiring surrogates in India to bear children, but that might no longer be possible if a draft bill to regulate IVF in India becomes law.

R.S. Sharma, the secretary of the committee writing a bill to govern assisted reproductive technology (ART), told the Herald that unless gay and lesbian relationships are legalised in India, gay couples would be excluded from hiring surrogates.

Delhi’s High Court recently overturned a 150-year-old section of the country’s penal code that outlawed ”carnal intercourse against the order of nature”.

However, gay activists warn this ruling, which in effect decriminalised sodomy, does not legalise gay relationships, leaving the status of such relationships unclear.

“If our government does not permit gay relationships, then it certainly will not be permitted for foreign gay couples to come to this country and have a [surrogacy] agreement,” said Dr Sharma, who is the deputy director-general of the reproductive health and nutrition division at the India Council of Medical Research.

John and Darren Allen-Drury, who live in the Blue Mountains, raced to India earlier this month when their surrogate mother entered labour. She gave birth to Noah on April 8. John Allen-Drury said changes to India’s laws would be a great disappointment, if passed.

”It would prevent a lot of same-sex couples from coming here,” he said.

Although some gay couples sought surrogate mothers in the United States and Thailand, ”India really is the closest country to Australia that offers affordable surrogacy,” he said.

The draft bill could make it difficult for all Australian couples to use Indian surrogates.

One stumbling block would be a requirement that foreign countries guarantee they will accept the surrogate child as a citizen – before a surrogacy could begin.

Dr Sharma said foreign couples would have to obtain a document from their embassy or foreign ministry pledging the surrogate child citizenship of their country. “Only then will they be entitled to sign an agreement with a surrogate or an ART clinic,” he said.

Parents using a surrogate would also be obliged to accept the baby even if it was born with abnormalities.

”Under the Australian Citizenship Act, there are no guarantees,” a spokesman for the Department of Immigration and Citizenship said on Friday. ”What you can infer from this is that while it’s not illegal, we certainly wouldn’t be encouraging it by giving a rubber stamp to anyone who entered into such an agreement.”

Mr Allen-Drury said surrogacy in the US cost $200,000 or more. In India the arrangements could be made for $40,000 to $50,000. Thailand’s laws were changed last year to stop surrogacies for same-sex couples, although it remains legal for single males.

Mr Allen-Drury said a requirement for the Australian government to guarantee citizenship before a surrogacy could begin was impractical. ”That would just close the door,” he said.

Trevor Elwell and his partner, Peter West, have twin girls, Evelyn and Gaia, from a surrogate mother in Mumbai. Mr Elwell predicted parliamentary inertia meant the Indian laws were months or years off. But he was concerned that interim guidelines could be adopted and, in effect, exclude same-sex couples.

Mr Elwell said the citizenship proposal could pose an insurmountable hurdle.

”If you want to do that process earlier and confirm citizenship, you’re going to have to have a government process upfront,” he said.

The demand for a guarantee of citizenship meant the Australian government would have to grant it on the basis of a contract it did not recognise.

”It is a bit of a tangle, so it might affect heterosexual couples in the long run,” Mr Elwell said.

Since the publicity after they got their twins, Mr Elwell and Mr West say they have helped more than 100 couples – some gay, some straight – arrange a surrogate mother in India.

”The tip of the iceberg may have been us.”

 Source: The Sydney Morning Herald (26 April, 2010)

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Vitrification of Cleavage Stage Embryos

Freezing Cleavage-stage Embryos by Vitrification Improves Outcome July 9, 2009 Embryo cryopreservation is known to offer several advantages during ART cycles, including enhancing cumulative pregnancy rates, preventing ovarian hyperstimulation syndrome, reducing multiple pregnancy rates, and lowering treatment costs. After the vitrification technology for cryopreservation was developed, several studies have compared the slow freezing technique and vitrification method in relation to post-thaw survival, implantation, and live-birth rates. Now, a new retrospective study published in the Journal of Assisted Reproduction and Genetics highlights the efficacy of cleavage-stage embryo vitrification in improving the survival rate, post-thaw embryo morphology, and pregnancy outcomes, compared to the slow-freezing technique. Mojtaba Rezazadeh Valojerdi and colleagues, from the Embryology Department, Royan Institute, Iran, compared the effect of vitrification against slow-freezing of cleavage-stage embryos with regard to post-thaw survival rate, embryo morphology, and clinical outcomes. Cleavage-stage embryos of 305 patients were either subjected to vitrification (n=153) or slow-freezing (n=152) procedures. The following results observed during the study demonstrated that vitrification is a better cryopreservation technique compared to the slow-freezing method. Variables Vitrification (%) Slow-freezing (%) Odds Ratio Survival rate 96.9 82.8 6.607 Morphology with intact blastomeres 91.8 56.2 8.769 Clinical pregnancy rate 40.5 21.4 2.427 Implantation rate 16.6 6.8 2.726 Previously, Loutradi et al (Fertility and Sterility, 2008) conducted a systemic review and meta-analysis to compare post-thaw survival rates following vitrification and slow-freezing of human embryos. The investigators analyzed four studies, including three randomized controlled trials, comprising of 7,482 vitrified and 1,342 slow-frozen human blastocysts/cleavage stage embryos. A substantially higher cleavage stage embryo survival rate was observed in the vitrification group as compared to the slow-freezing group (OR=15.57; random effects model). Post-thaw survival rate of blastocysts was also found to be considerably greater in the vitrification group than the slow-freezing group (OR=2.20; fixed effects model). The conventional cryopreservation, by means of the slow-rate freezing protocol is associated with disadvantages such as osmotic shock, cryoprotectant toxicity, and mainly intracellular ice formation that can damage the cell wall and structure. In contrast, vitrification, the ultra-rapid cryopreservation method, eliminates the formation of ice crystals, thereby reducing the chances of cellular damage. The superiority of vitrification over slow-freezing for embryo preservation has been documented by several authors. Balaban et al (Human Reproduction, 2008) demonstrated that vitrification has a lower effect on embryo metabolic rate, compared to slow-freezing; as evident by the higher survival rate and subsequent in vitro development. Apart from the potential advantages of embryo vitrification, the ultra-rapid technique of cryopreservation has also shown its superiority in oocyte and sperm cryopreservation, and is hence becoming a more favorable procedure in comparison to the slow-freezing technique. In a more recent review study, Kolibianakis and colleagues (Current Opinion in Obstetrics and Gynecology, 2009) noted that vitrification was significantly better than slow-freezing with regard to post-thaw survival rates and embryo development of cleavage-stage embryos and blastocysts. However, the clinical pregnancy rates per transfer were comparable between the two groups. Although there seems to be ample evidence from retrospective studies and meta-analyses on the potential benefits of vitrification compared to the conventional freezing techniques, further prospective, randomized controlled trials are mandated for validating these findings and also to assuage the concerns of embryo toxicity due to the cryoprotectants used for vitrification.

References:
1. Rezazadeh Valojerdi M, Eftekhari-Yazdi P, Karimian L, Hassani F, Movaghar B. Vitrification versus slow freezing gives excellent survival, post warming embryo morphology and pregnancy outcomes for human cleaved embryos. J Assist Reprod Genet. 2009 Jun 10. [Epub ahead of print]
2. Loutradi KE, Kolibianakis EM, Venetis CA, et al. Cryopreservation of human embryos by vitrification or slow freezing: a systematic review and meta-analysis. Fertil Steril. 2008 Jul;90(1):186-93.
3. Balaban B, Urman B, Ata B, et al. A randomized controlled study of human Day 3 embryo cryopreservation by slow freezing or vitrification: vitrification is associated with higher survival, metabolism and blastocyst formation. Hum Reprod. 2008 Sep;23(9):1976-82.
4. Kolibianakis EM, Venetis CA, Tarlatzis BC. Cryopreservation of human embryos by vitrification or slow freezing: which one is better? Curr Opin Obstet Gynecol. 2009 Jun;21(3):270-4.

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Surrogate Pregnancy after transfer of Cryoshipped, Vitrified Human Blastocysts

Rotunda achieved its first pregnancy with Cryoshipped Vitrified embryos from USA and transferring them into a surrogate mother.

Till now, we have received frozen embryos from many countries and successfully transferred them into surrogate mothers at Rotunda. Most of these embryos were frozen by the slow freezing process. As vitrification is becoming popular as a method of choice for freezing gametes, we have started receiving vitrified embryos from world over. Our first case of cryoshipped, vitrified blastocyst transfer has resulted in a pregnancy.

A short history lesson:

In 1972 preimplantation mammalian embryos were first successfully cryopreserved. The method was very time consuming. Slow cooling was used (1 degree/min or less) to about -80 degrees Centigrade. Then the embryos were placed in liquid nitrogen.

The embryos also needed to be thawed slowly and a cryoprotectant added and removed in many gradual steps. This was a lot of work.

The first reported pregnancy in humans from frozen embryos was in 1983.

Most of the research has been done on mouse embryos. Development of frozen thawed mouse embryos, in vitro and in vivo, is not statistically reduced as compared to their nonfrozen counterparts.

Research continues in this area and human embryo freezing and thawing protocols have improved tremendously over the past 25 years. Hopefully, the newer vitrification technique will prove to have equivalent success rates with human blastocyst embryos transferred fresh or after freezing and thawing.

What is the difference between slow freezing and vitrification?

Patients who undergo IVF may have several eggs collected. The eggs are then fertilized with a sperm and checked for fertilization. Fertilized eggs are called embryos. A patient may have multiple high quality embryos eligible for embryo transfer back to the uterus. A certain number of embryos are chosen for embryo transfer, and the surplus of high quality embryos can be cryopreserved for future use.

Previously, embryos were cryopreserved using a slow freeze method. Embryos were run through different solutions of media toStorage of Cryopreserved embryosdehydrate the cells of water and replace it with cryoprotectant. Then the cryoprotected embryos were individually labeled and stored in cryopreservation straws, which were put in special freezers. These freezers slowly (-0.3 degrees Celsius per minute), cooled the embryos to -35 degrees Celsius using liquid nitrogen. They were then stored in liquid nitrogen (-196 degrees Celsius). At that extremely cold temperature, cellular activity is essentially brought to a halt, allowing the embryos to remain viable indefinitely.

When patients decide to use their cryopreserved embryos to try for a pregnancy, the embryos are removed from the liquid nitrogen, warmed and run through solutions of media to remove the cryoprotectant and rehydrate the cells with water. During cryopreservation, the formation of intracellular ice crystals can damage the cells of the embryo, decreasing future viability. Therefore, new methods were developed to improve cryopreservation techniques.

vitrification-hook 1Recent technical advancement in the field of cryobiology has opened up various options for freezing gametes and embryos at different developmental stages. The tendency of the IVF world to switch over to natural cycle IVF and to elective single-embryo transfer has put cryotechnology in the forefront of IVF. Vitrification method is gaining popularity as the method of choice for gamete/embryo cryopreservation.

Vitrification is a new process for cryopreserving embryos. Through vitrification, the water molecules in an embryo are removed and replaced with a higher concentration of cryoprotectant than in the slow freeze method. The embryos are then plunged directly into liquid nitrogen. This drastic (-12,000 degrees Celsius per minute) freezing creates a glass transition temperature, commonly called a “glass” state, and the embryos are vitrified. This quick freezing reduces the chance for intercellular ice crystals to be formed, thus decreasing the degeneration of cells upon thawing for embryo transfer.

In 1998, it was shown that vitrification using an EG-based vitrification solution (EFS40) (Kasai et al., 1990) with conventional cryo-straws was effective for human embryos at the 4- to 8-cell stage (Mukaida et al., 1998). The effectiveness of vitrification was confirmed for human embryos at the 8- to 16-cell stage (Saito et al., 2000) and the morula stage (Yokota et al., 2001b), also using EG-based solutions.

Many studies show survival rates of vitrified embryos to be far higher than survival rates of slow freeze embryos. Thus far at Rotunda, vitrification results are very encouraging, and we are excited to offer this cutting edge technology to our patients.

For more information about vitrification, ask to speak to the embryologist at your center.

Vitrification, a cutting edge technology for cryopreservation of embryos, is now available at Rotunda – Center for Human Reproduction.

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