Professor Robert Edwards, the British pioneer of IVF

What an exciting week in the world of reproductive medicine! Robert G. Edwards who worked to develop and really invent the process of in vitro fertilization was awarded the 2010 Nobel Prize. His contributions have helped millions become parents and because of him, our work of matching intended parents with egg donors and surrogates to create a family is possible.

Article by Thomas H. Maugh II – Los Angeles Times

British biologist Robert G. Edwards, whose contributions to the technology of in vitro fertilization have made more than 4 million couples parents, has been awarded the 2010 Nobel Prize in physiology or medicine.

Working with Dr. Patrick Steptoe, Edwards, now 85, developed the techniques for removing mature eggs from a woman’s ovaries, fertilizing them in test tubes and inducing them to begin dividing before implanting them back in the mother.

Their efforts yielded the July 25, 1978, birth of Louise Brown, the first “test tube baby,” both demonstrating the success and the safety of the technique and bringing hope to infertile people all over the world. An estimated 10% of all couples are unable to conceive naturally.

Edwards, an emeritus professor at Cambridge University, is in failing health and was unable to accept the early morning call from Sweden’s Nobel Committee. “I spoke to his wife, and she was delighted, and she was sure he would be delighted too,” the committee’s secretary, Goran Hansson, told a Stockholm news conference.

In a statement released by Bourn Hall, the Cambridge in vitro fertilization, or IVF, clinic founded by Edwards and Steptoe, Ruth Edwards said, “The family is thrilled and delighted that Professor Edwards has been awarded the Nobel Prize for medicine for the development of IVF. The success of this research has touched the lives of millions of people worldwide, and his dedication and single-minded determination despite opposition from many quarters has led to successful application of his pioneering research.”

Steptoe was not named as a recipient of the $1.5-million prize because Nobel rules require that an honoree be alive at the time of the award. He died in 1988, 13 years before New York’s Lasker Foundation awarded Edwards its top award, which is often viewed as a precursor to the Nobel.

Critics have questioned why it has taken so long to honor the pair’s achievements. Some suspect that it is due in part to the Vatican’s disapproval of the technique because it physically separates the conjugal act and conception. Many other religious groups also initially expressed concerns about the ethics of IVF, and Britain’s Medical Research Council refused to fund the experiments, spurring Edwards and Steptoe to obtain private grants.

Most such groups have since changed their positions, and the Catholic Church remains the only major group opposed to IVF. In an e-mail statement Monday, Monsignor Ignacio Carrasco de Paula, head of the Pontifical Academy for Life, said that the award “is not completely out of place.” But he criticized the research for opening the door to the destruction of embryos and the creation of a commercial market for human eggs. He also said the research raised questions because it did not address the underlying problem of infertility, but only circumvented it.

Edwards began experimenting with IVF in the mid-1950s after receiving his doctorate from the University of Edinburgh in Scotland. Other researchers already had shown that rabbit eggs could be successfully inseminated in the test tube, leading to viable offspring, and Edwards initially assumed that human eggs would be little different.

It turned out, however, that human eggs had a very different life cycle from that of rabbit eggs. Over the next 20 years, Edwards made a number of fundamental discoveries, clarifying how human eggs matured, how different hormones regulated their maturation and at which times the eggs could be inseminated successfully. He also determined the conditions under which sperm were activated and had the capacity to fertilize eggs.

By 1969, he had successfully fertilized an egg in a test tube — or, more accurately, in a laboratory petri dish. But the egg would not proceed beyond the first cellular division. Edwards reasoned that the egg needed to mature in the womb. He contacted Steptoe, a gynecologist who was one of the pioneers in laparoscopy, in which a thin telescope inserted through the vagina is used to observe the ovaries and manipulate eggs.

After much further work, the pair performed the first successful IVF on Lesley Brown, who came to the clinic after she and her husband, John, had tried for nine years to have a child. Baby Louise was born, and a new world was opened.

“Louise’s birth signified so much,” Edwards said at her 25th birthday celebration in 2003. “We had to fight a lot of opposition, but we had concepts that we thought would work, and they worked.”

Louise recently had her own child, the old-fashioned way. In a statement released by Bourn Hall, she said, “It’s fantastic news; me and Mum are so glad that one of the pioneers of IVF has been given the recognition he deserves. We hold Bob in great affection and are delighted to send our personal congratulations to him and his family at this time.”

An estimated 142,000 IVF procedures are performed each year in the U.S. at a cost of about $4 billion. The success rate is about 1 in every 5 procedures, about the same rate as conventional attempts to become pregnant.

{ 0 comments }

There are many misconceptions surrounding egg donation. Elaine Gordon and Peggy Orlin, both mental health professionals specializing in third party reproduction shed some light on some of these myths.

Myth Busters on Egg Donation

by Elaine R. Gordon, Ph.D. and Peggy Orlin, MFT, Members of the AFA Mental Health Advisory Council

Myths surrounding gamete donation, like urban legends, are told and retold as truths when, in fact, they have little or no basis in reality. Most of the time they are false but some of the time there is an element of truth which serves not only to scare and confuse intended parents but to fuel the myth. Gamete donation practices are rapidly changing due to the incredible advances being made in the field of reproductive medicine but the social and psychological implications of this area lag far behind. These myths are misrepresentations of what we know to be true and they need to be dispelled.
The most often cited myths in gamete donation are:

1. I won’t bond with my baby if there is no genetic connection.
FALSE
Nothing could be further from the truth. Nevertheless, this is a fear often heard from those who have been advised to consider gamete donation as a family building option. Emotional connectedness emanates from one’s heart and does not reside within one’s chromosomes. Look around at those you love in your life…your spouse, best friend, partner, cat, dog….are you genetically related?  Bonds are forged on the ability to be open and allow one to be vulnerable in a relationship with another. It is this emotional availability that connects one individual to another and not one’s genes. This is not to say genes are unimportant because they are the seeds of who we are but they are not the determinants of whom we will love and bond. Societies have been historically organized in family units based on bloodlines simply because it just made sense. Globalization is changing all that and we are seeing a shift away from the biogenetic family to a more all-encompassing notion of family that includes non-genetic members. If you want to bond, you have to trust that you will and just let it happen.

2. Donors are donating SOLELY for the money.
FALSE
While it may be true that donors do want the compensation, this is definitely not the complete truth. Most donors have a personal commitment to the donation process. Some because they have witnessed a friend or a family member struggle with infertility as well as experience the joy of a subsequent success. Others see the donation as a way to give back; they tend to be young women who volunteer in their communities and see helping others as an important personal responsibility. There are some that report that donors may have a need to come to terms with unresolved guilt from a previous abortion and choose to donate in order to make-up for what they did. Finally, there are donors that do no see children in their personal futures and see donation as a means of “continuing on” in the genetic sense. Yes, financial compensation is a motivator but it is only one of the many factors that draw women to become egg donors. The altruistic component weighs just as heavily in a donor decision to donate. Donors are evaluated in many ways and on many levels. One aspect of the screening is to assess ‘need’ from ‘want’. While $25k in student loans points to a person’s drive and ambition to achieve, the same debt on a credit card debt may speak to impulsivity and irresponsibility. The donor demonstrating the latter would be considered an inappropriate donor and not pass screening. Donors understand the implications of their donation and their motivation to donate includes both an altruistic as well as a financial component.

3. Donors lie on their applications in order to “pass” screening.
FALSE
Donors, in general, are not inclined to lie on their application but because we can never say never, a system has been put in place in an effort to identity those that might be less than forthright when filling out their donor application.  For the most part donors are well meaning individuals who are donating for all the right reasons and are also grateful for the added benefit of being compensated for their efforts. They are not doing it solely for the compensation nor are their efforts totally altruistic. Legitimate agencies and medical practices offering up donors require them to undergo a thorough and comprehensive evaluation, which serves to weed out inappropriate applicants. There is a checks and balance system built into the process that substantiates and verifies the information donors provide. Information is gathered through an in-depth interview, psychological testing, genetic history, and medical screening. It allows the evaluator to cross check information and assess the veracity of the application. It is important to restate that most donors do not deliberately falsify their applications.

4. My partner will feel more entitled as the parent since he/she is genetically connected to the child.
FALSE
The answer is both yes and also no.  If your relationship with your partner is based on competition and rivalry, it is very possible one partner will use his/her genetic tie to assert their sense of entitlement. However, if you and your partner operate as a team and one does not ‘one-up’ the other, entitlement becomes a non-issue. It is important that the genetic parent does not use the genetic tie as a weapon against the other and that the non-genetic parent behaves in an entitled fashion and has confidence in their entitlement to parent. The one caveat here is that despite the parents’ feelings about who does or does not have a stronger hold on the child, it is the child who will dispel this myth. Children want to be loved, nurtured, and cared for. The parent who meets these basic needs is the one that will be reinforced by the child and this will have nothing to do with who has the genetic connection with the child. A child will respond to the attentive parent not the neglectful one; they will bond and love the one that is there to attend to their needs. Parents who are a team will get the lion’s share of their child’s love and devotion.

5. The donor will come back and interfere with my life-she might even lay claim to my child.
FALSE
Donors are not donating because they are interested in becoming parents. If they want to become a parent, they certainly do not need us nor do they need to go through the rigors of a donation process. Donors and recipients have two opposing perspectives on fertility and donation. On the one hand, a donor is a fertile being who has never struggled with the trials and tribulations of infertility; they have confidence in their fertility and view the donation process as easy and interesting. On the other hand, recipients have usually been beaten down by their infertility plight and look at donation as the end of the line. It is difficult for recipients to grasp the idea that donors are not interested in any ongoing relationship with you or your child. This does not mean they don’t care or are without feelings. Donors donate for a variety of reasons. There is no angst over failed cycles or repeated disappointments. Donors assume fertility whereas recipients assume infertility. It is difficult for the intended parent to grasp the ease with which donors can donate because their experience in trying to have a child has been thwarted again and again. Donors donate with the sole intention of helping someone else have a child. They have no interest in participating in the child’s life, as they do not see their donation efforts as equated with parenthood. Ask any donor and you will hear the same sentiment, “I am not the parent!”.

6. Donors will donate more than the recommended number of times leading to unintended consanguinity.
FALSE
Consanguinity is the state of being related by blood or descended from a common ancestor. It relates to ‘being of the same blood’ and the feared consequence of donors donating too many times. Inadvertent consanguinity resulting from egg donation is possible if a donor donates two or more times and if the resulting children are unaware of their genetic histories. Statistically we need to remember that consanguinity is highly unlikely.  In order to minimize this small but real risk, guidelines have been established by the American Society for Reproductive Medicine, which have advised a limit of no more than twenty-five pregnancies per sperm donor in an effort to diminish the risk of inadvertent consanguinity. This is much higher than the six cycles recommended for egg donors.  In general, donors are bright and thoughtful young women who have been counseled on the medical and psychological aspects of donation including how many times they should donate. They are also made aware of the risk that donation may pose to their own health. Most donors are disinclined to donate more times than what is advised and are unwilling to do anything that will put their own health at risk.  Therefore, unintended consanguinity is an unlikely scenario. Donors are proud of what they are doing and are excited about helping others have children. They have no intention of endangering anyone’s health…not their own and not the children they are helping create.

7. Every young woman who applies to be a donor is accepted.
FALSE
Donor applicants are required to undergo a rigorous evaluation process that includes a medical, a psychological, and legal contracts. Only about ten percent of potential donors pass muster and are accepted as suitable participants in an egg donation arrangement. They may fall out or be disqualified at any point in the screening process. The donor evaluative process usually starts with an in-depth written application of about fifteen to twenty pages in length. Along with this questionnaire are photos of donors and their families, with some programs requesting childhood pictures. After careful review of this initial questionnaire a psychological interview is completed by a licensed mental health practitioner. In addition, a psychological test battery is administered. Many programs also require a meeting with a genetic counselor in an effort to assess genetic risk. A thorough medical screening is completed by the treating physician, which includes blood work and a physical exam. Also, potential donors must be non-smokers, free of infectious diseases, non-drug users and have the flexibility in their schedule to meet the appointment demands of an IVF cycle. Only screened, qualified, enthusiastic, organized, responsible women get through the rigors of this process.

8. My family will reject my child if they know that I used donor eggs.
MOSTLY FALSE
This is a complicated question that has no “one size fits all” answer. Families will have different responses when it comes to the acceptance or rejection of a child born from a donor gamete. Some families will embrace the child without a second thought while others will not. Determinants of whether or not a child will be accepted or rejected depend on a multitude of factors including, family values, religious beliefs, psychological health, cultural biases, and level of family dysfunction. Taking all these factors into consideration will guide you in deciding what to share and what to keep private. If you are concerned that your family members will reject your child merely based on his/her genetic make-up, it might be useful to examine your fear and understand why you feel that way. Is your family really likely to reject your child? Are you projecting your own fear of not loving your child onto them?  If after making an honest assessment of your family’s reaction to your child and concluding that rejection is a real threat, there are some steps for you to take. Some parents choose to tell their family about the donation after the child is born…when they are all “in love” with the child.  Others choose to tell the child and not inform the other family members, keeping that information private until the child chooses to disclose. Once you have bonded with your child, the issue of family rejection will become moot and your worries will dissipate.
(For a discussion on disclosure to children there is an excellent article in the AFA archives on Talking to your children about Ovum Donation. It is a “must read”.)

Elaine R. Gordon, Ph.D. is a clinical psychologist with a specialty in infertility, child development, reproductive medicine, and third party family building. Her clinical work involves individual therapy, group process for couples and individuals, medical staff training and third party evaluations. Her involvement with egg donation and surrogacy programs has stimulated interest in issues surrounding secrecy, disclosure and anonymity in third party arrangements. As an outgrowth of her work she has become increasingly concerned about the ethical and moral dilemmas involved in reproductive medicine. Dr. Gordon is the author of “Mommy, Did I Grow in Your Tummy? Where some babies come from, a children’s book dedicated to explaining a child’s unique reproductive beginnings.

Peggy Orlin, MS, MFT, is a Marriage and Family Therapist who specializes in the emotional aspects of infertility and third party family building. She is in private practice in Berkeley and San Francisco. In addition, she counsels donors, gestational carriers and recipients at Pacific Fertility Center. Her professional associations include the American Society for Reproductive Medicine, where she was a former Chair of the Mental Health Professional Group. She is on the Mental Health Advisory Board of the AFA.

{ 0 comments }