pathoscribe

Written by Yong-Lin Hu | Art by Lily Ozaeta

Many say that the greatest single moment of their lives is the birth of their beloved children, but for some, this reality is unobtainable without the help of medical interference. Whether it be infertility, age, genetic problems, or matters of sex (two males or females); IVF, or In Vitro Fertilization, along with surrogacy, has proven to be an effective procedure for individuals to bypass such complications. 

IVF starts off by having a patient take fertility drugs in order to stimulate increased production of eggs. These eggs are then retrieved from the ovaries and fertilized with the collected sperm in a lab. After eggs fertilize, now becoming embryos, they are transferred back into the patient’s uterus, where it will attach and develop for 9 months until a baby is born. One cycle of IVF takes around 2-3 weeks and multiple cycles may be needed to produce successful results. Pregnancy from IVF is confirmed by taking a blood test 8-12 days after implantation, where levels of pregnancy hormone hCG will indicate pregnancy. This procedure differs slightly for same-sex couples. For lesbian couples, in order to allow both women to participate in the pregnancy, one woman will typically supply her eggs, use donated sperm to fertilize it, then have her partner carry the pregnancy to term, a procedure known as “reciprocal IVF”. Although the partner will carry the pregnancy to term, they will not be genetically related to the child, technically acting as the surrogate mother in this case. Oftentimes, this process may be reversed for the following pregnancy. For gay couples, a process called “split-cycle IVF” will allow both individuals to contribute their semen, where after an egg donor (and surrogate) is chosen and undergoes egg retrieval, the eggs will be divided into two groups: eggs fertilized from the sperm of one partner, and eggs fertilized from the sperm of the other partner. Both groups will be grown into embryos, and one embryo from each group will be transferred into the uterus of the surrogate, ultimately resulting in twins. 

Before undergoing IVF, couples may undergo various testing and screening, including: Ovarian Reserve testing (blood tests are used to determine the egg supply, which help predict how ovaries will respond to fertility medicine), Semen analysis (analysis of amount of sperm and its movement and shape in semen), Infectious Disease screening (screened for diseases, including HIV), and Practice Embryo Transfer (practice embryo is transferred to determine best technique of embryo insertion and depth of uterus).

Potential risks and complications include Ovarian Hyperstimulation syndrome, where due to fertility medicines, the ovaries may become swollen. Symptoms range from bloating, upset stomach, belly pain, vomiting, and diarrhea, and typically last for a week. Having a Multiple Pregnancy increases risks of pregnancy-related high blood pressure and diabetes, low birth weight, birth defects, and early labor and delivery than a single-baby pregnancy. An Ectopic pregnancy is a condition where the fertilized egg attaches to tissues outside the uterus, rather than the lining within. When this occurs, the fertilized egg is unable to survive. There are also typical birth risks, such as having a miscarriage or birth defects.

Younger people have significantly higher success rates of IVF than older people due to differences in quality and quantity of eggs and sperm used. Similarly, such decreased quality of eggs means that successfully attaching to the uterus also decreases with age. To combat this, multiple embryos may be transferred in order to maximize success of pregnancy. This number will be agreed on prior to the procedure and guidelines should be followed as to prevent a multiple pregnancy of three or more children. If an unexpected multiple pregnancy does occur, one may undergo a fetal reduction surgery in order to reduce the number of babies being delivered, as well as lower health risks. Extra embryos, eggs, and sperm can all be frozen and stored to be used for future use. While some may not survive the freezing and thawing process, the majority will. Extra embryos, etc, may also be donated to other couples, to a research facility, or even discarded.

There are two types of surrogates. The first is a traditional surrogate, or when a woman gets artificially inseminated with sperm and carries the baby to term. Here, the surrogate is the baby’s biological mother. On the other hand, Gestational surrogates are when an embryo is placed into the surrogate to deliver. Although they are technically the baby’s birthing mother, she is not biologically related to the child. Legally, using a surrogate presents a multitude of complications, especially amongst traditional surrogates. Surrogacy laws vary by state. Based on different definitions of parental rights, in some states, couples still have to pass adoption proceedings in order to gain legal custody. Whereas in others, a “declaration of parentage” suffices. To help combat potential legal issues that may arise, it is best to draft a surrogacy contract.

Sources:

“In Vitro Fertilization (IVF).” Yale Medicine, 2 Apr. 2024, https://www.yalemedicine.org/conditions/ivf#:~:text=%E2%80%A2A%20procedure%20that%20involves,increase%20the%20chances%20of%20pregnancy. Accessed 6 July 2024. 

“Reciprocal IVF.” Reproductive Science Center of New Jersey, 8 May 2019, https://fertilitynj.com/services/lgbtqia-family-building/reciprocal-ivf/#:~:text=Reciprocal%20in%20vitro%20fertilization%20(IVF,pregnancy%20as%20a%20gestational%20carrier. Accessed 6 July 2024. 

“Reproductive Medicine Associates of New York.” Reproductive Medicine Associates of New York, https://www.rmany.com/lgbtqia/gay-men/ivf. Accessed 6 July 2024. 

view, Log in or sign up to. “What Is Surrogacy and How Does It Work?” WebMD, https://www.webmd.com/infertility-and-reproduction/using-surrogate-mother. Accessed 6 July 2024. 

“In Vitro Fertilization (IVF).” Mayo Clinic, 1 Sept. 2023, https://www.mayoclinic.org/tests-procedures/in-vitro-fertilization/about/pac-20384716. Accessed 6 July 2024.