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Prof. Oladapo Ashiru
The history of Assisted Reproductive Technology (ART) dates back to 1963 when Yanagimachi and Chang reported in-vitro fertilisation of hamster eggs. After that, Yanagimachi demonstrated in vitro capacitation of hamster spermatozoa in follicular fluid. Capacitation, a term used to describe hyperactivated motility of the sperm, is required for fertilisation.
In 1977, Andrew Schally and Roger Guillemin were awarded the Nobel Prize in Medicine and Physiology for their work in the isolation of LHRH from the hypothalamus. In 1978, Oladapo Ashiru and Charles Blake also reported FSH positive feedback mechanism on the pituitary. These and many others have been the bedrock for the achievement of the first live birth via in vitro fertilisation, Louis Brown, popularly called the first ‘test-tube’ baby, in 1978, after a failed attempt that resulted in ectopic pregnancy in 1976. Steptoe and Edwards achieved this groundbreaking success in Oldham, England, and Robert Edwards was subsequently awarded the Nobel Prize in Medicine/Physiology in 2010.
Other countries reported their successes, Australia by Carl Woods in 1980, USA by Howard &Georgeanna Jones in 1981 and Nigeria by Ashiru, Giwa-Osagie in 1984 following a miscarriage attempt successfully delivered the first GIFT/IVF baby in 1986, and the delivery of a baby Olusola through IVF in 1989.
Since then, several technologies have emerged to assist human conception. They include preimplantation genetic diagnosis, gestational surrogacy, stem cell therapy, and others. I want to focus on surrogacy in this review.
What is surrogacy?
Surrogacy involves using one woman’s uterus to implant and carry the embryo and deliver the baby to another person or couple. It is done utilising IVF – in vitro fertilisation.
The woman that carries the pregnancy is called the surrogate, “surrogate mother,” or “gestational carrier.” Surrogacy is an arrangement or agreement whereby a woman agrees to carry a pregnancy for another person or persons who will become the newborn child’s parent(s) after birth.
In 1985 – A woman carried the first successful gestational surrogate pregnancy. By 1986 – Melissa Stern, otherwise known as “Baby M,” was born in the U.S. The surrogate and biological mother, Mary Beth Whitehead, refused to cede custody of Melissa to the couple with whom she made the surrogacy agreement. The courts of New Jersey found that Whitehead was the child’s legal mother and declared contracts for surrogate motherhood illegal and invalid. However, the court found it in the infant’s best interest to award custody of Melissa to the child’s biological father, William Stern, and his wife Elizabeth Stern, rather than to Whitehead, the surrogate mother. Since then, the legal contract for gestational surrogacy has been bound to all, and the transfer of the baby to the biological parents or the commissioning Parents is now very hitch-free.
This technology is available in Nigeria. Several babies have been born through this unique technique in Nigeria using the guideline regulation stipulated by the Association for Fertility and Reproductive Health of Nigeria (AFRH) guidelines. Their guidelines are almost similar to that of the American Society for Reproductive Medicine and HFEA in the U.K.
Who should be treated with gestational surrogacy?
It is often done for a woman who has had her uterus removed but still has ovaries.
She can provide the egg to make a baby but has no womb to carry it. Using her eggs and in vitro fertilization technology, IVF, she can utilize a surrogate mother to carry the pregnancy (her genetic child).
A surrogate is also sometimes used for cases where a young woman has a medical condition that could pose serious health risks to the mother or the baby. These include but are not limited to patients with lupus, heart disease, uterine anomaly, severe Ashermans, and congenital absence of the uterus.
How is gestational surrogacy performed?
An appropriate surrogate is chosen and thoroughly screened for infectious diseases. Physical and psychological evaluations, including medical history, are done before being considered a surrogate.
All parties sign consents and surrogacy agreement/legal forms. It is an essential step in surrogacy cases. All potential issues need to be carefully clarified by their lawyers, put in writing, and signed.
The patient is stimulated for IVF with medications to develop multiple eggs.
The surrogate is placed on medications that suppress her menstrual cycle and stimulate the development of a receptive uterine lining.
When the patient’s follicles are mature, an egg retrieval procedure is performed to remove eggs from her ovaries.
The eggs are fertilised in the laboratory with her partner’s (Husband) sperm. The embryos develop in the laboratory for three to five days, after which an embryo transfer procedure is done. A maximum of two embryos are placed in the surrogate mother’s uterus, where they will hopefully implant. There is a close obstetrics monitoring of the surrogate throughout the pregnancy.
The surrogate delivers the baby.
The baby goes home from the hospital with the “genetic parents.”
Success rates for surrogacy IVF procedures vary considerably.
The age of the woman providing the eggs is one critical factor.
In general, pregnancy rates are higher than with eggs from infertile women.
Some programs report delivery rates of over 50 per cent per transfer for gestational surrogacy cases (using eggs from women under about age 37). The number of successes recorded at our center has encouraged awareness and huge referrals from Nigeria and the diaspora. Our experience over fifteen years is that the need for surrogacy increases.
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