Free Sperm Donors
|Donated for love??|
The risks of using free sperm donors
In the UK, current convictions over the usage of ‘free sperm donors’ operating through the internet and without a license have again brought to light the hazards of this practice.
A website called ‘fertility 1st’ was shut down and two males convicted for running the web site. Basically, the web site supplied ‘fresh’ semen at home picked from a list of free sperm donors for a cost, stated to be to deal with ‘expenditures’.
We have reviewed the advantages and disadvantages of free sperm donors in this blog site. We want to help remind everyone that wishes to get pregnant of the hazards of this, and similar practices:
1) From 2007, it is illegal to obtain, test or circulate gametes (i.e. semen or eggs) from donors in the UK without a licence from the HFEA. This does not suggest that patients will certainly go to prison, they are considered the sufferers. If you utilize semen samples from ‘unlicensed’ donors, you are running the risk of infection with venereal diseases (STD’s) including HIV. The explanation the legislation was introduced is not to secure the semen banks, IVF centres or specialists, but to secure YOU, the customer.
2) Sperm donors registered with licensed centres are normally checked for STD’s two times; prior to producing the sample AND 6 months after the donation. Consequently, there is a dual check that no infection has developed prior to release of the samples for usage.
3) The same risk of genetic disease exists in both free sperm donation AND cryopreserved semen samples. Nevertheless, some of the most frequent genetic illness (Cystic Fibrosis for instance) are checked in potential semen donors. Please ask yourself– does an unlicensed donor go through these examinations?
4) Even if you have an agreement with the free sperm donor in which he relinquishes being a parent; will such an agreement, stemmed from an outlawed practice, stand?
The essence of the account is that regulations are put in place to secure the customers that are normally be open to exploitation. You might find that ‘free sperm donation’ comes to be anything but ‘cost-free’ without appropriate regulations.
Paying for IVF
|Once you have embarked on a program of IVF treatment, one of the major concerns is how to pay for IVF. If you are lucky and you have a mild infertility problem, this can often be resolved at low cost. However, with the current pregnancy rate after IVF in the region of 30%, it is possible that you will have to prepare a solid plan of action to fund IVF treatment. The more severe your infertility diagnosis, the more you should prepare in advance for funding IVF treatment. You may find you need to repeat the procedure or require more complex and therefore costly IVF tests, and this can start to burn a hole in your budget.|
Infertility costs may include IVF specialist visits, blood tests and other examinations, surgical procedures, and of course IVF. Although the IVF procedure is apparently the major cost, other visits can often accumulate and become a major financial strain. Another major cost are the hormonal therapies required to enable the production of multiple eggs for IVF.
So, how to pay for IVF, win, and not blow a hole in your family finances? The first consideration should be to establish a yearly budget. If for example your joint income is in the region of £20000 ($30000-$35000), you should really try not to spend over $3000 per year on infertility treatment. This of course depends on your overall disposable income which is the money left after basic expenses are met.
Some tips for paying for IVF without blowing a hole in your budget:
1) Choice of infertility therapy.
Typical infertility therapy costs can run into thousands of pounds just for the hormones. However, did you know you have a choice? For example, if you are a suitable case, you could use clomiphene citrate instead of recombinant FSH. Of course, this depends on your suitability and you should follow the advice of your doctor, but perhaps you could ask your IVF specialist to prescribe a cheaper therapy, at least for the first attempt.
2) Egg sharing.
In this procedure, you go through an IVF cycle, but some of your eggs will be donated to another couple. Usually, there is a major discount to your own IVF cycle with this form of treatment. In many cases, the discount runs to your own cycle free of charge. This is an excellent way of paying for IVF. However, there are drawbacks. One drawback is the theory that you have fewer embryos to choose from for your own IVF cycle. However, this tends not to affect the chances of egg sharers of getting pregnant; although you may not have excess embryos to cryopreserve. Secondly; although in some countries egg donation is an anonymous procedure; in other countries egg donation is traceable by Law. When egg donation is traceable, you must leave identifiable information, and a child born through egg donation has the right to search his or her parents (once they reach 18 years of age). This means that you might find that a child born with your eggs contacts you.
3) Donate blood.
To be able to have an IVF procedure, you must have blood tests for infectious diseases such as HBsAg, HCV, HIV. Although these tests do not cost an excessive amount, they must not be older than 6 months. To get them free, why not donate blood? In this way, you do good for someone else (‘feel good factor’) and get your tests free. The tests do not usually cover all required exams, but many of the exams required for the oocyte retrieval process are covered here.
4) Paying for IVF with a credit card or other loan.
A credit card is effectively a small unsecured loan right there in your pocket. Credit cards are a good way of paying for IVF, because once you have a credit card you don’t need to ask or produce documents for your loan. Choose a reasonable monthly repayment and you have budgeted for IVF. The bad side of credit cards: the interest rates are higher than other forms of loan. Furthermore, don’t use the card to get into excess debt because this will become a problem in itself and a cause of stress between you and your partner. Another form of loan could be remortgaging the house. This tends to release extra funds, and is effectively a cheap, long-term loan. Again, don’t get into debt that you can’t pay for.
5) Pay multiple cycles together.
Some IVF centres offer packages of IVF. For example, pay for a packages of 3 cycles upfront, and the cost will be equivalent to 2 cycles. Therefore, if you need all 3, you have effectively saved about 30% of the cost. Pay with a loan, and you have budgeted for 1-2 years cycles together. It is a good way of budgeting for IVF, but the drawback is that if you get pregnant on the first cycle, you have effectively overpaid your IVF treatment (but you got pregnant so the major aim of the treatment has been achieved). That’s part of the risk of IVF (and the risk is in the positive sense here). Unfortunately, centres consider the ‘contract’ and therefore the package complete here – you can’t use the credit for a second child for example.
6) Crowdfunded IVF.
Crowdfunding is where the mass helps share the risk that a few will need. National health services for example are a form of crowdfunding. The example above is also a form of crowdfunding, because patients achieving pregnancy after 1 cycle effectively finance the 3rd cycle of repeaters. Another form of crowdfunded IVF is listed on this site: here, people contribute a small amount of money to pay for your IVF cycle. So, send us your story and we will attempt to fund you an IVF cycle.
In essence, although you may need IVF, don’t lose sight of your budget; remember that you need to look towards the long term wellbeing for the health of yourself, partner and child, and financial considerations form part of this wellbeing.
Which is better – ICSI or IMSI?
|Since the birth of the first child with assisted reproduction technology, the analysis of morphology (i.e. visual characteristics of sperm, eggs and embryos) has been used to determine the best embryos to select for the transfer procedure. The technique of intracytoplasmic morphology-selected sperm injection (IMSI) continues this philosophy.|
|Traditionally, it was embryo morphology that interested the IVF practitioner. In recent years, the Laws of certain countries (such as Germany and Italy), and ethical considerations have limited the number of embryos that can be left in culture and transferred into the uterus. Therefore, it was necessary to extend the analysis of morphology to that of zygotes (i.e. the first stage of fertilisation) and even oocytes(unfertilized eggs). Combinations of these selection criteria have been found to be powerful determinants of pregnancy, since embryos with top quality scores in all 3 stages are known to implant more frequently than those not achieving a high score.|
On this basis, the technique of IMSI was developed.
IMSI is a simple extension of the ICSI technique already established around the world, during which the morphology of the spermatozoa is closely examined with high resolution computerized digital microscopy.
With IMSI, new features of spermatozoa have been observed such as the presence of vacuoles in the head.
|The presence of vacuoles and other defects does appear to negatively affect the probability of pregnancy. Since all analyses of semen have revealed a percentage of these ‘compromised’ spermatozoa, we can see that some embryos formed by standard ICSI procedures are destined never to implant because of the spermatozoa. These theoretical ideas have been shown to be true in practice; IMSI is known to increase pregnancy rates, especially when males have over 20% spermatozoa with defects. Therefore, before thinking about a cycle of ICSI, try IMSI – you may be about to throw money away!.|
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IVF, the birth of in vitro fertilisation
The IVF Revolution
|1) IVF can only be performed in a very limited group of couples i.e. those where the male has a reasonable number of sperm in his semen (i.e. >15,000,000/ml). This means many patients cannot be treated with the technique.
2) There is a real possibility of ‘fertilisation failure’ i.e. no eggs fertilized with IVF even when the prospect was good. Although this happens in about 1% of cases, it never happens with ICSI, therefore many IVF centres have become ‘all ICSI’ centres. In fact, more recently National Statistics have adopted to present their annual reports without differentiating for technique.
GIFT (Gamete IntraFallopian Transfer) is a variation on IVF. With GIFT, eggs and sperm are returned to the Fallopian tubes without in vitro insemination. The idea is to replace the gametes into the most natural environment to maximise embryo growth and development.
Which types of infertility can be treated with IVF?
Couples in which the male partner is considered normospermic or has mild subfertility are commonly treated with in vitro fertilisation. In cases where the male subfertility is more severe, ICSI, or intracytoplasmic sperm injection, is preferred.
What is the success rate based on?
In a good standard laboratory, the success rate (that is pregnancy rate) is dependent mainly on maternal age. In general, patients where the woman is below 30 years can expect a success rate in the range 55-60%. Women of between 30 and 37 years can hope for pregnancy in 40-50% of attempts and women over 37 years old can expect a 15% chance of achieving pregnancy. Of course, other factors (such as the womans hormonal status) have an effect, but the major influencing factor is maternal age.
Clinical infertility specialist
|After a year of trying to conceive, couples should visit a clinical infertility specialist to start to examine the causes of infertility. A year of unprotected intercourse is usually determined as the best startpoint since each embryo formed appears to have an approximately 10% chance of implantation and therefore pregnancy. Therefore, after 12 attempts (i.e. 12 menstrual cycles), we can consider that the couple should have successfully conceived.What does an infertility specialist do? An infertility specialist will examine the couple’s reproductive health both on the female and male side. For the female, measurements can be taken of basal hormone levels such as Follicle Stimulating Hormone (FSH), Luteinizing hormone (LH), and Anti Mullerian hormone (AMH), which give an idea of the follicular reserve in the ovaries. Ultrasound examinations are also made, together with hysteroscopy (a look inside the uterus) and hysterosalpingography (to examine uterine morphology and see if the Fallopian tubes are open). If all appears normal, the menstrual cycle itself may be followed to observe if follicles develop and ovulation occurs.|
On the male side, the easiest, and most important examination is the spermiogram. Here, the number, motility and morphology of sperm are assessed. Other exams are the spermioculture, where the presence and resistance of any bacteria to antibiotics is assessed. If spermatozoa are not observed in these exams, further investigation is necessary, for example by attempting a testicular biopsy to find spermatozoa.
Where the cause of infertility is found to be physical, a small operation to remove this is often enough. (for example to open the Fallopian tubes). In other cases, assisted reproduction may be required. This is often proposed as a simple alternative to surgery because it is reliable and more acceptable to patients life schedules (work etc).
In some cases, the use of the couples own material (i.e. sperm and/or eggs) may be considered too wasteful (i.e. too low a chance to conceive). Here, couples can be offered gamete donation.
Infertility medication describes the series of medications, both hormonal and otherwise, that can help people achieve pregnancy. Simple medications are the treatments often administered to males such as vitamin supplements that increase sperm quality and production. Females are usually prescribed hormonal therapies which can restart ovulation, or increase the number of eggs produced during each menstrual cycle. These have to be administered under the guidance of a specialist, and may require assisted reproduction techniques to safely help patients get pregnant.
Two fundamental exams to consider if you have trouble conceiving are the hormonal analysis of the female’s menstrual cycle, and the analysis of the quality of sperm produced by the male partner. The hormonal analysis of the female partner includes hormones such as follicle stimulation hormone (FSH) and luteinizing hormone (LH), but also other factors such as inhibins and anti-Mullerian hormone (AMH). These give an indication of the health of the ovaries and the quality of eggs produced. Ultrasound examinations are also made, together with hysteroscopy (a look inside the uterus) and hysterosalpingography (to examine uterine morphology and see if the Fallopian tubes are open). If all appears normal, the menstrual cycle itself may be followed to observe if follicles develop and ovulation occurs. The spermiogram gives an indication of the male fertility. Parameters examined usually are the concentration of spermatozoi, the motility of these sperm and their morphology. Defects in any one of these parameters suggest that the quality may not be sufficient to permit conception without assisted reproduction. Where the cause of infertility is found to be physical, a small operation to remove this is often enough. (for example to open the Fallopian tubes). In other cases, assisted reproduction may be required. This is often proposed as a simple alternative to surgery because it is reliable and more acceptable to patients life schedules (work etc).
Assisted reproduction describes the various techniques to help you have a baby. Modern techniques are IVF, ICSI, IMSI, pICSI and pIMSI. These consist of laboratory techniques performed in specialist centres of assisted reproduction. The intent is to form human embryos in vitro (outside the body) and place developing embryos into the uterus in a process known as ‘embryo transfer’. The embryo then implants and forms a baby as in nature. Embryos are usually from the husband and wife, but in some cases an external source is used such as in egg or sperm donation.
Physiological ICSI and IMSI (pICSI and pIMSI)
|The technique of pICSI (physiological ICSI) has been developed to try to return to nature during ICSI (as much as possible of course!). The idea of the technique is to select the best sperm for your ICSI procedure, with as little bias from the embryologist.||
Image courtesy of Biocoat
|The technique relies on a naturally occurring protein – hyaluronic acid, to select sperm. Yes – hyaluronic acid - the same molecule used in plastic surgery – can get you pregnant naturally!!!.|
Why hyaluronic acid? – Because it forms part of the tissue surrounding the egg. In nature, sperm bind to this molecule when they are ripe for fertilisation -get through the outer layers of the egg protective coat and reach the egg itself. In the IVF lab, we don’t use it in the same way – but the principle is the same i.e. if sperm bind to hyaluronic acid- they are the best sperm.
|Unfortunately, sperm binding to hyaluronic acid does not mean the absolute best sperm (poor ones can bind but not penetrate the outer layers of the egg). To get the best sperm, you need to combine pICSI with IMSI. We call this technique pIMSI (physiological IMSI).||
Image courtesy of Biocoat
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Increase your chances after an IVF cycle
Tips and tricks to unlock that door…
Bear in mind that, although you do not need to do anything else till the pregnancy test, an embryo is growing in your uterus and will try to implant and form a pregnancy. We desire that this embryo has the optimum possibility, so as not to lose hard earned cash, resources, wishes or time.
So, here are ten regulations to assist you to increase your opportunities of pregnancy after an IVF cycle:
1. Don’t drink substantial amounts of alcohol
2. Don’t head out in the sunlight, rainstorm or wind for long periods
3. Don’t lift heavy items, perform hard jobs or stressful work
4. Eat consistently, drink great deals of water
5. Try to rest as much as possible
6. Take the medications recommended by your gynecologist in the time intervals recommended
7. Avoid sex. If you just can’t avoid it make use of the Porcupine method (i.e. be incredibly cautious !!!).
8. If you have children, get your husband to care for them a little more in order not to tire yourself
9. If you fall ill throughout the waiting period, go to bed immediately and rest well
10. Don’t use tight trousers or additional clothing that may strain the uterus
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What is chromosomal mosaicism in IVF?
What is ‘chromosomal mosaicism’ and why is it important for IVF?
‘Chromosomal mosaicism’ refers to the presence of more than one cell line within the body.
You are a mosaic with respect to your chromosomes if you have had a karyotype in which two or more cell lines have been noted (such as mos (45, X0; 47, XYY) or mos (46, XY; 47, XY + 21).
Chromosomal mosaicism stems from the unequal separation of sister chromatids during fetal life, leading to some cells containing extra chromosomes, and others lacking the same chromosome.
What does chromosomal mosaicism mean for me?
If you have been diagnosed as a chromosomal mosaic, you can have a perfectly healthy life, but you may have problems when you decide to have children. In fact,the reason you had a chromosomal analysis is almost certainly because your clinical infertility specialist recommended as part of your infertility diagnosis.
The level of chromosomal mosaicism in the blood should, but does not necessarily reflect the levels of mosaicism in the reproductive organs. This means that if you have 5% mosaicism in the blood for chromosome 21, you may still have 50% mosaicism in the reproductive tissues.
Why is this important? because you may be at risk of passing on genetic disease to your offspring.
Take this example, a cell with 3 copies of chromosome 21 can become two daughter cells with one containg a single 21 and one containing two 21′s. If this cell forms a spermatozoa or egg, the embryo will have three copies of chromosome 21 (Downs syndome).
So, it is advisable always to have a karyotype performed before considering having children.
What can I do if I am diagnosed with chromosomal mosaicism?
If your chromosome analysis does reveal the presence of mosaicism, your best course of action is to seek advice from a clinical geneticist. The best course of treatment for you is probably preimplantation genetic diagnosis.
IVF treatment abroad
Nice place for an IVF cycle?
Infertility treatment in Europe is well established and many IVF centres of high quality are present. Advantages of having infertility treatments in Europe include costs that are lower than in the UK or USA, pregnancy rates which are as high as, or even higher than that in the UK, and often more IVF choices such as egg, embryo and sperm donation are offered. In countries where identifiable donation is obligatory, the number of potential donors has collapsed, suggesting that donors at least prefer to remain anonymous. Because Laws vary from country-to-country, egg and sperm donation cycles can be either anonymous (i.e. neither donor nor recipient can identify the other partner) or identifiable (such as in the United Kingdom). Therefore, prospective patients can always find the treatment package corresponding to their needs abroad from the home country. Waiting lists can also vary between obtaining treatment immediately, or having to wait until a suitable partner is found. Another advantage is the lower cost of IVF or ICSI treatment with respect to the United Kingdom or USA.
On the negative side, disadvantages to going abroad for IVF or ICSI treatment can include the stress of preparing for their IVF cycle, travel and staying expenses and the time lost from work. This last aspect is usually reduced to between 2-3 days depending on the treatment. Obviously, one of the riskier aspects of having IVF or ICSI treatment abroad is that it is difficult to seek recourse if you are unhappy about any aspects of the treatment cycle. For this reason, many people prefer to trust themselves to an agency such as IVFAgent, for the guarantees this gives them.
Trust yourself with an experienced IVF agency; you can have a successful IVF treatment abroad without the risks and stress associated with going independently. You can plan for IVF treatment in combination with a holiday, even a weekend away from home. Depending on the country, the costs of IVF treatment can be so much lower than treatment at home that the holiday pays for itself. And what better than having an IVF cycle, for example by the sea!
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Frozen IVF embryos result in healthier babies
|Are we made better this way?|
New research has revealed that using frozen IVF embryos may result in healthier babies than fresh IVF embryos. Recent research conducted at Aberdeen University has provided evidence that fetuses conceived from frozen IVF embryos often result in healthier pregnancies and healthier babies. The study showed that using frozen (and then thawed) IVF embryos reduced the chance of bleeding during pregnancy and reduced the chances of low preterm and post-birth weights.
The research considered data from over 37,000 pregnancies stemming from either fresh or frozen IVF usage and showed clearly that frozen IVF embryos fared far better than fresh IVF embryos.
The researchers involved offered a few theories as to why this might be. Previous intuitive thinking had led medical professionals to assume that frozen embryos may not perform as well as fresh in the same way that fresh produce contains more vitamins and nutrients than frozen fare. However, by freezing embryos, it is thought that the mother’s womb, ovaries and hormones have more time to recover from the hormone injections used to stimulate egg production during the IVF process.
By giving a woman’s body time to recover from this process, freezing embryos allows for a much more fertile and natural environment for implantation. This is one, fairly compelling theory.
Another theory comes close to Darwin’s survival of the fittest. During the freezing and thawing processes, it is thought that only the strongest and most viable embryos survive (however embryo survival rates are now higher than 90% in many clinics and this does not necessarily account for healthier pregnancies).
This discovery is causing fertility specialists to seriously reconsider how IVF processes are undertaken. If, by providing a window of opportunity for a prospective mother’s body to recover from hormone injections, we can significantly improve the success rates and safety of IVF treatment, should the practice of implanting fresh embryos be scrapped altogether?
The figures are compelling:
- Frozen IVF embryos have 16% less risk of being born pre-term
- Frozen embryos have 50% less risk of being below average size for their gestational age
- There is a significantly lower risk of a low birth weight
- The risk of death soon after birth is also significantly reduced
More research is required to determine exactly why frozen embryos fare so much better in IVF processes, yet the prevailing view is that this breathing space for prospective mothers is behind the greater success rate. This study is a promising start to a new understanding of IVF which could significantly improve the technique in future. Keep your eyes peeled for more news soon.
Author Bio: This post was written by the London Women’s Clinic, UK fertility clinic offering a range of fertility treatments including frozen embryo transfer. For more information, visit www.londonwomensclinic.com.