What is it like to spend nine-plus months carrying someone else’s baby? How can you not get attached to the baby growing inside you? How can you talk yourself through morning sickness, swollen ankles and back pain when you don’t get the ultimate payoff of holding your own precious baby when all is said and done?

I was very fortunate to speak to Alison Adams, an amazing woman who speaks very openly and honestly about her experiences as a surrogate.

1. What made you decide to be a surrogate?

Helping others has always been a deep seeded interest of mine. When I was in my later teen years, I became aware of egg donation.  When I met my boyfriend (now husband), I told him of my desires pretty early on. He thought the idea of it was great, being I waited until after we were done having our own children (I agreed).

2. How do you choose the family?

With my first surrogacy, I met the couple I chose through an agency. With my second surrogacy, I met the couple through Facebook, of all places!

3. What is it like to carry someone else’s baby?

I do the same things – watch what I eat, take my prenatal vitamins, go to my appointments as necessary, rub my belly, talk to the baby, etc. But of course, there’s no preparing for a baby, so that was a bit odd the first time around. It just seemed so strange to be so very pregnant, and not be setting up a nursery or installing a car seat. But how I felt towards my surrogate son was very different – I loved him and cared for him, yes. But I did not love him as I love my own children.

4. Who handles the financial obligation associated with the surrogate pregnancy?

In most all surrogacy journeys, the IPs (intended parents) cover the finances. This could/should include attorneys (for both the surrogate and parents!), insurance copays, etc.

5. Are you financially compensated for being a surrogate?

Most first time surrogates in the US receive around 20k for a first time surrogacy. Some surrogates receive a higher compensation for a second time journey, and some, like myself, opt to receive the same compensation that they received the first time. If you figure it out, it calculates out to under $3 per hour. But as is true for most surrogates, compensation isn’t close to one of the top reasons we choose to do this. It is a nice bonus, though.

6. Do you keep in contact with the family after the baby is born?

Yes, this is actually a requirement of mine. I ask that the family opt to keep up with me and keep me updated on them (not just the baby).

7. How important is the emotional support of your family while you are a surrogate?

Very important. My husband is my rock. He not only has to submit himself to STD testing and sign the contract, he is there with me as I go through the cycling, the pregnancy and the postpartum time. It is not easy on him, but he chooses to support me and hold me up through the hard times. I think I fell in love with him even more after the birth of my surrogate son, just knowing how awesome he was during the pregnancy – a pregnancy that wasn’t even for us, if that makes sense.

Read more about Alison’s surrogacy journeys in her blog.

It used to be said that a mom is always sure it’s her child but a man’s paternity can always be questioned. Not anymore.

Every year, hundreds of thousands of embryos are implanted into women’s wombs during in vitro fertilization (IVF). What are the chances that an embryo is implanted in a womb where it isn’t supposed to be? No, this is not something out of Private Practice. It happened before and it has happened again.

According to this CNN report, when the couple Carolyn and Sean Savage got a phone call informing them of the mistake after implantation, shock is a poor word to describe their feelings. It is not only about the “strange” embryo that is growing in Caroline’s uterus that concerns them. In fact, there are many things one has to consider when one is involved in embryo mix up situation.

Health and Future Pregnancy

If you were the one who is carrying the embryo, how would this pregnancy affect your health? Does it put you at risk for pregnancy complications? Does it jeopardize your chances of getting pregnant again? And as the DNA mom, are you willing to wait out this pregnancy until you try for the next one? Is your age a determining factor?

After going through miscarriages, several failed IVF cycles, health problems and difficult pregnancies, this could be Carolyn’s last chance to have another child. In fact, the doctor has advised Carolyn from getting pregnant again.

Religious Beliefs and Convictions

In cases of mix ups, a termination of the pregnancy is a very likely outcome. How would you feel about an abortion if you were the DNA-mother? If you were the accidental surrogate mother?

Carolyn and Sean, due to their religious beliefs, strongly believe in human life in the embryos. Carolyn is not willing to terminate this pregnancy. To complicate things, the couple still had 5 frozen embryos left over from IVF which they are not willing to destroy or leave frozen forever. They are now looking at surrogacy options for these embryos.

Unintended Surrogacy

What is your attitude towards surrogacy? How would you feel if you became a surrogate mother unintentionally? Would you treat this pregnancy the same way as any other normal pregnancy? A clinic in Wales accidentally implanted the last of a couple’s embryo in another woman. The unwilling surrogate mom decided to terminate the pregnancy and the couple was left with nothing.

Isn’t it ironic that Carolyn and Sean are looking for a surrogate mother for their embryos when Carolyn herself has become an unintentional surrogate mother to somebody else’s embryo?

Custody

Whose child is it? In 1993, a white couple in Australia gave birth to black twin babies after going through IVF. At that time, according to the Australian Human Fertilisation and Embryology Act 1990, a woman delivered the child, even if it is not through genetically hers, is the “legal mother”. Paternity, however, is “open to legal interpretation.” In another mix up case in 2004, an American woman who got implanted with the wrong embryo was sued by the DNA parents for custody after delivery. Laws change but still vary from country to country or even from state to state in the US.

Carolyn is the biological or womb mother but she is not the DNA mother of the child. It is not clear how the law will decide when it comes to a custody battle. Fortunately for the DNA, Carolyn, again due to her strong religious principles, will never put a claim to a child that is not hers despite the ordeal she has to go through. Both sets of parents are talking to each other to find a solution. After all, this was none of their fault. Nor it was that of the unborn child.

Bonding

Mother-child bonding starts at the womb. Will you be able to give up a baby after carrying it for 9 months in your womb? Surrogate moms can do this but Carolyn is not just any surrogate mom. She really wanted, fought for, and risked a lot for this pregnancy.

In the current case, will the DNA mom bond with her baby? She, too, wanted to be pregnant and now she has been denied of the privilege (at least this time around) of carrying her baby in her womb.

Nowadays, mix ups are discovered before delivery. In case of the Australian couple, and another reported case in the Netherlands, they only found out about the mistake at birth. The blow in these cases is much harder since mom and baby have already strongly bonded for 9 months without any doubts about their relationship.

This is not the first case of embryo mix ups. According to American Fertility Association experts, the odds of this happening are 1 in a million, mainly due to human error.

So what would you do if you were involved in an embryo mix-up?

Alas, the Brits have done it again! They gave the world the first IVF baby (the called test-tube baby) more than 30 years ago. Last year, they presented the first “breast-cancer-free” baby. And now, here’s their latest coup: the first egg-screening baby.

Welcome Oliver, the first baby ever produced using Array Comparative Genomic Hybridisation (Array CGH), a new technique that allows doctors to check eggs for chromosomal defects before fertilization. Chromosomal aberrations in embryos are responsible for a lot of miscarriages and failed IVF attempts and they are mainly due to defects in the eggs.

During Ovulation

The egg has to discard duplicate copies of its chromosomes to give space for sperm chromosomes during fertilization. The discarded chromosomes are contained in a small cell called a polar body. Sometimes, something goes awry, producing an egg which has too many or two few chromosomes. Down’s Syndrome or trisomy 21 is due to an extra 21 chromosome in the fertilized embryo. About 50% of female eggs have defective chromosomes. This increases dramatically as the woman gets older and could be up to 75% by the time she reaches 39.

In an IVF cycle, embryos are pre-screened before implantation, usually through visual screening under the microscope. However, this pre-implantation screening method does not seem to increase IVF success.

Array CGH

Array CGH performs an “inventory” of the chromosomes in the polar body in order to determine whether the egg has the right number of chromosomes. The test takes 1 to 2 days to complete. By pre-screening the eggs before fertilization, only viable, chromosome defect-free embryos are implanted. The chances of success during an IVF procedure are increased two- fold. What is interesting is that the scientists who develop the method reported that healthy, defect-free eggs are not necessary the “best looking” when viewed under the microscope, casting further doubt on visual egg screening.

Strictly speaking, Oliver is not the first baby to be conceived pre-screened. However, other babies born using similar techniques developed from frozen embryos. In Oliver’s case, using the new technique, the egg was screened, fertilized, and implanted within 48 hours, skipping the cryopreservation step.

Oliver’s mom is 41 years old and is of advanced maternal age through no fault of hers. She had three miscarriages and 13 failed IVF attempts. Late last year, the doctors screened 8 of her eggs using, Array CGH and only 2 were found to be normal. One of those eggs was fertilized, implanted and produced Oliver. I remember writing a post about this technique and her story in January when she was still in her 2^nd trimester. I’ve been wondering all this time how it worked out and now I’m glad to bring you this update.

The Ethical Issues

As usual, in such cases, there are always ethical issues to deal with. For the pro-life advocates, a human embryo represents life, with or without chromosomal aberrations. Do we have the right to choose? Do we have the right the screen? Is this assisted evolution, favoring the strong over the weak? Others would even venture to criticize: why waste so much time and money on IVF? Why not adopt?

I am pretty sure that for Oliver’s mom, what matters most is that she finally got her wish – her very own baby. After all she’s been through, she must be ecstatic to finally have Oliver, who was born two months ago. Only another mom can understand how she feels.

Oliver is the first but he won’t be the last. With his birth, many wanna-be moms’ hopes have been rekindled. All the best for Oliver and his mom.

Almost three years ago, Maria del Carmen Bousada gave birth to twins, setting the record as the oldest mother ever at age 66. This record was broken by Rajo Devi Lohan of India last year who gave birth for the first time at the ancient age of 70. However, Bousada is still the oldest mom to ever give birth to multiples until she passed away earlier this week at the age of 69, leaving her 31-month old twin boys orphans.

In Vitro Fertilization Aided the Late in Life Conception

Bousada has never been married and got pregnant through in vitro fertilization using an unknown donor’s sperms. She reportedly spent all her life savings and even sold her house in order to pay for the fertility treatments. The IVF procedure was performed in Los Angeles where she supposedly lied about her age. Many countries, including the US, have set a maximum age limit for women who want to go through IVF but some don’t.

Bousada’s case will surely spark up the debate of the ethics of having children so late in life. While proponents of the issue argue for freedom of choice that science has enabled us, its opponents question whether it is fair to have children and put them at risk of being orphaned at an early age. One can say that Bousada’s story has proven the opponents right. Earlier this year, a 65-year old British woman created a furor when she decided to have a child and had fertility treatments in an eastern European country.

What Happens to the Children?

Sources told CNN that the children are being well taken care of by a nephew of Bousada. One source (a neighbour) told CNN that “God didn’t let her enjoy her children very much. He should have given her more time.” But what about the kids? They, too, didn’t have much time with their mom. It is sad, but they will barely remember her when they grow up to be adults.

Great Britain is trying to come to grips with the extremes of parenthood – first the 13-year father (Alfie) and now the 66-year mother Elizabeth Adeney.

Elizabeth shocked the country when she decided to have a child at the advanced age of 66 – when most women of her age are easing into retirement and coping with the empty nest syndrome. Apparently for the successful career woman, nesting has just started. She reportedly has already delivered her son on Tuesday this week by C-section. Her case highlights the controversies surrounding assisted production, medical tourism, and the laws governing these. Apparently, Elizabeth had in vitro fertilization outside the UK where the age limit is 50. Should her act of circumventing the law through medical tourism be considered illegal? Elizabeth reportedly received hate mails about her decision to have a child.

Elizabeth’s case brought out the question as to when is a mother too old to have a child?

For many people, the answer is clear – the biological clock decides. There are others, however, who believe in taking advantage of what science has to offer. After all, even in the Bible, there is the case of Sarah who delivered Isaac at the very ripe age of 80+.

Many people are also bringing up the gender question – when is a father too old to be a father? Think of Anthony Quinn, Larry King, and J. Howard Marshall. Is anybody complaining at all?

What do you think? When is it too old to have a child?

What happens when you are down to your last embryo and your chances of producing more are slim? This is a question facing many parents who are undergoing IVF. And this Greek fertility expert seems to have found a solution – artificially split up the embryo. In the process, Karl Illmensee, laboratory director at the Genesis Fertility Center in Patras, Greece, is creating twins and multiples in the lab.

Monozygotic (identical) twins and multiples are produced when an embryo spontaneously splits to produce several identical embryos. Illmensee does this manually. He claims that by splitting high quality embryos at the 6-to-8 cell stage, viable twins can be produced.

The success of an IVF cycle can depend largely on the number of embryos implanted. This technique can give couples who have a short supply of embryos higher chances of getting pregnant.

As expected, this technique is embroiled in controversy. Two main questions crop up: Is it ethical? Is it safe?

Is it ethical? After claims of human cloning, or performance of IVF on a 70-year-old woman, the ethical question in this issue seems pretty tame.

I am more concerned about the safety of the technique. Would the babies be healthy? Multiple pregnancies as such as associated with a high potential for genetic aberrations plus pregnancy complications that can threaten both the mother and the unborn children.

Illmensee counters objections by saying “splitting one embryo into two or more embryos could serve the needs of infertile couples in several ways. As long as a couple is fully informed of the risk of such an outcome, there would appear to be no major ethical objection.”

She is 70 years, cannot read nor write but she holds the record of being the oldest first time mother in the world. According to Randeep Ramesh of The Guardian, this biological wonder came about through the fusion of social taboo and science.

By social taboo, Ramesh was referring to childlessness, by science to in vitro fertilization (IVF).

In her community, Rajo Devi Lohan has been living a life of shame and anguish because she and her husband couldn’t bear children. When a neighbor who could read told them about the “miracle medicine” that enables event postmenopausal women to conceive, the couple entered the world of assisted reproduction technology. By selling all that they have (2 buffalos) and taking loans and mortgages, the family managed to raise 175,000 rupees (£2,500) for the IVF procedure which was conducted in a town just 30 miles away.

There were some age-associated barriers to overcome. Lohan couldn’t produce eggs anymore so an egg was purchased from a local donor. Her husband Baba’s sperms were unable to penetrate the eggs, so it has to be directly injected. The resulting embryo was implanted and resulted in a baby girl delivered in November 2008.

India is making headlines as a favorite destination in the medical tourism industry and assisted reproduction is one of the most common procedures involved. India’s success is due to the fact that there are no guidelines that regulate the maximum age of the mother or the maximum number of embryos to be implanted. As one IVF doctor was quoted as saying “moral questions about rights and wrongs do not delay us.” India’s culture focuses more on the social stigma of infertility and the mother’s right to produce children. Less consideration is given to the rights of the child.

Earlier this year, there was a controversy about a 60-year old woman who circumvented the IVF age limit in Canada by having the procedure done in India but delivered her twins in Canada.

For the oldest mother, the way ahead is clear. She plans to breastfeed her baby for at least three years and then give IVF another try. Hopefully, it will be a boy the next time around.

Ranjit Hayer is 60 years old and is one of the oldest women to give birth, definitely among the oldest in Canada, and certainly as a mom of twins, according the CBC Canada. After several decades of trying to conceive, her patience finally paid off in double dose and delivered twins earlier this week.

Ranjit has been through several miscarriages and even an IVF scam. She and her husband were originally from India.

Ranjit’s case put fuel into the ongoing ethical debate about IVF treatments. In this case, the ground for objection is Ranjit’s advanced age. The cut off age for IVF treatment in Canada is 45 to 50 years old. Because of her disqualification due to her age in Canada, Ranjit went to India to have the IVF procedure done using donor eggs. She was initially pregnant with triplets but lost one embryo. However, she came back to Canada to deliver in Calgary.

With advancing age, pregnancy becomes more difficult and riskier. Ranjit suffered from gestational diabetes and hypertension, as well as placenta previa. She had hemorrhage in her 7^th week of gestation and her twins were delivered by emergency C-section. The babies are doing well but one baby needs breathing assistance and the other is in a special neonatal care unit. The mother had severe bleeding that led to the removal of her uterus as well as blood transfusion and a stay in an intensive care unit..

Many critics are objecting to the fact that people like Ranjit are circumventing the cut off age under Canadian law by having IVF outside the country but still the Canadian health care system has to bear the burden of the costs of prenatal complications as well as the postnatal and neonatal care.

Aside from pregnancy complications and the costs, there are also the social, psychological and financial implications of people close to retirement age still having to raise children to adulthood.

The IVF-at-any-age issue is a very difficult and sensitive topic. On the one hand, technology offers people the possibility of fulfilling their wish for children. On the other hand, at what price and how would it affect the children?

What do you think?

A new technique that rapidly screens for genetic abnormalities in IVF embryos has borne fruit. A 41-year old woman in the UK is pregnant using this technique after going through 13 unsuccessful IVF cycles, according to Nature News.

The array comparative genomic hybridization can now screen rapidly eggs which are not deemed viable due to chromosomal aberrations and other genetic abnormalities.

In the process of in vitro fertilization (IVF), several embryos are produced in a dish. However, many of these embryos are not viable because of genetic abnormalities coming from the eggs. That is why the success rate of IVF is low. To compensate for this uncertainty, multiple embryos are implanted and many others are frozen as “reserve” embryos for another IVF cycle in case the current cycle is not successful.

The new technique offers the following advantages:

• Only viable embryos need be implanted.
• Only embryos which are viable need to be frozen, thus reducing the number of left over embryos and the problem of disposition.
• It lessens the necessity of implanting multiple embryos and thus the likelihood of having multiples.
• The success rate of IVF is doubled.

Using this new technique, 2 out of 8 eggs removed from the pregnant woman proved to be chromosomally complete while the other 6 were not. These two were fertilized and implanted. One embryo successfully survived and the baby is due in spring.

Interesting, the viable eggs were not the best looking of the lot, thus casting doubt on the current practice of manually screening eggs under the microscope based on their appearance. The new DNA screening technique takes 1-2 days to complete.

It seems that the UK is far ahead in IVF technology. The first IVF baby was born in Britain 30 years ago. Just last week, the first IVF baby preselected as breast cancer-free was born, also in the UK.

What would you do if you wanted a baby, but all your husband’s female relatives had suffered from breast cancer, the kind that doctors knew was caused by a faulty gene?

A controversial egg selection technique selection has resulted in the first baby girl born in the UK this week that doctors know is free from breast cancer genes. Women with either of the genes, called BRCA1 and BRCA2, are seven times more likely to get breast cancer – that means that 60% of women who have either BRCA1 or BRCA2 will get breast cancer in their lifetimes.

The faulty genes cause around 10% of breast cancer cases, and are carried from generation to generation, which is why the parents of the baby girl chose to have doctors screen and select an embryo that was free from both genes.

Doctors in London used in-vitro fertilization techniques to fertilize 11 of the mother’s eggs with the fathers sperm, and then let the eggs develop for several days. When the embryos were several days old, one cell was removed from each and tested for the BRCA1 and BRCA2 genes. Six of the eggs tested positive. Two of the five remaining eggs were implanted, resulting in a single pregnancy and a healthy baby girl.

The fertility doctors haven’t released what happened to the six embryos that tested positive for the breast cancer genes, but it’s likely they will be destroyed or used for research.

Genetic screening is only legal in the United Kingdom to screen for genetic diseases. It’s been used for diseases like Huntingdon’s Disease and Cystic Fibrosis, conditions for which if a baby has the gene, it will certainly get the disease.

Having the breast cancer gene doesn’t necessarily mean that a woman will get breast cancer, and if she does, it has the potential to be cured. And not having the breast cancer gene doesn’t mean that a woman will never get breast cancer, since the other 90% of non-genetic breast cancer cases don’t have a known cause.

It’s less of an ethical dilemma to select embryos to avoid a fatal genetic disease that all carriers of the gene will die from. But is it ethical to select embryos to avoid the breast cancer gene?

The numbers are staggering- 500,000 -that’s half million – embryos are currently stored in deep freeze in the US, waiting for a decision that is not so easy to arrive at.

In the majority of IVF treatment cycles, several embryos are frozen as “back up” in case the current cycle doesn’t work. Some speculate that frozen embryos are healthier than the fresh ones. But those who succeed in having children through this method are only too happy they don’t have to go through it again. But what happens to the left-embryos?

A recent survey of over 1000 fertility patients by Duke University researchers show that there is no clear answer to this question. Many patients try to put off the decision as long as possible by keeping the embryos frozen indefinitely, mainly for lack of acceptable options.

The survey presented the respondents 4 disposition options, namely:

1. thawing and discarding
2. reproductive donation
3. indefinite freezing
4. donation for research

The first three seems unacceptable where as the majority (60%) would actually go for the 4^th option. However, the laws of many states in the US actually do not allow this. Currently, a law that would consider an embryo as complete human being is being lobbied; if passed, frozen embryos might be put up for adoption or become “wards of the state.” This is an option that most parents aren’t prepared to accept.

In another study, two other options were presented, which are somewhat acceptable to those concerned, namely:

1. Implanting the embryos in the mother’s womb at a time when she is infertile
2. Ritual disposal ceremony, somewhat equivalent to a funeral

However, not many fertility centers offer such options. In fact, many do not offer any disposition options at all.

For those of you who are considering IVF, be sure to inquire about the embryo disposition options and policies of the fertility clinics before you choose.

If yourwere in these peoples’ situation, which option would you go for?

Here are some troubling study results that bring bad news to both parents and doctors who had anything to do with assisted reproductive techniques – babies born via in vitro fertilization (IVF) have 2 to 4 times higher likelihood of having birth defects compared to babies conceived naturally, according to an article in the New York Times.

Now, before you start panicking, there are some limitations to the study mainly:

• The study only looked at singletons, not multiples.
• The study only looked at babies born via IVF, i.e. fertility treatments that involved handing the eggs and the sperm in the lab, but not babies born through other types of treatment.
• The birth defects in question – cleft lip and cleft palate and abnormalities in the heart, esophagus or rectum – are very rare conditions, so that despite the increased likelihood, the risk is still low.
• The study only compared 281 IVF-assisted births vs 14,085 natural births, thus making its statistical power a bit suspect.
• The study observed an IVF-birth defect link but could not explain the mechanism behind the link.

The article moved on to give us the following statistics:

• 52,000 babies were born via assisted reproduction in the US in 2005.
• 12% American of women ages 15 to 44 years seek fertility treatments.

Conclusions of the experts? Maybe. But larger studies are needed to confirm the results before doctors and parents should start worrying.

On June 29, 2008, the world?s first ?pregnant man? gave birth to a baby girl. Ever since then, Thomas, Nancy, and Susan Beatie have lived in seclusion, refusing media appearances, and quite a bit of money, in order to be a normal family. But in Thomas?s own words, “Hiding a pregnant man is like hiding an 800-pound gorilla.” And now that the couple is expecting their second child, they decided to speak with Barbara Walters.

Once a teen model and beauty queen (as a finalist for Miss Teen Hawaii USA), Tracy never felt comfortable in her body. Beginning in 1998, she underwent gender transformation. First she took injections of testosterone, then she had her breasts removed. Though she never had phalloplasty (surgery to create male genitalia), nor had her female reproductive organs removed, Tracy was legally declared male, and changed her name to Thomas.

In 2003, Thomas married his long-time partner Nancy. And soon, as with many couples, they decided to have a baby. Since Nancy had had a hysterectomy, the couple decided that Thomas was the best surrogate they could possibly have. Although they were rejected by nine doctors for fertility treatment, the couple managed to inseminate Thomas without medical assistance, using donor sperm and an animal syringe.

After the delivery, the Beaties faced unusual issues when it came to identifying the baby?s parents on her birth certificate. But despite the challenges, and a few death threats, Thomas stayed off of testosterone so they could conceive again. Now in his first trimester, Thomas says he is healthy and feels good. The baby is due next June. Their announcement of baby #2 coincides with the release of Thomas?s book Labor of Love.

This is a weird one for me to wrap my brain around. Of course, it?s difficult for me to truly consider anyone male without a Y-chromosome. So in that respect, ?he? is really just a pregnant woman. Yet the state where they live recognizes Thomas as legally male, and their marriage as heterosexual. It just happens that Dad carried and delivered the baby. The Beaties insist they are a normal family. What do you think?

IVF babies which developed from frozen embryos are much healthier compared to those which developed from fresh embryos. This is according to three different studies in three different countries in three continents, as reported by several news dailies, including the British paper The Herald.

Study #1:

A Finnish study observed that babies from fresh embryos have 35% and 64% higher likelihood to be premature and have low birth weight, respectively compared to babies from frozen embryos.

Study # 2:

A US study did a similar comparison and found that babies from frozen embryos are 51% more likely to have low birth weight and 15% more likely to die.

Study # 3:

A similar comparative study in Australia gave the following results:

• Low birth weight – 11% (fresh embryos) vs 6.5% (frozen embryos)
• Prematurity – 12.3% vs. 9.4%
• Mortality – 1.9% vs. 1.2%

All three studies were presented at the 64^th American Society for Reproductive Medicine conference in San Francisco which runs from November 8 to 12.

The reason why frozen embryos produce fitter and healthier babies is not so clear. However, it is known that the success rate of IVF using frozen embryos is much lower than success rate using fresh embryos. It may be possible that the unhealthy frozen embryos do not survive beyond the implantation stage, leaving the fittest and the healthiest to survive with good outcomes. Other experts believe that there may be subtle biological reasons that are not yet fully known.

In any case, these developments are of particular interest for people who are considering to undergo IVF.

Canadian fertility experts have released guidelines regarding the number of embryos to be transferred during an in vitro fertilization (IVF) cycle. The guidelines were jointly published by the Society of Obstetricians and Gynecologists of Canada and the Canadian Fertility and Andrology Society.

IVF is a very tricky process. In order to increase the likelihood of success, several embryos are transferred to a woman’s uterus. However, this also increases the chances of having a multifetal pregnancy.

The purpose of the guideline is to minimize multiple, especially high-order multiple pregnancies without necessarily lowering the success rate of IVF. The experts based their recommendations on a thorough study of medical articles published between 1990 and April 2006.

In recent years, the rates of multiple births have risen. I am not one to complain. I feel lucky to have had twins. However, multiple pregnancies, especially high-order multiples (e.g. 3 babies or more) can pose risks both for the mothers and the babies.

Here are some of the recommendations:

• 1 fresh embryo for women under 35 years old with “excellent” prognoses and 2 fresh embryos for those with less than excellent prognoses.
• A maximum of 3 embryos for women 29 to 38 years old
• A maximum of 4 embryos for women 39 years old and older.

The guidelines are published in the September 2008 issue of the International Journal of Gynecology & Obstetrics.

An unnamed 59 year old Frenchwoman, of Vietnamese origin, gave birth to triplets on Saturday night. After seeking in vitro fertilization (IVF) in Vietnam, the woman delivered two boys and a girl by cesarean at a Paris hospital. According to a spokesman, ‘everything went smoothly.’ The babies are healthy, weighing between 4 lbs 9 oz and 5 lbs 5 oz. No further details have been released yet.

There is obvious controversy surrounding this announcement. In France, the maximum age set by most clinics for a woman to participate in IVF is 42. In Vietnam it is 45. According to French media, it is illegal to provide fertility treatment to a woman past natural childbearing age. And according to at least one spokesman for the Catholic church, it is wrong. Archbishop Andre Vingt-Trois said, ‘On this particular point, scientific progress is not good for mankind.’ But she is not the first, nor the oldest, Frenchwoman to have accomplished this.

A baby was born in 2001 to a 62-year-old. And a 70 year old Indian woman gave birth to twins after receiving IVF treatment.

I’m still on the fence about this. But I’m leaning toward thinking if a woman wants a child this badly, I believe she’ll probably do her best to be a good mother. The life expectancy for a Frenchwoman, according to the CIA World Factbook, is 84. So it’s not like she won’t be able to see the children grow up. And I have had several close friends and a family member go through the pain of infertility, so I understand why couples pursue IVF, though I don’t think I’d do it myself. I’m not sure why a country would even have laws about how young you have to be to get pregnant. I also don’t agree with the Archbishop who thinks it’s bad for mankind.

For my part, I just don’t know why anyone would want to have a baby at that age. I’m feeling too old sometimes for my 5-month old, and I’m ‘only’ 35. My OB told me there was still plenty of time to have babies, but I think he must be working on job security. Because, as long as I have a say about it, I’m done.

Last July 25, Louise Brown, turned 30. The day was marked as a major milestone in science and medicine. You see, Louise is the first test tube baby ? the first ever person born through in vitro fertilization (IVF).

Assisted reproduction technology (ART) has come a long way since 1978. Women of menopausal age can now carry and deliver babies. Surrogate mothers or ?wombs for rent? enables women who have undergone hysterectomy to have biological offsprings. Preimplantation genetic diagnostic screening enables parents to screen their embryos for genetic diseases and gender. In April this year, the first ?man? became pregnant and delivered a daughter. So one may ask, where do we go from here?

The 17 July issue of Nature published a special report on ?Making babies: the next 30 years? and interviewed several reproductive medicine experts on what we can expect in the next 30 years. Some of the replies are given below:

• Low-budget IVF – Currently, an IVF cycle can cost thousands of dollars. For the lucky few, it can even be covered by health insurance. There are, however, many countries in this world where IVF is inaccessible financially. By streamlining the procedure and using low-cost drugs, IVF might soon be available to almost anybody.
• Gametes from skin cells – Last year, pluripotent stem cells have been developed from ordinary human skin cells [2]. Research is now being stepped on on the development of gametes from stem cells [3], mainly because of the scarcity of egg donors as well as the legal restrictions associated with egg donations [4]. If this happens within the next 30 years, anybody ? and I mean anybody can have biological offsprings ? and infertility will be a thing of the past.
• Genetic banking – This is the storage of young, healthy cells of people before they start aging and accumulate genetic errors. These cells can be used as ?genetic cassettes? that can be used to correct aging-related errors.
• Artificial wombs – Some researchers are working at the other end of the process ? at delivery. In recent years, premature infants born as early as the 22^nd week of gestation period have been known to survive. The idea of an artificial uterus to carry an embryo to full term is not so far-fetched but can have a lot of ethical and legal implications.
• Cloned babies – According to one expert, reproductive cloning is not that far away although there is no need for it medically.

Louise Brown was a great milestone in science. So was Dolly. I think we can expect great things from reproductive medicine in the coming 3 decades. Maybe even terrible things. But great.

References

1. Nature 454, 260-262 (17 July 2008)
2. Science 318, 1917 – 192021 December 2007
3. Nature 452, 913 (24 April 2008)
4. Nature 453, 828-829 (2008)

A few months back, I posted a list of 10 most common questions that a mom of twins gets to hear. I’ve been meaning to go through the list of questions but somehow there were other more interesting topics to write about.

A recent post by Mrs H on Lisa Marie Presley expecting twins sparked my interest again in the issue and I feel it’s now time to tackle question # 10 – Are they IVF babies?

As Mrs H has written

“If not for multiples running in the family.. I’m sure conjectures regarding IVF would be swirling by now.” And she’s right.

In the same way, in last week’s People magazine exclusive interview with Angelina and Brad, the topic of IVF also came up in connection with their twins.

Believe me, it’s not only celebrities who are confronted with this question.

Now I know statistics show that the rate of twinning and having multiples has increased in the last decade or so and this has been attributed partly to assisted reproduction technology. But not all twins and multiples are conceived through IVF. There were twins before the first IVF baby was born and there will always be. And take note – there are many IVF babies out there who are singletons. Do they get scrutinized like twins and multiples? No way!

For me, this is the most stupid and offensive question to come from strangers and casual acquaintances. For one thing, it’s a very personal question and asking it amounts to invasion of privacy. In many cultures and for some people, fertility is a very sensitive issue and unlike Brad and Angelina, some people wouldn’t be “happy to discuss it.” That includes me. Rant over .

On Friday, July 25th, Australian courts ruled that the unnamed Lesbian couple who underwent In-vitro fertilization (IVF) treatment for one baby and instead got two, had no valid claim and dismissed the case. The controversial lawsuit has sparked outrage amongst many in Australia, with the couple, who insist that the unplanned twin birth had affected their relationship negatively, asking for $400,000 from the doctor who had implanted not one but two embryos.

Most of Australians who learn about the lawsuit are overwhelmingly against the couple, and has convinced others even more that homosexual couples should not be allowed to undergo IVF procedures.

The Lesbian couple, who to this day remains anonymous, have issued a statement that states their love for their twin daughters, now 4 yrs. old. The statement also clarifies that their lawsuit was about the negligence of their obstetrician in implanting two embryos instead of one.

What do you think of this lawsuit? Are you glad it was overturned, or did you think the couple had a valid claim?

July 25th – 30 years ago from today, the first IVF baby was born in Britain. Louise Joy Brown was called the first “test tube baby”, a term that is today considered to be politically incorrect. We’ve come a long way in 30 years. Since then, millions of babies have been brought into this world using assisted reproduction technology (ART). Through ART, we have witnessed postmenopausal women delivering babies, young women earning bucks as “wombs for hire“, and very recently, the first “pregnant father” gives birth to his daughter.

Assisted reproduction has become a billion-dollar service industry. The question is, where does it go from here?

In its July 16 online issue, Nature magazine asked several IVF experts of their expectations for the next 30 years. And their answers range from the hopeful – total eradication of infertility, higher embryonic survival – to the scary – cloning and 100-year-old mommies.

So where is Louise Brown now? She can be seen in this BBC video clip. Louise tells of her life being always the attention of the media. As a child, she was also asked by total strangers bizarre questions like how she could fit in a test tube. Her mom tells about her ordeal of being chased by reporters during her pregnancy. Nowadays, IVF is a routine procedure nobody pays attention unless a celebrity is involved.

Louise conceived naturally and gave birth to her son Cameron who is now 18 months old.

Sources:

Nature 454, 260-262 (2008)

BBC 14 July