Single mothers with egg donation
By Giuliana Baccino, PhD Fiv Madrid Clinic
In 1978, Louise Brown was born, first child product of in vitro fertilization (IVF). Since then, more than five million children have been born by assisted reproduction treatments (ART), some using eggs and sperm from the patients themselves and others with donated gametes. This high number of births has led to numerous studies that explore different aspects of the development of children: cognitive, neuromotor, behavioral, affective, among others. Studies have been mainly conducted with children product of ICSI.
ICSI (intracytoplasmic sperm injection) is one of the laboratory techniques used to generate embryos and consists of a manual injection of a single sperm into the egg, unlike IVF (another laboratory technique) which allow several sperm near the ova waiting for the best to get in. Both procedures are carried out in a laboratory, but one is more intrusive than the other.
For this reason, the indication to carry out an ICSI, the safety and potential risks to the newborn, have been and continue to be, the subject of many debates. Some authors suggest that the diseases or complications that may present children born of IVF or ICSI are not necessarily due to the technique itsef, but to the reproductive problems of their parents, some directly related to age (Pinborg et al. 2013, Alastair and Ludwig, 2007).
Therefore, we could say that one of the reasons associated with newborn complications is that related to maternal age, which in many cases coincides with the age of the egg. That is, when a 40-year-old woman chooses to have the possibility of having a child genetically linked to her, she must also be aware of the genetic risks to the child.
The incidence of fetal malformations and chromosomal abnormalities increases with maternal age. For example, the incidence of Down syndrome at 20 years of women is 0.08%, however for a 39-year-old woman, it is 1%, at 40 years, 1.2% and at 45 years, 4.5%.
At present, an obstetric screening for detecting these anomalies is done. For example, in case you do not want to continue the pregnancy if you have a malformed fetus, the alternative is abortion. After an abortion, many women can not even think of repeating that experience so painful. In these cases, the completion of a pre-implantation genetic diagnosis (PGD) or egg donation, reduce the risk of birth malformations.
Consequently, one of the possibilities to reduce these risks if you make an ART is to use donor eggs, that is to say, not be genetically related to the child, with the advantage that the child has less risk to suffer some complications of advanced age of the egg.
However, the use of donor eggs is often seen as the last option. Women would rather have a child genetically linked to them, so that they can fully see their dream come true: having a child who also resembles them physically, among others things.
When a pregnancy is not achieved spontaneously, having to resort to an Assisted Reproduction Clinic to have a child is undoubtfully a source of stress. This desire of expectant mothers should not be seen as a whim but as a choice difficult to rule out when there are chances of pregnancy, although these are minimal. In turn, the society in which we live does not help these mothers choose more easily by using donor eggs. A person will quickly accept a donation of blood or bone marrow to save life, but when the donation brings transmissible genetic load, it is another story.
Moreover, neither the use oef donor eggs is the panacea. There are many factors that must be evaluated, for example, the child will not have the possibility to physically resemble his mother, he will not be able to know the identity of the donor, his mother will have to mourn genetic untying to her son and accept that she will not transmit to her son many things that could be transmitted genetically.
Added to this, we find the economic factor, no less important. Having to resort to an ART to have a child is very often related to economic investment. At times, this investment can only be done once, because many people can only afford one or two cycles. Therefore, the decision of a woman over 40 and under these economic circumstances should also have in mind the economic factor related to the treatment.
The key to the decision is reflection together with a professional who can guide the patient towards what the best would be for her particular case and what mourns should she take to reach a safe and thoughtful decision. The question should be: shall I take the risk of having a child genetically related at an old age or shall I choose to use donor eggs and renounce genetic link?
It is not a quick or easy question to answer, and it must of course be asessed on a cost-benefit analysis emotional, physical and economic which derive from the complexity of having a child with an ART at an advanced maternal age.