Third Party Reproduction (TPR)

Kemi Ailoje

Assisted Reproductive Technology (ART) seem to have an answer to every problem regarding infertility, irrespective of the causes, duration of infertility and the age of the couple trying to achieve pregnancy. With current trends in the management of infertility, questions like am I too old to ever get pregnant? Can I ever have my genetic baby since my womb or ovaries have been removed? Can we ever be parents since the Doctor said my husband has no sperm? On and on the questions could go and this brings us to this very interesting topic today:  Third Party Reproduction.

Third Party Reproduction also referred to as Donor Assisted Reproduction, is the term used to describe any human reproduction in which DNA or pregnancy is provided by a third party or donor, other than the two parents (intending parents), who will raise the resulting child. 

Third party reproduction goes beyond the traditional mother-father model; the third party involvement is limited to the reproductive process and does not extend into raising the child.

Third Party Reproduction can be applied to: (i) egg donation (ii) sperm donation, (iii) donor embryos that have been donated by a third person (donor) to enable an infertile individual or couple (intended recipient) to become parents (iv) embryo adoption (v) mitochondrial donation: a special kind of IVF procedure in which the future baby’s Mitochondrial DNA comes from a third party. A very useful technique used in cases where mothers have mitochondrial diseases; (vi) use of a Gestational Carrier or Host. A gestational carrier is an individual who carries a pregnancy for an infertile couple or an individual. Gestational carriers are not biologically related to the intended parents or child. (vii) a combination of one or more of the above listed.

What is a Donor Treatment?

A donor treatment is where gametes, i.e. sperm, egg, or embryos are provided or “donated” by a third party for the purpose of a third party reproduction. That is: Donor eggs with own sperm, Own eggs with donor sperm, Both egg and sperm from donor (third party), and Embryo donation and adoption. 

Egg donation: A donor provides the ova (egg) to a woman or couple in order for the egg to be fertilised and embryo resulting transferred into the recipient woman, for implantation to take place. Embryo donation is where extra embryos from a successful IVF of a couple are given to other couples or women for transfer using donor eggs and sperm, or in some cases donor eggs and donor sperm. It may thus be seen as a combination of sperm donation and egg donation, since what is donated is a combination of these. Such embryos may also be donated to a “commissioning” couple and gestated by a surrogate where, for example, the “commissioning” woman or the woman of the “commissioning” couple is infertile and is unable to bring a pregnancy to full term on grounds, or is unwilling for social, medical or other reasons, to do so.  

Sperm donation: A donor provides sperm in order to father a child for the third party female.

Embryo donation: The use of embryos which were originally created for a genetic mother’s assisted pregnancy. Once the genetic mother has completed her own treatment, she may donate unused embryos for use by a third party. It can also be a case where embryos are created using donor sperm and donor eggs.

Embryo adoption: Embryos created during a donor assisted pregnancy are adopted to be transferred in a third party recipient with the aim of achieving implantation and successful pregnancy.

Surrogacy: An embryo is transferred into the womb of a third party (traditional surrogacy) or a woman is inseminated in order to gestate a child for a third party (straight surrogacy).

It includes all situations where a surrogate carries a pregnancy for another person. Recently, there has been tendency to separate the gestational carrier situation from the “true” surrogate restricting the term for a woman who provides a combination of ovum donation and gestational services.

In conventional surrogacy: A surrogate agrees to be inseminated with the sperm of the male partner of the commissioning couple. The surrogate conceives and hands over the baby at the completion of the pregnancy. In this case, the eggs, which is fertilised is therefore that of the surrogate. 

In gestational surrogacy: A surrogate agrees for embryos to be transferred into her uterus, for the purpose of implantation. Such embryos may have been created either by use of egg donor or the egg of the commissioning woman; the egg may have been fertilised using donor sperm or sperm from the commissioning father, also the commissioning mother may be a single woman and may be using her egg or the donor egg.

Surrogacy tourism has become an industry in itself with wealthy couples travel to different places such as India and Thailand to hire surrogate mothers to carry their children for them until the recent ban on commercial surrogacy in India.

While some surrogate mothers agree to carry another couple’s child for what they consider to be altruistic (volunteer/humanitarian) reasons, the more common motivation is the financial incentive that couples desperate to conceive a child can offer. Monetary compensation is therefore a powerful incentive in surrogacy.

If the intended parents’ circumstances change during the surrogate pregnancy or if the child is born with health problems or disabilities, the infants may be left to the surrogate or abandoned. Intended parents may find that they face unplanned financial costs and inadequate legal protections.

Who could benefit from third party reproduction?

Couples whose cases involve any of the following may be candidates for third party reproduction.

Females with: 

.Age related diminished ovarian reserve (resultant effect on poor quantity and quality of eggs), Premature ovarian failure due to the following- Autoimmune disorder, Chemotherapy or radiation therapy, and Genetic, Environmental or Unexplained causes.

.Surgical menopause

.Natural menopause

.Genetic mutation or diseases

.Surgical removal of the uterus(womb) e.g. due to multiple fibroids etc.

.Other medical conditions e.g. severe Asherman’s syndrome, multiple miscarriages, repeated IVF failure, etc

 

Males who:

. Have had a vasectomy (by surgical removal or sealing of the Vas deference, a means of sterilisation)

. With irreversible sterility from any cause

. Who have a problem with ejaculation that cannot be overcome by current technology

. Male with undescended testis

. Male with anti-sperm antibodies (means the man’s immune mistakenly targets and destroys its own sperm)

 

Couples: 

. With anatomical abnormalities

. Genetic alterations

. Reproductive incompatibilities problems

. Unhealthy lifestyles etc.

Third party reproduction procedures can involve as many as five people: sperm donor, egg donor, gestational carrier, and intended parents, it is therefore important for intending parents to secure their parental rights and make sure they are protected by ensuring  appropriate ethical, confidential , medico-legal agreements are duly consented to and signed to before the process is started to avoid future pitfalls  and conflicts by all parties concerned.

Third party reproduction no doubt remains a viable method of having children by intended parents and has been done successfully over the years in Assisted Reproductive Technology /Assisted Conception processes, and couples who require these services need to access them after proper counseling.