Principles of Oocyte and Embryo Donation

427 Pages·2013·4.752 MB·English

by  Mark V. Sauer M.D. (auth.), Mark V. Sauer (eds.)

Mark V. Sauer
Editor
Principles of Oocyte
and Embryo Donation
Second Edition
123
Principles of Oocyte and Embryo
Donation

Mark V. Sauer
Editor
Principles of Oocyte
and Embryo Donation
Second Edition
Editor
Mark V. Sauer, M.D.
Department of Obstetrics
and Gynecology
College of Physicians and Surgeons
Columbia University
New York Presbyterian
Hospital-Columbia University
Medical Center
New York
NY
USA
ISBN 978-1-4471-2391-0 ISBN 978-1-4471-2392-7 (eBook)
DOI 10.1007/978-1-4471-2392-7
Springer London Heidelberg New York Dordrecht
Library of Congress Control Number: 2013933716
© Springer-Verlag London 2013
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Foreword to the 2nd Edition
This second edition of Principles of Oocyte and Embryo Donation , published
15 years in the wake of the fi rst, is timely and welcome. The volume chroni-
cles more recent stages of a scienti fi c saga that began over 25 years ago when
in 1984 the fi rst oocyte and embryo donation births were reported [1, 2].
Though the fundamental science was sound, the fi rst births came only after
researchers overcame technological limits of the time and excruciating public
and private skepticism. Thus, the fi rst edition in 1997 chronicled the initial
investigational and early clinical phases of oocyte and embryo donation.
Today, after hundreds of thousands of healthy newborns, the paradigm is
mainstream. This new volume describes a very different scienti fi c landscape,
where oocyte and embryo donation has been enhanced by novel and sophis-
ticated laboratory embryology, cryobiology, molecular genetics, and more
ef fi cient clinical protocols. Success rates have increased. Public acceptance is
improved. More diverse applications have been exploited. Today, fresh and
cryopreserved oocyte and embryo donations comprise well over 10 % of the
IVF cycles and births recorded in the United States by the Center for Disease
Control statistics.
As editor, Dr. Mark Sauer assembled an outstanding panel of expertise for
this multiauthored work. That expertise begins with Dr. Sauer himself, cer-
tainly among the most experienced and highly published fi gures on the fi eld
of oocyte and embryo donation. His participation in the fi eld began with our
UCLA team during the earliest days. His personal contributions include ini-
tial work on methods to synchronize and enhance the receptivity of the endo-
metrium. His work extended shortly thereafter to establish principles of donor
management, adapting the use of transvaginal oocyte retrievals for oocyte
donation performed by in vitro fertilization. He pioneered and memorialized
the principles and outcomes of oocyte donation to menopausal women of
advanced maternal age, and he has played a fundamental role in the setting of
good practice standards that have been adopted by widely recognized expert
panels and government agencies.
The heart of this book is the expert contributions. The fl ow of topics is
logical in that it begins as practical and ends in useful but futuristic, legal,
social, and theological esoterica. The authors are uniformly selected for their
expertise in this area, and the contributions are well edited. The topics begin
with the practical management issues. Thus, Part I begins with preliminary
considerations for patients and clinicians and includes the history of the tech-
nique by Dr. Sauer describing practical aspects of experience he lived through
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vi Foreword to the 2nd Edition
himself. It moves into the various indications for donor oocytes, the screening
and evaluation of donors and recipients, pregnancy rates, and genetic aspects
of donor selection. Part I I addresses the practical management issues and
reviews aspects of donor and recipient synchronization, the use of blastocysts
vs. cleavage stage embryos, techniques to minimize multiple gestations, out-
comes of supernumerary embryos, and ends with complex psychological
treatment of parties involved in third-party reproduction, as well as the medi-
cal legal issues. Part I II deals with of fi ce management and includes discus-
sion of the donor nurse coordinator, the fi nances of oocyte donation, and
insurance issues. Part I V , the new frontiers section, deals with oocyte and
embryo banking, gestational carriers, assisted reproduction in same-sex cou-
ples, and immunological consequences of oocyte and embryo donation preg-
nancies. Part V deals with regulatory issues, the FDA policies governing
reproductive tissues, informed consent, and statutory regulation of third-party
reproduction. Each contribution is clearly expert written and well edited.
Readers interested in or working with oocyte and embryo donation will
genuinely appreciate the care taken in the organization, expertise, authority,
and diversity of content ranging from total basic to technological and social
sciences. The work is a scholarly memorial to the continuing evolution of
oocyte and embryo donation and to the hundreds of thousands of children
born to otherwise impossibly infertile women as a result of it.
It is a joy to see this story unfolding in a book like Principles of Oocyte
and Embryo Donation . This book contains volumes of useful information
that will be highly appreciated by the many readers who will consult it.
Thank you, Dr. Sauer.
John E. Buster, M.D.
Professor of Obstetrics and Gynecology
Women and Infants Hospital of Rhode Island.
Warren Alpert Medical School of Brown University
Providence, RI 02905
References
Lutjen P, Trounson A, Leeton J, et al. The establishment and maintenance of pregnancy
using in-vitro fertilization and embryo donation in a patient with primary ovarian failure.
Nature. 1984;307:174–5.
Bustillo M, Buster JE, Cohen SW, et al. Nonsurgical ovum transfer as a treatment in infertile
women. JAMA. 1984;251:1171–3.
Foreword to the 1st Edition
This textbook deals with one of the most important aspects of assisted
conception today. Oocyte and embryo donation encompasses many of the
clinical, scienti fi c, and ethical problems in the fi eld. Oocyte donation, the
main theme in the book, demands an empathy with patients in the dif fi cult
situation of primary or secondary menopause or who have a severe genetic
disease that precludes using their own oocytes. Each couple searches for their
own solution to an intractable problem. Perhaps a sister or a friend will donate
an oocyte willingly and sel fl essly, or there may be no other recourse but to
hope for help from a stranger who may or may not be paid for her oocytes.
The donor must be prepared to forgo any right to a resulting child. Donation
requires counseling and advice to the couple and to the donor. Two cycles
must be balanced, in donor and recipient, to ensure synchrony between
embryo growth and a receptive endometrium in the mother, and to ensure that
all clinical and scienti fi c practices accord with state law. Fertilization and
embryo growth are watched closely by donors and recipients, within a frame-
work of a busy in vitro fertilization (IVF) clinic where hopes and fears are
high, and disappointment is, sadly, more often the outcome than pregnancy.
Success is wonderful, especially for patients who have been trying to establish
their pregnancy for many years and now fi nd themselves well past meno-
pause. In today’s world of science and medicine, their cause is not lost, for
they too have the chance of pregnancy.
All of this is the stuff of high emotions and expectations, ethics and law,
allied to fi rst-class embryology and gynecology. A book devoted to this topic,
and organized and edited by one of the world’s leading exponents in this fi eld,
would be expected to be comprehensive, realistic, and sympathetic to the
patients searching for help. Mark Sauer has led this fi eld from the front to
establish an authority second to none, and a glance at the contents is enough
to con fi rm that this book lives up to the highest of expectations.
The in-depth coverage of these chapters is provided through the fascinating,
detailed, and responsible contributions of many distinguished commentators.
No stone is left unturned in describing the search for happiness through
oocyte donation and the ethical, social, and legal challenges it has brought in
its wake. All this knowledge displayed so carefully, and compassionately,
makes me recall our earliest days in human IVF, when Steptoe and I debated
all the ethical issues that could possibly arise- cloning, sexing, surrogacy,
spare parts surgery, and oocyte donation- and also decided that the bene fi ts
overwhelmingly outweighed the risks. Today, many voices are heard on ethics
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viii Foreword to the 1st Edition
and law, and many countries have legislated strict or liberal laws in attempts
to regulate every possible aspect of this fi eld. My own opinion is that the ethics
of care should be paramount and raised above many of the other issues. We
have witnessed the application of too much written legislation in my country,
concerned with the destruction of many cryopreserved embryos and the with-
holding of a dead husband’s semen from his widow. We must accept a funda-
mental truth- that virtually all of our patients are searching for happiness, and
usually within a framework of love for a child and a partner. This book
addresses these issues dispassionately and provides much room for thought.
It will stand tall among the books published on the care and practice of
assisted conception, and especially among those on oocyte donation.
Robert G. Edwards, Ph.D.
Preface to the 2nd Edition
The versatility of oocyte and embryo donation has proven to be extremely
valuable to both patients and doctors engaged in reproductive medicine.
Originally thought to be applicable only to a rather small subset of infertile
women, who were mostly young with premature ovarian failure, today busy
practices commonly recommend the procedure to serve the reproductive
needs of an aging population who in the past were considered to be hopeless
cases. In the United States only a handful of centers offered egg and embryo
donation throughout the 1980s, but contemporary estimates suggest that
nearly all of the 400 or more IVF programs provide these services. Oocyte
and embryo donation has established itself as a mainstay procedure within
assisted reproductive care, and the breadth, depth, and complexity of practice
are deserving of focused attention.
I recognized in the mid-1990s a need to address the many facets of oocyte
and embryo donation within a single dedicated textbook, and thus the 1st edi-
tion of Principles of Oocyte and Embryo Donation was written. Much has
changed within our fi eld since it was published 15 years ago. The need for an
updated and more expansive text was apparent to me, especially as the prac-
tice continued to grow in popularity and expand throughout the world. This
2nd edition resembles the 1st edition in title only, as the content is essentially
all new, contributed by different authors with up-to-date information and per-
spectives from around the world. Each author was speci fi cally chosen because
of their prominence and active involvement with oocyte and embryo dona-
tion. Their individual perspectives weave a nice consortium of opinion, not
necessarily always in agreement, but all equally valid and representative of
the diversity of practice that occurs within our fi eld.
This book provides an overview of the major issues affecting men and
women engaged in the practice of oocyte and embryo donation. A primary
emphasis has been placed on de fi ning the standards of practice that have
evolved over the past 30 years, clearly stating the outcomes expected from
adhering to these established protocols. Details of both the basic science and
the clinical medicine are presented together and always in the important con-
text of the social sensitivities surrounding gamete donation that have been a
part of the discussion from its inception.
Attention is also focused on the nonreproductive aspects inherent to this
unique method of assisted reproduction that involves opinions from lawyers,
ethicists, mental health-care professionals, and theologians. This book is
meant to be informative to physicians and the lay public alike, discussing the
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