A UCLA Doctor, First to Transplant Human Embryos, Offers Hope to Infertile Women
How is the ovum transfer accomplished?
It is done in five steps. First, the ovulation dates of the donor and recipient are determined by hormone measurements and the procedure begins when they are synchronized naturally. Second, the donor is inseminated with sperm from the infertile recipient's husband on the day the measurements show ovulation is about to occur. Third is lavage, or washing the donor's uterus, five days after the hormonal peak to extract with a soft plastic tube the free-floating egg. Fourth, we search the fluid under a microscope to find the ovum. Fifth, we transfer it, within four hours of extraction, to the recipient using a thin plastic tube—a modified tomcat catheter. Tomcats get bladder obstructions, and this is a modification of a vet's tool used to clear them.
Is ovum transfer painful?
It can be done in a doctor's office and it causes about as much discomfort as having an IUD inserted. It's slightly more uncomfortable for the donor than the recipient.
Why use ovum transfer?
Ovum transfer can do things in vitro [test-tube fertilization] can't do: A woman with no ovaries or blocked fallopian tubes can have a child this way. She simply must have a normal uterus. It also means that women who carry genetic diseases like Tay-Sachs, cystic fibrosis, hemophilia or sickle-cell anemia can carry their husbands' children without fear. In vitro can't solve that problem.
Do you expect psychological problems for a woman carrying a child to whom she has no genetic relation?
I think they feel this is one step better than adoption. They feel this is an opportunity for them to have the husband's child, and that child is better than getting a baby who is one hundred percent foreign genetic material.
What are the origins of ovum transplants?
The earliest successful surgical experiments were begun with rabbits around 1890. Then, in the 1970s, the nonsurgical technique was applied commercially in cattle breeding. With the aid of fertility drugs, cows produce about eight embryos in one cycle, which can be fertilized and transplanted to other bearer cows as a way of increasing the herd quickly. [The possibility of human ovum transplants, in fact, was first suggested by Chicago physicist and inventor Richard Seed and his surgeon brother, Randolph, who have been using the technique to breed cattle since 1970. The Seed brothers' company, Fertility & Genetic Research Inc., provided a $400,000 grant to UCLA for the project in 1982. Dr. Buster, who had unsuccessfully approached seven Wall Street investment firms for the money, expects to have the grant repaid when the procedure becomes profitable.]
Why did it take so long to try the technique with humans?
It had a lot to do with moral and legal issues. For instance, the wrathful reaction of the pro-lifers if we lost just one ovum. If there was one malformed child, and we assisted in anyway to make that possible, we'd have legal problems so serious it wouldn't be worth the risk. We were surprised to find that those issues weren't that difficult once the world had more experience with in vitro fertilization. People's attitudes had changed with the times and were more open.
What kind of agreement is made between donor and recipient?
There are consent forms making absolutely clear the obligations of all parties. They all agree that the donor is giving the egg away and relinquishing all rights to that child. The donor agrees that if she should become pregnant with a retained egg (one that inadvertently was not flushed out) she would have a menstrual extraction or abortion. Also, the donor must abstain from intercourse because we want to be sure it's the recipient's husband's sperm that fertilizes the egg.
How difficult is it to find donors and what qualities do you look for in them?
We have a long waiting list of recipients but only about 12 donors. We've been getting them by advertising in local newspapers and by word of mouth. We require that they be 25 to 35 years of age, live near the hospital and be available on a fairly regular basis, and that's a limiting factor. We like women who have fulfilled their desires for childbearing because they have a stronger motivation: They feel strongly about motherhood and want to share it with someone else.
How is this different morally from surrogate motherhood?
We dislike the comparison. For five days the donor is a surrogate mother, but her motivation isn't money. Our donors are paid only $20 to $250 per cycle. With ovum transfer the child doesn't grow in the surrogate mother. With a full-term surrogate mother the woman must have feelings about the child; no wonder some fight to keep them. And there are risks in being pregnant but very limited risk in having the flushing-out process.
How are donors and recipients matched?
By blood type and physical characteristics. We do some screening regarding intelligence, but we don't match by IQ. If we had a tremendous donor pool we'd be able to match people more closely.
How great is the potential for ovum transfer?
Many of the more than 500,000 women with tubal disease might be candidates for ovum transfer, in addition to those with genetic diseases. When it becomes a common procedure in two or three years, we think there will be thousands per year in clinics all over. It's so easy once you understand the timing and how to use the instruments. The key is finding the donors.
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