27 November 2017
ByAppeared in BioNews 928
In 2008, parliament voted to scrap the controversial 'need for a father' requirement from the Human Fertilisation and Embryology Act; a consideration for 'supportive parenting' took its place. Alongside legislation giving rights to civil partnership (2004) and to marriage (2014) to same-sex couples, this provided the basis for a sudden surge in fertility treatment options for single and lesbian women. These rights, now given statutory authority in the UK, were echoed in professional treatment guidelines in some, but not all, European countries and the USA. They were reflected too in changing social attitudes.
The London Women's Clinic's first lesbian couple was treated by donor insemination in 1998. Since then our records indicate that more than 10,000 treatments for patients using donor sperm have been completed at The London Women's Clinic, with good results. One increasingly common request is for a treatment which offers 'shared motherhood' to both partners. The technique allows one partner to provide the egg and the other to provide the uterus for the continuation of pregnancy. Now, in a retrospective analysis of the 121 couples treated between 2011 and 2016, all using donor sperm, we have found high birth rates and reassuringly safe outcomes associated with this method. Results of the study, the first of this kind to be published, will soon appear in the international journal Reproductive BioMedicine Online (Bodri et al. 2018).
The study comprised 121 consecutive lesbian couples whose treatments were mainly performed as fresh embryo transfers, following 141 cycles of IVF and 172 embryo transfers. The cumulative live birth rate per receiver was 60 percent (73 of 121) and the twin delivery rate was 14 percent. The oldest donor achieving a live birth was 40 years old. Live birth rates were slightly higher among those having fresh embryo transfers, although success rates were comparable in all age categories.
The analysis also showed that in 60 percent of couples, no medical cause of infertility was present. Instead, patients chose the treatment to emphasise shared parenthood, to reflect a more positive relationship between the parents and to avoid anonymous egg donation. It's our view that shared motherhood IVF has become increasingly accepted among practitioners and patients, although its overall efficiency and outcomes remain poorly understood.
With a 60 percent cumulative live birth rate from such a large series (the largest to date by far) we can confirm high levels of efficacy. To minimise the risk of developing the potentially serious complication of OHSS (Ovarian Hyperstimulation Syndrome), clinicians usually used a mild ovarian stimulation treatment.
Over the six-year study period, there was an evident gradual shift to transferring more mature embryos and one rather than two embryos per treatment cycle. In 2011, 25 percent were single embryo transfers. By 2016, 73 percent were single transfers. Overall twin delivery rate was 14 percent. As expected, perinatal outcomes were significantly better for singleton than twin pregnancies, although the latter also had generally favourable outcomes.
It is our view that this approach to shared motherhood IVF for lesbian couples – that is, OHSS-free stimulation with single blastocyst transfer – provides a safe and effective treatment with reassuring obstetric and perinatal outcomes.
The technique has come a long way since it was first reported in 2010 in a small Spanish study. There it was described as ROPA (receiving eggs/embryos from the partner). Since then, others have described the technique as co-IVF or reciprocal IVF. We favour the term shared motherhood IVF, as this better reflects the emotional connection patients hope to achieve with the child.
Because of national regulations, shared motherhood IVF is not allowed in France, where fertility patients must have a clear diagnosis of infertility to receive the treatment, Germany and many other countries. However, it is practised in the UK, Spain and Belgium within the regulatory framework. We were therefore not surprised to see overseas couples applying to receive shared motherhood treatment in the UK (Ahuja, 2015). In our study, 12 couples (10 percent) were cross-border patients living in countries where this treatment was not permitted or routinely practised (France: 3, Sweden: 2, Denmark: 1, Norway: 1, Ireland: 1, Bulgaria: 1, Switzerland: 1, Singapore: 1, New Zealand:1).
The environment in the UK, regulated by the Human Fertilisation and Embryology Act, is clearly welcomed by some patients from other countries who wish to access shared motherhood IVF. In time we feel that shared motherhood IVF will become more widely adopted worldwide. In the meantime, studies on mother-child relationships will become important to understand the psychological wellbeing of children born through this emerging medical procedure.