A 49-year-old woman presents to a private clinic expressing her desire to become pregnant.
She has no past medical history.
Initial investigations show that she still has ovarian function, is ovulating and is having regular periods.
An ultrasound of her pelvis shows no structural abnormality and an hysterosalpingography demonstrates patent fallopian tubes.
Analysis of her partner’s semen is normal.
Which would not be an appropriate first line management option?
A. In vitro fertilisation (IVF)
B. Intracytoplasmic sperm implantation
C. Intrauterine insemination D. Clomiphene
E. Egg donation IVF
ANSWER IS D Most students, and indeed many postgraduate trainees, will have little experience with which to tackle this question since only in private practice would a 49-year-old woman normally be offered IVF.
The important point is that in 2008 the average success rate of IVF with a patient’s own eggs if she was over 44 years old was 2.5 per cent. (A), (B) and (C) would be appropriate measures to try and achieve a pregnancy.
Option (E) may well provide a better success rate as the donor’s eggs will be potentially of a better quality than the patient’s. Clomiphene is the wrong answer.
Clomiphene is a selective oestrogen receptor modulator which, by inhibiting negative feedback on the hypothalamus, increases the production of gonadotrophins. In this way, it is used to induce ovulation. Given that the woman in this case is ovulating, treatment with clomiphene would be inappropriate.
Surrogacy is when another woman carries and gives birth to a child for you. Though it can be an emotionally intense and legally complex arrangement, it is growing in popularity among parents as a way of having children.
Surrogacy requires a lot of time, money and patience to succeed, whether it’s carried out privately or through an agency. But it can bring happiness to all concerned if the medical, legal, financial and emotional aspects are properly considered.
Why choose surrogacy?
You and your partner may choose surrogacy if you can’t carry a pregnancy, perhaps because:
A surrogate mum typically conceives after being artificially inseminated though IUI with the intended dad’s sperm. This is called full or straight surrogacy because the surrogate’s eggs and uterus are used.
She will then go on to carry the baby to term. When the child is born, the surrogate mum gives the baby to you and your partner and terminates her parental rights. You, being the dad’s partner, can then apply to legally adopt the baby as the other parent.