By Sola Ogundipe

It used to be that a woman who had no uterus could not be a mother. But that is no longer the case. Women are not only getting pregnant at older ages, they are becoming mothers even without a uterus.

There are several cases of successful out-of-uterus or “surrogate uterus” pregnancies. Getting pregnant without a uterus was once highlighted in the celebrated case of a grandmother who gave birth to her own grandchildren, using her daughter’s eggs and her son-in-law’s sperm. This was reported as far back as 1989, and the whole procedure was necessitated because the woman’s daughter had no uterus.

•Insight into the procedure of surrogacy...
•Insight into the procedure of surrogacy…

The 27 year-old woman had lost her uterus from the hysterectomy necessitated by severe bleeding occurring in her previous pregnancy. The only way the doctors could save the young woman’s life from the obstetric disaster was to remove her uterus. Yet she had normal ovaries and her husband had good sperm. What was the solution? As it turned out, her 48 year-old mother was quite willing to serve as a surrogate uterus to carry her daughter’s baby. Their menstrual cycles were synchronized with birth control pills so that day one of the mother occurred simultaneously with day one of the daughter.

Then the daughter’s eggs along with her husband’s sperm were used to create two embryos in a culture dish. Both embryos were then placed in the uterus (womb) of the 48 year-old grandmother-to-be who became pregnant with her daughter’s twins. Nine months later, she gave birth to two healthy grandchildren whom she then immediately turned over to her daughter and son-in-law. Thus, in one delivery the grandmother gave birth to her own grandchildren. This is one of  the earliest surrogate uterus cases reported.

Essentially the history of “gestational surrogacy” is well known. It was actually in 1985 that the first successful case of a woman with no uterus whatsoever was able to have her own genetic child was reported. The 37-year-old woman became pregnant, but the uterus spontaneously ruptured at 28 weeks of gestation, necessitating a Caesarean Section and a hysterectomy. The baby girl subsequently died and the woman was left childless and without a uterus.

The couple, however, remained strongly committed to having their own genetic child and the wife asked that an embryo of hers be transferred to the uterus of a friend who was interested and willing to carry the child as a surrogate. The friend was a healthy, married young mother of two. The reproductive cycles of the two women were synchronized. The patient’s eggs were incubated with sperm from the husband, and three days later an eight-cell embryo was transferred to the uterus of the surrogate. The surrogate became pregnant and nine months later delivered the healthy genetic baby of her friend.

Another case in point explains the onset of gestational surrogacy. A woman who had gone through many failed attempts at in vitro fertilization (IVF), considered her sister had already had several children without any problem and was quite willing to carry a baby for her. Fertility experts were able to obtain six embryos from her eggs and her husband’s sperm. There were transplanted into her and three into her sister. As it turned out, both sisters conceived, one with twins and the other with a singleton. The nfants were born a month apart.  The surrogate sister, of course, gladly gave the children back to their genetic parents.

There is also the case of a 29 year-old woman who had her uterus and both ovaries removed, and desperately wanted to have a child. Her husband had perfectly normal sperm, and they both wanted a baby by her husband’s sperm. The question for this patient was who would provide the eggs and who would provide the uterus? In her family, one of her sisters was willing to donate an egg, the husband of course would provide his sperm, and another sister would allow the eggs and the sperm to be transferred to her so that she could carry the baby.

This couple now had a beautiful daughter, with two special aunts, one who provided the eggs, and one who carried her. Thus, with an open attitude, and loving friends and family who are willing to help, virtually any woman can have a baby.

This medical revolution is made possible by the scientific revolution known as in-vitro fertilization (IVF) and egg donation. It’s thanks to these landmarks that women who have no uterus can still “bear” their own biological children, assuming their ovaries are still functional.

Giving insight into the procedure of surrogacy, Medical Director, Nordica Fertility Centre, Lagos, Abuja and Asaba, Dr. Abayomi Ajayi, explained there are basically two types— natural (traditional surrogates) or IVF surrogate mother (gestational surrogate).

According to Ajayi, surrogacy is a situation in which a third party (woman) agrees to carry a pregnancy to term on behalf of an infertile couple.
He said a natural surrogate mother is genetically related to the child, apart from carrying the child she has also gone through the procedure of insemination, with the use or her own eggs.

On the other hand however, an IVF surrogate is not genetically related to the child. She carries a pregnancy, created by the egg and sperm of the commissioning couple. Ideally the surrogate should be under the age of 38 years, married or in a stable relationship. She should also preferably at least have previous live birth without complications.

Further, he noted that a prospective surrogate is thoroughly and counselled. Such person should not have medical disorders, such as diabetes or blood group incompatibilities and shouldn’t smoke, drink or abuse drugs.

He said couples requiring IVF surrogacy is usually those in which the woman’s ovaries are producing good quality eggs, but her womb has been has been damaged or surgically removed. This can occur in stances whereby a woman had uterine cancer, severe hemorrhage for some reasons, or a ruptured womb from previous pregnancy.
Ajayi observed that sometimes women who suffer from medical problems such as severe diabetes, heart and kidney diseases put themselves at risk if they were to carry a pregnancy to term.

But for others, surrogacy may be indicated because there is history of repeated miscarriage, due to some immunological incompatibilities i.e. Rhesus blood group incompatibility between mother and foetus.

Ajayi observed that success rates for traditional surrogacy are approximately 10-20 per cent per cycle if intrauterine insemination is done but with IVF, the chances depend on the age of the surrogate.  For IVF surrogacy, live birth rates are in the range of 35-40 per cent per cycle.

“Surrogacy is a treatment of last resort in most places all over the world this is much more so in our environment. Proper legal and medical precautions should be taken at every step of the process,” he remarked.

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