Self therapy does not exist.
Chemotherapy of ovarian cancer is a type of cancer treatment using anti-cancer drugs. Treatment of ovarian cancer (OC; Pic. 1) is based on the combination of surgery and chemotherapy.
Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a category of cancer treatment that uses one or more anti-cancer drugs (chemotherapeutic agents). Traditional chemotherapeutic agents are cytotoxic by means of interfering with cell division (mitosis) but cancer cells vary widely in their susceptibility to these agents. To a large extent, chemotherapy can be thought of as a way to damage or stress cells, which may then lead to cell death if apoptosis (a type of cell death) is initiated.
Chemotherapy is used after surgery to treat any residual disease, if appropriate. In some cases, there may be reason to perform chemotherapy first, followed by surgery. This is called "neoadjuvant chemotherapy", and is common when a tumor cannot be completely removed or optimally debulked via surgery. Though it has not been shown to increase survival, it can reduce the risk of complications after surgery.
If a unilateral salpingo-oophorectomy (removal of Fallopian tube and ovary on one side) or other surgery is performed, additional chemotherapy, called "adjuvant chemotherapy", can be given. Adjuvant chemotherapy is used in stage I cancer (the cancer is located only in ovary) typically. Adjuvant chemotherapy is associated with statistically significant improvement in overall and recurrence-free survival in non-optimally staged patients.
Chemotherapy has been a general standard of care for ovarian cancer for decades, although with variable protocols. Bevacizumab may be used as an adjuvant chemotherapy if the tumor is not completely removed during surgery or if the cancer is stage IV (cancer has spread to other body organs some distance away from the ovaries, such as the liver or lungs); it can extend progression-free survival but has not been shown to extend overall survival. Chemotherapy is curative in approximately 20% of advanced ovarian cancers; it is more often curative with malignant germ cell tumors than epithelial tumors.
Chemotherapy in ovarian cancer typically consists of platins, a group of platinum-based drugs, combined with non-platins. Common therapies can include paclitaxel, cisplatin, topotecan, doxorubicin, epirubicin, and gemcitabine. Carboplatin is typically given in combination with either paclitaxel or docetaxel; the typical combination is carboplatin with paclitaxel. It is recommended an intravenous infusion of 3-hour paclitaxel carboplatin repeated every 3 weeks for six cycles. Carboplatin is superior to cisplatin in that it is less toxic and has fewer side effects, generally allowing for an improved quality of life in comparison, though both are similarly effective. Three-drug regimens have not been found to be more effective, and platins alone or nonplatins alone are less effective than platins and nonplatins in combination.
Salpingectomy refers to the surgical removal of a Fallopian tube. It is often related to tubal pregnancies and is a procedure that is preferred over its ovarian tube-sparing counterparts due to the high rate of recurrence in said ectopic pregnancies.
Salpingectomy is different from a salpingostomy and salpingotomy. The latter two terms are often used interchangeably and refer to creating an opening into the tube (e.g. to remove an ectopic pregnancy), but the tube itself is not removed. Technically, the creation of a new tubal opening (os) by surgery would be a salpingostomy, while the incision into the tube to remove an ectopic is a salpingotomy.
Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries, fallopian tubes and other surrounding structures.
Usually performed by a gynecologist, hysterectomy may be total (removing the body, fundus, and cervix of the uterus; often called "complete") or partial (removal of the uterine body while leaving the cervix intact; also called "supracervical"). It is the most commonly performed gynecological surgical procedure. In 2003, over 600,000 hysterectomies were performed in the United States alone, of which over 90% were performed for benign conditions. Such rates being highest in the industrialized world has led to the major controversy that hysterectomies are being largely performed for unwarranted and unnecessary reasons.
Removal of the uterus renders the patient unable to bear children (as does removal of ovaries and fallopian tubes) and has surgical risks as well as long-term effects, so the surgery is normally recommended when other treatment options are not available or have failed. It is expected that the frequency of hysterectomies for non-malignant indications will fall as there are good alternatives in many cases.
Occasionally, women will express a desire to undergo an elective hysterectomy—that is, a hysterectomy for reasons other than the resolution of reproductive system conditions or illnesses. Some of the conditions under which a woman may request to have a hysterectomy (or have one requested for her if the woman is incapable of making the request) for non-illness reasons include:
Oophorectomy is a surgical procedure in which one or both ovaries (Pic. 1; Pic. 2) are removed. The term ovariectomy can also be used, but traditionally it has referred to animals (e. g. laboratory mice) rather than humans. Removal of female ovaries is the equivalent to castration of males, where the testes are withdrawn. However, in medical literature, castration is used mostly in relation to men.
Oophorectomy can be divided into several categories. Either into unilateral (on one side) and bilateral (on both sides), or depending on the amount of removed tissue. If the whole ovary is taken away, it is a complete oophorectomy. If a part of the ovary is preserved, we are talking about partial oophorectomy (or ovariotomy). The term partial oophorectomy is sometimes used to describe a variety of surgeries such as an ovarian cyst removal or resection of parts of the ovaries. Such a surgery preserves fertility, although ovarian failure (i. e. loos of normal function of the ovaries before 40 years of age) may occur.
In some cases, it might be necessary to remove more than the ovaries only. Salpingo-oophorectomy, unilateral salpingo-oophorectomy or adnexectomy means removal of an ovary together with the Fallopian tube. When both ovaries and both Fallopian tubes are removed, the term bilateral salpingo-oophorectomy (or bilateral adnexectomy) is used. Oophorectomy may also be performed together with hysterectomy (i. e. removal of the uterus), which means that the whole reproductive system of the woman is removed. It is usually referred to as ovariohysterectomy, although the formal name is total abdominal hysterectomy with bilateral salpingo-oophorectomy.
The need to remove one or both ovaries can result from several medical conditions. Most bilateral oophorectomies are performed within ovariohysterectomy, mainly because of a uterine pathology. Another indication can be female-to-male gender reassignment. Unilateral oophorectomy is commonly performed not in conjunction with hysterectomy, often because of diseases such as ovarian cysts (Pic. 3) or cancer (Pic. 4), or as a prophylaxis to reduce the risks of developing ovarian or breast cancer.
Radiation therapy is used as a treatment of ovarian cancer in cases to prevent recurrence and as a palliative therapy (treatment of symptoms) to cease the symptoms.
Radiation therapy is used on tumors because of its ability to control cell growth. Ionizing radiation works by damaging the DNA of target tissue thus killing it. To spare normal tissues (such as skin or organs which radiation must pass through in order to treat the tumor), doctors aim weaker radiation beams from several angles of exposure to intersect at the tumor, providing a much larger absorbed dose there than in the surrounding, healthy tissue. Besides the tumor itself, the target for the radiation may also include the lymph nodesthat drain the area.
Radiation therapy is used in an effort to prevent recurrence of ovarian cancer after surgery. This is called adjuvant radiation therapy. The main purpose is to clean the body from micrometastases, which can be spreaded in the lymph nodes, but cannot be detected with available tests. Micrometastases can be responsile for reccurence after surgery treatment alone. Radiation therapy leads to improvement of survival.
In case of palliative treatment the radiation is used to shrinking a tumor, which leads to relief of symptom and improvement in patient’s quality of life.
Radiation therapy may also be used in cases of a treatment in women, which do not tolerate chemotherapy drugs.
A radiation therapy is administered daily, from Monday through Friday, from 3 to 5 weeks. It may vary depending on individual circumstances. The aplication lasts less than few minutes, patient does not feel any discomfort.
Egg donation is the process by which a woman donates eggs for purposes of assisted reproduction or biomedical research. For assisted reproduction purposes, egg donation typically involves IVF technology, with the eggs being fertilized in the laboratory; more rarely, unfertilized eggs may be frozen and stored for later use. Egg donation is a third party reproduction as part of ART.
Egg donor may have several reasons for donate her eggs:
First step is choosing the egg donor by a recipient from the profiles on or clinic databases (or, in countries where donors are required to remain anonymous, they are chosen by the recipient's doctor based on recipient woman’s desired trait). This is due to the fact that all of the mentioned examinations are expensive and the agencies/clinics must first confirm that a match is possible or guaranteed before investing in the process.
Each egg donor is first referred to a psychologist who will evaluate if she is mentally prepared to undertake and complete the donation process. These evaluations are necessary to ensure that the donor is fully prepared and capable of completing the donation cycle in safe and success manner. The donor is then required to undergo a thorough medical examination, including a pelvic exam, blood tests to check hormone levels and to test for infectious diseases, Rh factor, blood type, and drugs and an ultrasound to examine her ovaries, uterus and other pelvic organs. A family history of approximately the past three generations is also required, meaning that adoptees are usually not accepted because of the lack of past health knowledge. Genetic testing is also usually done on donors to ensure that they do not carry mutations (e.g., cystic fibrosis) that could harm the resulting children; however, not all clinics automatically perform such testing and thus recipients must clarify with their clinics whether such testing will be done. During the process, which usually takes several months, the donor must abstain from alcohol, sexual intercourse, cigarettes, and drugs, both prescription and non-prescription.
Once the screening is complete and a legal contract signed, the donor will begin the donation cycle, which typically takes between three and six weeks. An egg retrieval procedure comprises both the egg donor's cycle and the recipient's cycle. Birth control pills are administered during the first few weeks of the egg donation process to synchronize the donor's cycle with her recipient's, followed by a series of injections which halt the normal functioning of the donor's ovaries. These injections may be self-administered on a daily basis for a period of one to three weeks. Next, FSH is given to the donor to stimulate egg production and increases the number of mature eggs produced by the ovaries. Throughout the cycle the donor is monitored often by a physician using blood tests and ultrasound exams to determine the donor's reaction to the hormones and the progress of follicle growth.
Once the doctor decides the follicles are mature, the doctor will establish the date and time for the egg retrieval procedure. Approximately 36 hours before retrieval, the donor must administer one last injection of hCG to ensure that her eggs are ready to be harvested. The egg retrieval itself is a minimally invasive surgical procedure lasting 20-30 minutes, performed under sedation (but sometimes without any). A small ultrasound-guided needle is inserted through the vagina to aspirate the follicles in both ovaries, which extracts the eggs. After resting in a recovery room for an hour or two, the donor is released. Most donors resume regular activities by the next day.
Laws by state
The legal status and compensation of egg donation has several models across states with examples:
Fertility preservation procedures are indicated when it's predicted that there will be exposure to a cause of infertility. Mainly cancer treatment, such as chemotherapy, radiation, and surgery, may destroy a person's ability to have children later in life, and oncofertility research focuses on increasing fertility preservation options. Oncofertility is a subfield that bridges oncology and reproductive research to explore and expand options for the reproductive future of cancer survivors. It is scientifically proven that the number and quality of sex cells decreases with age. That is why this procedure (known as Social freezing) is also used by healthy men and women who want to postpone their parenting on later for any reason. They want to have the certainty of a young and healthy sperm and oocytes at a later age.
The main methods of fertility preservation are ovarian protection by GnRH agonists, cryopreservation of ovarian tissue, eggs or sperm, or of embryos after in vitro fertilization. The patient may also choose to use egg or sperm from a donor by third party reproduction rather than having biological children.
1. Options for females
Ovarian Suppression by GnRH during Chemotherapy
Chemotherapeutic agents have high levels of ovarian toxicity. Oocytes are contained in ovarian primordial follicles, which are very susceptible to the gonadotoxic effects of chemotherapy. Suppression of ovarian function through manipulation of GnRH has been evaluated as a mechanism to decrease the loss of primordial follicles. This has been studied in animal models with promising results but data regarding effectiveness in humans is limited to small retrospective reports. Unfortunately, it cannot be determined from these studies that the administration of GnRH agonists provided definitive ovarian protection.
Ovarian tissue cryopreservation
The basic principle of cryopreservation is to store cells or tissue for future use. Ovarian tissue cryopreservation involves surgically removing all or a part of the ovary, which contains thousands of primordial follicles. The resected tissue is cut into strips, cryopreserved and transplanted back to the pelvis, or other location (arm or abdominal wall) after cancer treatment. This procedure is usually performed by laparoscopy, can be planned immediately after the diagnosis of malignant disease and does not require hormonal stimulation. The advantage is that this is the only fertility preservation technique that is available to pre-pubertal girls or females in whom initiation of treatment cannot be delayed. It is also recommended to healthy women fearing the loss of their fertility.
On the other hand there is a risk of graft failure or reactivation of cancerous cells, particularly in hematologic malignancies after the return of ovarian tissue into the body.
Oocyte and embryo cryopreservation
Embryo and oocyte cryopreservation are both considered non-experimental options for fertility preservation in post pubertal females. Oocyte cryopreservation is the most commonly used for women who want to postpone their motherhood for the time being. Both interventions involve controlled two-week period of ovarian stimulation to produce multiple mature oocytes. Because of hormonal stimulation, this procedure is not optimal for patients with hormone-sensitive cancers (such as breast cancer or ovarian cancer) or those who cannot delay cancer treatment.
Cryopreservation is typically performed by incubation in a low concentration of cryoprotectant to minimize ice crystal formation during freezing; however, cells with a high osmotic content such as oocytes are particularly vulnerable to damage. Embryos are composed of multiple blastomere cells and are more stable for cryopreservation. Due to the difficulties with oocyte cryopreservation, embryo cryopreservation has been the primary modality for fertility preservation.
In embryo cryopreservation the mature follicles are fertilized in vitro with partner or donor sperm and then cryopreserved. In oocyte cryopreservation the oocytes are cryopreserved following their extraction. When the woman is ready to initiate pregnancy, the embryo is thawed and implanted into the uterus for maturation and birth. While this option is the most common fertility preservation method in women, it is not available to pre-pubescent girls, who do not have mature eggs that can be fertilized.
Protection of Ovarian Function
Oophoropexy, the relocation of the ovaries outside of the radiation field, may mitigate ovarian damage, although radiation scatter can still cause follicle depletion. Shielding of the ovaries during radiation therapy should be considered standard of care, when ovaries are not in the treatment field.
2. Options for males
Preservation of fertility in post pubertal males is reliably accomplished by cryopreserving sperm prior to the onset of gonadotoxic therapy which may lead to testicular failure or ejaculatory dysfunction. Semen can be used successfully indefinitely after cryopreservation.
The most common method to obtain sperm is through masturbation, which can be done in the in-patient or out-patient setting, or via referral to a sperm bank. Optimal procedures for the collection of sperm include abstinence 48 h prior to collection and the collection of multiple specimens, at least 24 h apart. The semen sample is evaluated for sperm count, morphology and motility prior to cryopreservation. Limitations to this form of cryopreservation are related primarily to an inability to masturbate, whether secondary to age, illness or cultural mores that prohibit masturbation. Emotional and practical issues may also be present that limit success. Alternative approaches exist when masturbation is not possible. Electroejaculation involves the placement of a transrectal probe while the patient is under general anesthesia. Electrical stimulation is applied until ejaculation occurs and sperm is collected.
After cryopreservation can potentially increase the risk of mutations in offspring DNA. In long-term follow-up studies, no evidence has been found either of an increase in birth defects or chromosomal abnormalities in people conceived from cryopreserved sperm compared with the general population.
Testicular Tissue Cryopreservation
Sperm banking is not possible for pre-pubertal boys as they cannot yet produce mature spermatozoa. However cryopreservation of gonadal tissue offers hope to childhood cancer survivors and also post-pubertal males who cannot produce a sperm sample. Immature boys at risk of losing their spermatozoa, mostly cancer patients, are the main target group that may benefit from testicular tissue cryopreservation and spermatozoa autotransplantation.
Procedure is similar to ovarian tissue cryopreservation - testicular tissue is surgically removed and frozen.
Success has been reported in cryopreservation methods of testicular tissue but more research is still needed in how to use the frozen-thawed tissue and obtain mature spermatozoa in vitro.
Protection of the Testes during Treatment
The testes should be shielded during radiation therapy to try to minimize the exposure to scatter radiation. Consideration can also be given to moving the testes out of the radiation field.
3. Options for both
Many patients diagnosed with a malignancy or another disease requiring treatment that may impair their fertility consider alternatives to bearing biological children, such as assisted reproductive technology (ART) using in vitro fertilization (IVF) with donor eggs or donor sperm. The resulting embryo can be implanted into the woman's uterus after her endometrium (the lining of the uterus) is stimulated with hormones to prepare for the development of the embryo.
During ICSI just one sperm is injected directly into the egg cytoplasm using a micromanipulative apparatus that transforms imperfect hand movements into fine and precise movements of micromanipulation tools.
Intracytoplasmic Sperm Injection (ICSI) is an assisted reproductive technique (ART) initially developed by Dr. Gianpiero D. Palermo in 1993 to treat male infertility. It is most commonly used in conjunction with in vitro fertilization (IVF). Following IVF procedure, the physician places the fertilized egg into the female’s uterus for implantation. Sperm are obtained by the same methods as with IVF: either through masturbation, by using a collection condom, or by surgically removing sperm from a testicle through a small incision (MESA, TESE). The females are treated with fertility medications for approximately two weeks prior to oocyte retrieval to stimulate superovulation, where the ovaries produce multiple oocytes rather than the normal one oocyte. The oocytes are retrieved by either laparoscopy, or more commonly, transvaginal oocyte retrieval. In the latter procedure, the physician inserts a thin needle through the cervix, guided by a sonogram and pierces the vaginal wall and then the ovaries to extract several mature ova. Before the embryologist can inject the sperm into the oocyte, the sperm must be prepared by washing and exposing it to various chemicals to slow the sperm movement and prevent it from sticking to the injection plate. Also, the oocytes are treated with hyaluronidase to single out the oocyte ready for fertilization by the presence of the first polar body. Then, one prepared sperm is injected into an oocyte with a thin needle. Often, embryologists try to fertilize several eggs so they can implant more than one into the uterus and increase the chance of at least one successful pregnancy. This also allows them to save extra embryos, using cryopreservation, in case later IVF rounds are needed.
After the embryologist manually fertilizes the oocytes, they are incubated for sixteen to eighteen hours and develop into a pronucleate eggs (successfully fertilized eggs about to divide into an embryo). The egg then grows for one to five days in the laboratory before the physician places it in the female’s uterus for implantation.
The chance of fertilization increases dramatically with ICSI compared to simply mixing the oocytes and sperm in a Petri dish and waiting for fertilization to occur unaided (classical IVF procedure). Studies have shown that successful fertilizations occur 50% to 80% of the time. Since the introduction of ICSI, intrauterine insemination (IUI) has decreased in popularity by 80%.See full description of ICSI
In the last 30 years, genetic testing techniques have been developed to identify chromosomally normal embryos in vitro, thereby potentially increasing the proportion of successful cycles with elective single-embryo transfer, and minimizing twin-pregnancy complications and miscarriages. This testing is termed "pre-implantation genetic screening" (PGS), in contrast to pre-implantation genetic diagnosis PGD), in which testing is performed for specific genetic defects.
Today, PGS technologies have evolved to include screening of all 24 chromosomes (22 pairs of autosomes and the 2 sex chromosomes). Ongoing pregnancy rates of about 60% following single embryo transfer have been described in couples with a maternal age of 38 years whose embryos have undergone PGS. It has not, however, been definitively established that the cumulative delivery rates are better with PGS, although it has been argued that the reduction in miscarriage rates and maternal and neonatal complications due to multiple pregnancies justifies the expense of this technology.
Trends toward delayed childbearing have resulted in an increasing number of women of advanced maternal age seeking to become pregnant and in a consequent increase in demand for assisted reproductive technology, most commonly in-vitro fertilization (IVF). In such women, the proportion of aneuploid embryos can exceed 60%, with a risk of miscarriage of about 40%, potentially resulting in significant emotional and financial hardship for affected couples.
Indications for PGS
Commonly quoted indications for PGS include advanced maternal age, repeated implantation failure, recurrent miscarriage, severe male factor infertility, or subfertility (those who experience unrecognized embryonic losses and who are labelled clinically as infertile). It should be noted that the chances of selecting an euploid embryo mainly depend of the number of embryos produced during the procedure. When it is suspected that the couple has a major chromosomal risk due to advanced maternal age or severe male factors, it is mandatory to inform them of the low chance of achieving a pregnancy with the PGS procedure, unless the couple produces many embryos that provide one or two euploid embryos apt for transfer.
Women at an advanced age have a greater chance of having aneuploid pregnancies because they have increased rates of producing aneuploid oocytes. Oocytes are always the same age as the woman. However, in males, sperm are produced every 65-75 days. Therefore, it might be said that sperm are not the same age as the male. The prolonged arrest of oocytes at meiotic prophase I mainly contributes to aneuploidy due to the decline in competence of the cytoplasm of the oocyte. The number and distribution of chiasmata during prophase I as the weak centromeric cohesion may be the main factor that predisposes aneuploidy that is inherent to age. In fact, the principal cause of oocyte aneuploidy is the precocious separation of sister chromatids rather than classic non-disjunction. In the male, the expected sperm aneuploidy rate is between 0.5 and 1% because the sperm is not the age of the male, but if the sperm is not ejaculated for prolonged periods, it could have a high rate of DNA fragmentation, which is also responsible for abnormal fertilization. Competent oocytes from young women can repair the DNA fragmentation of the sperm, but the oocytes from older women cannot. Therefore, women of advanced age have higher probabilities of having abnormal pregnancies that might end in miscarriage or in a malformed newborn. Most of these embryos are lost during pre or post implantation stages, while a minority come to term. That is why the possibility of miscarriage also increases with the age of the woman (Tab. 1).
Usually, RPL is defined as two or more consecutive pregnancies lost before 20 weeks of gestation. Different cytogenetic studies of miscarriages in the first trimester of pregnancy show that aneuploidy rates varied between 50% and 80%. Additionally, it has been documented that couples with RPL produce more aneuploid embryos than those who have not had RPL (Pellicer et al., 1999). According to some authors, PGS does not improve the rate of pregnancy in RPL, but increases the chance of birth at term (Platteau et al., 2005).
RIF is usually defined as the failure of three or more IVF attempts with good quality embryo transfer. Some authors argue that these couples produce more embryos with aneuploidies. However, there is no evidence that PGS improves the rate of pregnancy or live IVF births.
As mentioned above, the rate of aneuploidy in spermatozoa from fertile males with a normal spermiogram is much lower than that observed in oocytes, and aneuploidy also does not increase with age in men. On the other hand, sperm aneuploidies increase with the severity of OAT. These findings put in evidence the importance of the genetic risk assessment before the ICSI procedure to predict the chance of success. Now, with the possibility of PGS/PGD and lower costs, FISH is no longer used to assess sperm.
Sperm donation is the donation by a male (known as a sperm donor) of his sperm (known as donor sperm), principally for the purpose of inseminating a female who is not his sexual partner. Sperm donation is a form of third party reproduction including sperm donation, oocyte donation, embryo donation, surrogacy, or adoption. Number of births per donor sample will depend on the actual ART method used, the age and medical condition of the female bearing the child, and the quality of the embryos produced by fertilization. Donor sperm is more commonly used for artificial insemination (IUI or ICI) than for IVF treatments. This is because IVF treatments are usually required only when there is a problem with the female conceiving, or where there is a “male factor problem” involving the female's partner. Donor sperm is also used for IVF in surrogacy arrangements where an embryo may be created in an IVF procedure using donor sperm and this is then implanted in a surrogate. In a case where IVF treatments are employed using donor sperm, surplus embryos may be donated to other women or couples and used in embryo transfer procedures.
On the other hand, insemination may also be achieved by a donor having sexual intercourse with a female for the sole purpose of initiating conception. This method is known as natural insemination.
Donor sperm and fertility treatments using donor sperm may be obtained at a sperm bank or fertility clinic. Here, the recipient may select donor sperm on the basis of the donor's characteristics, e.g. looks, personality, academic ability, race, and many other factors. Sperm banks or clinics may be subject to state or professional regulations, including restrictions on donor anonymity and the number of offspring that may be produced, and there may be other legal protections of the rights and responsibilities of both recipient and donor. Some sperm banks, either by choice or regulation, limit the amount of information available to potential recipients; a desire to obtain more information on donors is one reason why recipients may choose to use a known donor and/or private donation.
A sperm donor will usually donate sperm to a sperm bank under a contract, which typically specifies the period during which the donor will be required to produce sperm, which generally ranges from 6–24 months depending on the number of pregnancies which the sperm bank intends to produce from the donor. Donors may or may not be paid for their samples, according to local laws and agreed arrangements. Even in unpaid arrangements, expenses are often reimbursed. Depending on local law and on private arrangements, men may donate anonymously or agree to provide identifying information to their offspring in the future. Private donations facilitated by an agency often use a "directed" donor, when a male directs that his sperm is to be used by a specific person. Non-anonymous donors are also called known donors, open donors or identity disclosure donors.
A sperm donate must generally meet specific requirements regarding age (most often up to 40) and medical history. Potential donors are typically screened for genetic diseases, chromosomal abnormalities and sexually transmitted infections that may be transmitted through sperm. The donor's sperm must also withstand the freezing and thawing process necessary to store and quarantine the sperm. Samples are stored for at least 6 months after which the donor will be re-tested for sexually transmitted infections. This is to ensure no new infections have been acquired or have developed during the period of donation. If the result is negative, the sperm samples can be released from quarantine and used in treatments.
Preparing the samples
A sperm donor is usually advised not to ejaculate for two to three days before providing the sample, to increase sperm count and to maximize the conception rate. A sperm donor produces and collects sperm by masturbation or during sexual intercourse with the use of a collection condom.
Sperm banks and clinics usually "wash" the sperm sample to extract sperm from the rest of the material in the semen. A cryoprotectant semen extender is added if the sperm is to be placed in frozen storage in liquid nitrogen, and the sample is then frozen in a number of vials or straws. One sample will be divided into 1-20 vials or straws depending on the quantity of the ejaculate and whether the sample is washed or unwashed. Following the necessary quarantine period, the samples are thawed and used to inseminate women through artificial insemination or other ART treatments. Unwashed samples are used for ICI treatments, and washed samples are used in IUI and IVF procedures.
Anonymous sperm donation occurs where the child and/or receiving couple will never learn the identity of the donor, and non-anonymous when they will. Non-anonymous sperm donors are, to a substantially higher degree, driven by altruistic motives for their donations.
Even with anonymous donation, some information about the donor may be released to the female/couple at the time of treatment. Limited donor information includes height, weight, eye, skin and hair color. In Sweden, this is all the information a receiver gets. In the US, on the other hand, additional information may be given, such as a comprehensive biography and sound/video samples.
Information made available by a sperm bank will usually include the race, height, weight, blood group, health, and eye color of the donor. Sometimes information about his age, family history and educational achievements will also be given.
Different factors motivate individuals to seek sperm from outside their home state. For example, some jurisdictions do not allow unmarried women to receive donor sperm. Jurisdictional regulatory choices as well as cultural factors that discourage sperm donation have also led to international fertility tourism and sperm markets.
A sperm donor is generally not intended to be the legal or de jure father of a child produced from his sperm. Depending on the jurisdiction and its laws, he may or may not later be eligible to seek parental rights or be held responsible for parental obligations. Generally, a male who provides sperm as a sperm donor gives up all legal and other rights over the biological children produced from his sperm. However, in private arrangements, some degree of co-parenting may be agreed, although the enforceability of those agreements varies by jurisdiction.
Laws prohibits sperm donation in several countries: Algeria, Bahrain, Costa Rica, Egypt, Hong Kong, Jordan, Lebanon, Lithuania, Libya, Maldives, Oman, Pakistan, Philippines, Qatar, Saudi Arabia, Syria, Tajikistan, Tunisia, Turkey, UnitedArab Emirates, and Yemen.See full description of Sperm donation
In vitro fertilization (IVF) is a process by which an egg is fertilised by sperm outside the body: in vitro . The process involves monitoring and stimulating a woman's ovulatory process, removing an ovum or ova (egg or eggs) from the woman's ovaries and letting sperm fertilise them in a liquid in a laboratory. The fertilised egg (zygote) is cultured for 2–6 days in a growth medium and is then implanted in the same or another woman's uterus, with the intention of establishing a successful pregnancy.
IVF techniques can be used in different types of situations. It is a technique of assisted reproductive technology for treatment of infertility. IVF techniques are also employed in gestational surrogacy, in which case the fertilised egg is implanted into a surrogate's uterus, and the resulting child is genetically unrelated to the surrogate. In some situations, donated eggs or sperms may be used. Some countries ban or otherwise regulate the availability of IVF treatment, giving raise to fertility tourism. Restrictions on availability of IVF include to single females, to lesbians and to surrogacy arrangements. Due to the costs of the procedure, IVF is mostly attempted only after less expensive options have failed.
The first successful birth of a "test tube baby", Louise Brown, occurred in 1978. Louise Brown was born as a result of natural cycle IVF where no stimulation was made. Robert G. Edwards, the physiologist who developed the treatment, was awarded the Nobel Prize in Physiology or Medicine in 2010. With egg donation and IVF, women who are past their reproductive years or menopause can still become pregnant. Adriana Iliescu held the record as the oldest woman to give birth using IVF and donated egg, when she gave birth in 2004 at the age of 66, a record passed in 2006.
Surrogacy describes an alternate means of conception for individuals who are unable to conceive a child naturally. In surrogacy, one woman (surrogate mother) carries a child for another person/s (commissioning person/couple), based on an agreement before conception requiring the child to be handed over to the commissioning person/couple following birth.
Traditional surrogacy is defined as a woman who agrees to carry a pregnancy using her own oocytes but the sperm of another couple and relinquish the child to this couple upon delivery. The surrogate is naturally or artificially inseminated via IUI, IVF or home insemination. With this method, the resulting child is genetically related to intended father and genetically related to the surrogate mother.
Gestational surrogacy, by contrast, involves a couple who undergoes IVF with their genetic gametes and then places the resultant embryo in another woman’s uterus, the gestational carrier, who will carry the pregnancy and relinquish the child to this couple upon delivery. The resulting child is genetically unrelated to the surrogate. There are several sub-types of gestational surrogacy as noted below.
Currently, the use of gestational carriers is far more common than that of surrogates.
A surrogacy contract is a contract no different to any other contract as it essentially relates to the agreement or promise made by both parties: contract law is primarily concerned with agreements that involve one party, or each party, giving an undertaking or promise to the other party. The rights and duties of the surrogate stem from two basic promises that she makes to the commissioning couple. First, she promises to be treated with the commissioning couple's genetic material (partial/full surrogacy) and carry the child to term. The surrogate will also give an assurance that she will attend regular prenatal appointments so as to ensure the health and safety of the foetus.
Secondly, the surrogate will promise to surrender all rights in the child to the commissioning couple. This latter promise may become complicated if the surrogate is married, as the law presumes that a child born to a married woman is the child of the woman and her husband. However, this presumption is rebuttable and thus, the commissioning couple should from the outset, make it a term of the contract that the surrogate and her husband explicitly agree to make no claim to the resulting child; without this statement, the intention of the parties may be undercut. Such a provision would help reduce emotional strain and the probability of litigation, and would avoid harming the child by involving it in custody proceedings.
A surrogacy arrangement based on contractual intention should not be designed to commodify offspring. Surrogacy arrangements do not deal with fungibles and must not encourage a system where children are treated as goods that may be contracted in and out of. While the notion of surrogacy could understandably figure centrally in the arena of family law, when examining the matrix of relationships embraced by surrogacy, one may see that surrogacy also has a basis in contract law. As with all contracts, they are designed to protect the interests of both parties as well as to bring to fruition, the express and implied terms of the contract. This perspective derives from the basic agreement made between the surrogate and the commissioning couple; the surrogate agrees to carry the foetus to term, for the benefit of the commissioning person/s and, the latter agree to re-compensate the surrogate for her time and expense in carrying out said procedure, of which, would not be possible without her agreement.
There are 2 types of surrogacy arrangement:
If the jurisdiction specifically prohibits surrogacy, however, and finds out about the arrangement, there may be financial and legal consequences for the parties involved. Some jurisdictions specifically prohibit only commercial and not altruistic surrogacy. Even jurisdictions that do not prohibit surrogacy may rule that surrogacy contracts (commercial, altruistic, or both) are void. If the contract is either prohibited or void, then there is no recourse if one party to the agreement has a change of heart: If a surrogate changes her mind and decides to keep the child, the intended mother has no claim to the child even if it is her genetic offspring, and the couple cannot get back any money they may have paid or reimbursed to the surrogate; if the intended parents change their mind and do not want the child after all, the surrogate cannot get any reimbursement for expenses, or any promised payment, and she will be left with legal custody of the child.
Jurisdictions that permit surrogacy sometimes offer a way for the intended mother, especially if she is also the genetic mother, to be recognized as the legal mother without going through the process of abandonment and adoption.
Often this is via a birth order in which a court rules on the legal parentage of a child. These orders usually require the consent of all parties involved, sometimes including even the husband of a married gestational surrogate. Most jurisdictions provide for only a post-birth order, often out of an unwillingness to force the surrogate mother to give up parental rights if she changes her mind after the birth.
A few jurisdictions do provide for pre-birth orders, generally in only those cases when the surrogate mother is not genetically related to the expected child. Some jurisdictions impose other requirements in order to issue birth orders, for example, that the intended parents be heterosexual and married to one another. Jurisdictions that provide for pre-birth orders are also more likely to provide for some kind of enforcement of surrogacy contracts.
Additionally, the rights of the surrogate or gestational carrier to not relinquish the infant following deliver are not well described.
A parentage order is a court order that transfers parentage from the birth parent/s to the intended parent/s - as part of the surrogacy arrangement. This means the birth mother and her partner (if she has one) no longer have a legal parental relationship with the child and the intended parents become the child’s legal parents. A prebirth form of parentage order could be used.
Surrogacy laws by state
Surrogacy is completely prohibited in Finland, France, China, Iceland, Italy, Japan, Pakistan, Saudi Arabia, Serbia, Spain and Switzerland.
Countries where a commercial surrogacy is legal and a woman could be paid to carry another's child through IVF and embryo transfer included Georgia, Russia, Thailand, Ukraine and a few US states.
Two possibilities have been discussed with regard to the relationship between ovarian cancer and fertility treatment. One possibility is that fertility treatment involving ovarian stimulation and controlled ovulation contributes to the development of ovarian cancer. IVF (in vitro fertilisation) requires a pharmacological ovarian hyperstimulation. Generally the intensive ovulation induction treatments are represented by injectable gonadotropins (FSH analogues), GnRH agonist and GnRH antagonist. Some studies suggested an association among the use of ovulation-inducing drugs, IVF, and ovarian cancer risk, but only few cases of ovarian cancer have been described in women followed in IVF programs.
Another possibility is the involvement of patient background factors and predisposing factors of infertility, such as ovulation disorder and endometritis. Standard surgical procedure in ovarian cancer patients leads to permanent sterility (since it includes the execution of hysterectomy plus bilateral salpingo-oophorectomy), young women who wish to preserve their childbearing potential may benefit by conservative (with uterine and contralateral andexal preservation) approach. Fertility preservation, such as ovarian tissue or oocyte cryopreservation, may also be used to prevent infertility but the proportion of patients with early ovarian cancer demanding fertility-preserving techniques is increasing. This represents a challenge to the gynecologic oncologist when setting the limits in order to not affect the prognosis and survival of these patients.