04/24/2012
Dr. Schoolcraft Discusses Modern Alternatives to Having a Child
As was the case with Giuliana and Bill Rancic, couples who can't get pregnant still have other options. Fertility specialist Dr. William Schoolcraft sheds light on those modern alternatives—from IVF to gestational surrogacy—below.
First things first, what do you attribute the high success rates of your fertility treatment clinic to?
The Colorado Center for Reproductive Medicine has among the highest pregnancy rates in the world because of our laboratory. We have developed a lot of unique technology in the lab to grow embryos, including vitrification, or very rapid freezing. A lot of times, embryos have been frozen via slow freezing and it results in a much lower survival, but with vitrification, nearly 100 percent of embryos and even eggs survive. It has really changed or revolutionized the idea of freezing; you don't really hesitate to do that anymore. That enabled us to freeze Giuliana's embryos and implant them in the gestational carrier.
Aside from a mammogram, which you required of G, what other preliminary screenings do you mandate?
We require a complete annual physical exam, which includes a pap smear and a mammogram. In addition, we talk to patients about pre-conception behavior, such as taking pre-natal vitamins and staying away from any medications that would harm the baby. Of course, the woman has to avoid smoking and drinking alcohol and caffeine. We want to make sure their health can tolerate a pregnancy. At the same time, we want to make sure that they can provide a healthy environment for the baby.
Tell us about in vitro fertilization. What is the process? Are there discomforts women should know about?
The patient does three things. After some pre-testing, the patient takes fertility medications for about 10 days. That stimulates her ovaries to make a lot of eggs, not just one. The second step is to go to sleep for about 10 minutes in an IV sedation. In that procedure, we pull the eggs that have grown from the medication out of the ovary. Then, in the laboratory, we fertilize those eggs and develop them into embryos. The third stage is to transfer those eggs into the uterus. In Giuliana's case, we did the third part to the gestational carrier. With IVF, sometimes there is aching and bloating from the ovaries enlarging. That's it. It's not a scary or painful procedure. The only time there would be any discomfort beyond that is in the retrieval of the eggs and the patient is asleep for that, so that's not painful.
What is the difference between surrogacy and gestational surrogacy, which is what G&B chose to do?
True surrogacy, we don't do. That's where you'd take a sperm from a couple and inseminate a woman. That woman would get pregnant and agree to give the baby back to the couple, but it's really her egg. It's her biological baby. It's really hard for a woman to carry a baby that is her baby and, then, give it back to the couple. A gestational carrier means the woman is carrying a baby, but it's not her egg or her husband's sperm, so it has no relationship to her. Obviously, it's more psychologically reasonable to say to somebody, Look, this is not your baby. It's not related to you, but you're going to donate your time and the use of your uterus for 9 months to help this child have life. We think that is more of a reasonable way to go. Asking a woman to be a true surrogate is not a very appropriate thing.
What are some of the challenges that couples should be aware of when considering gestational surrogacy?
Gestational surrogacy is a very successful path to a baby, but it isn't without its challenges. It's expensive and you have to spend quite a bit of time to find a gestational carrier who is a good fit for you. You've got to like that person and feel like you can work with and trust that person. We explain to couples how they should screen that person medically and psychologically. We definitely make sure that gestational surrogacy is a road they want to go down.
What are some other fertility options that reproductively challenged couples can look into these days?
Before IVF, there are more basic treatments, such as using fertility medications or undergoing insemination, where we inject the sperm into the uterus. That's a less aggressive approach. Sometimes, surgical therapy is helpful if they have anatomic problems. For patients who don't succeed in IVF, there's even other options like egg donation. It's not too common, but there are couples who get to a point where they're at an age where either their eggs aren't viable or their too old to carry a pregnancy. There are times where the uterus is not healthy to carry a pregnancy and, at that point, there are alternatives. They can use a donor egg. They can use a gestational carrier. Some couples decide that, if they're not going to be successful with their own eggs, sperm and uterus, they'd rather adopt.
Can you recommend some reliable resources for couples who want to do more research into their options?
A lot of the information on the Internet is not very accurate, so I would be cautious about that. There is a website that our society—the ASRM, American Society of Reproductive Medicine—put together. If you go to asrm.org, there's a section for patients that has accurate information. Aside from that, I wrote a fertility book about a year and a half ago for patients called If At First You Don't Conceive. I tried to write in a way that was factual and accurate for patients. The book gives them an overview for what they need to know if they are pursuing fertility treatments.
