Option for acquiring motherhood in absolute uterine factor infertility TOG 2021 Flashcards
Options for acquiring motherhood in absolute uterine factor infertility
Aboption
Surrogacy
Uterine transplantation
Management graph for for acquiring motherhood in absolute uterine factor infertility
Advantages adoption
Acquires social and legal parenthood
Provides opportunity to enhance the life of a less fortunate child, with subsequent better psychological outcomes, especially if adopted earlier
Generally positive outcomes; three-quarters of adoptive parents report adoption had a positive effect on family
Disadvantages adoption
Lengthy process involving extensive formal evaluation
Potential for increased anxiety if not able to bond with child
Challenging process: approximately 1 in 10 adoptions report breaking down and one-quarter report finding it difficult.
Risk of disruption to current family unit
Advantages surrogacy
Allows biological relation to child
Following successful completion of parental order, legal parenthood is obtained
Excellent perinatal and long-term psychological outcomes in children, comparable to oocyte donation
Excellent outcomes for intended parents, with similar psychological outcomes compared with natural conception
More than one child can be attained, if relationship with surrogate remains positive, with the possibility of a second sibling
Disadvantages surrogacy
Ethical/cultural/religious barriers
Legal prohibitions in many countries curtail availability
In the UK, the surrogate is legally recognised as the mother at birth despite origin of the gametes and contractual agreements
Small transient risk of surrogate finding relinquishing care difficult
Increased anxiety for intended parents: potential for surrogate not transferring parental rights after birth of child
High costs: UK £25,000; USA £120,00039
Advantages uterine transplant
Restores reproductive function, enabling the woman to experience gestation and childbirth
Allows biological relation to child
Automatically considered legal parents
Widely accepted across the main cultural/religious groups
More than one child can be attained with the possibility of a second pregnancy
Disadvtanges uterine tranplant
Significant surgical risks related to 3–4 open surgeries
Immunosuppression risks related to transient use while graft in situ
Risk of failure: one-quarter require emergency hysterectomy
Exposure of additional risk to a second individual if using a living donor
Strict selection criteria curtail availability
High financial cost: Europe €100,00078
In uterine transplant how is rejection of the graft detected?
Cervical Bx
How long after uterine transplantation can an embryo be transferred?
6-12 months, following stabilisation on immunosuppression regime.
Single blastocyst.
When should delivery take place
CS at 37 weeks
Be aware may have painless contractions.
