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  • From Test-Tube To Kindergarten

    FROM TEST-TUBE TO KINDERGARTEN

    Karina Manukyan, ArmInfo, 18 October 2006

    The problem of sterility today remains urgent for millions of
    married couples all over the world. Despite the variety of sterility
    treatment methods and recovery of disturbed reproductive functions,
    artificial fertilization for many is the only way to the desired
    pregnancy and maternity. Successful operations of IVF (in vitro
    fertilization) and ICSI (intracytoplasmic sperm injection) have been
    carried out in Armenia for 3 years already in the SRI of Mother and
    Child's Health Protection, due to which over hundred babies were
    born. As the Director General of the SRI of Mother and Child's Health
    Protection, professor Georgy Okoyev, noted in an interview to the,
    the specialists of the Marseille Institute of Human Reproduction,
    who have been actively cooperating with the Armenian doctors within
    several years, contributed greatly to the formation and development
    of artificial fertilization methods in Armenia.

    - Mr. Okoyev, which methods of artificial fertilization would you
    mark out as the most efficient?

    - Before talking of efficiency of one or another method, I will
    note that the artificial fertilization is a rather capacious
    concept. Artificial insemination by a donor sperm is the simplest
    method of auxiliary reproductive technologies. Thousands of such
    operations were carried out since 1985, when a sperm bank was created
    in our center for the whole region (Armenia, Azerbaijan, Georgia and
    Krasnodar territory). However, a very delicate psychological moment
    exists here, namely, a child from the donor arouses the husband's
    suspicion and unwillingness to take this step. Certainly, it is a quite
    natural response since everyone wants to have his (her) own child. It
    is not random that the number of artificial insemination by a donor
    sperm has considerably reduced in the Republic with implementation
    of the extracorporal fertilization method. Moreover, in cases when
    carrying of pregnancy is contraindicated or impossible (no uterus,
    inoperable injuries of uterus/endometrium, etc.), some of our patients
    agree for an ersatz maternity. Three such cases are already fixed in
    Armenia by this time - the patient's immediate relatives have become
    ersatz mothers.

    - By which criteria are the ersatz mothers, as well as the donors of
    sperm and ovum selected?

    There is a great difference between an ersatz mother and a donor. An
    ersatz mother must be absolutely healthy and we carry out a strict
    examination for infections, transferred by genital tracts and check
    that pregnancy is not contraindicated to her. Unlike her, the donor is
    a carrier of a gene, chromosome and hereditary information. Therefore,
    we also carry out a medical-genetic investigation to make certain that
    the donor is a not a carrier of any severe hereditary disease. Nearly
    15 young and healthy men-donors of sperm are registered in the center
    for today. We change our donors from time to time so as not to increase
    the risk of birth of a great number of kindred children. As for the
    ovum donors, they are intimate patients, as a rule (but not of her
    husband, so that to avoid a kindred marriage). Unlike sperm, ovum
    does not stand the freezing process, therefore, we use it just after
    stimulation of the woman-donor's ovaries and obtainment of oocytes
    by method of paracentesis.

    - As far as I know, you achieved the first positive results of
    using IVF in February, 2004, when a citizen of Georgia, who had been
    suffering sterility for 12 years before that, gave birth to triplet
    babies. For how many patients more the treatment has become efficient
    for the last three years?

    About 300 women have addressed our center for this period, not only
    from Armenia but from other countries of the world as well, namely,
    from Belgium, Iran, Holland and the USA. Unfortunately, most of them
    address us very late, the main contingent of our clients re women
    above 30. This circumstance is especially oppressive since the IVF
    and ICSI efficiency considerably decreases with age. Thus, if the
    efficiency of such operations at the age of 30 makes up 40%, after
    35 it makes up only 20%. As you see, the effectiveness of artificial
    fertilization directly depends on woman's age. The more is the age the
    less is the percent of pregnancy. Unfortunately, the science could
    not yet give an unambiguous answer to the question, which processes
    exactly in the woman's organism hamper a 100% pregnancy appearance and
    why no implantation of fetal ovum to uterus happens after successful
    fertilization by IVF and ICSI methods.

    - What is the reason of the women's address to your Center in a more
    mature age?

    First of all, one of the indications for IVF conduction is a
    disturbance of uterine tubes function. Usually, in case of such
    pathologies, the young woman is prescribed a laporoscopy. However,
    if 6 months later the treatment is of no desirable effect, the patient
    is again prescribed drugs and her uterine tubes "open" again... As a
    result, having spent a lot of time and money for inefficient treatment,
    the woman addresses us, sometimes 8-12 year later, but "treated" by
    hormones, ovulation stimulators and often with resected ovaries. All
    these factors, as well as the patient's mature age, considerably
    reduce the efficiency of our interference.

    - How exactly the operation for artificial fertilization is conducted?

    We stimulate the patient's ovulation (super ovulation) under influence
    of definite medicines as a result of which the woman's organism starts
    to produce a great number of ovums. After fertilization in a test-tube,
    2-5 days later, we transfer the embryo to the cavity of uterus. The
    ICSI operation is conducted similarly with only difference that here
    the spermatozoon is injected directly into the ovum. If indications for
    IVF are an unexplainable sterility (sterility of unclear genesis), from
    which 10% of married couples suffer, as well as a commissural process
    in the abdominal cavity, the indications for ICSI are an expressed
    sperm quality loss or a severe autoimmune men's sterility. To note,
    we also carry out a freezing of embryos, obtained during an artificial
    fertilization, which afterwards can be transplanted to the cavity of
    uterus after an unsuccessful attempt of IVF or if the patient wishes
    to give birth to one baby more. In many countries of the world,
    the embryo is considered a biological creature with human rights,
    therefore, we thoroughly discuss the issue of further freezing of
    embryos together with a married couple. Embryos of about 15 women
    are now stored in our Bank.

    - If a pre-implantation genetic diagnosis is carried out in your
    Center?

    I hope very much that such a diagnosis will be carried out in our
    Center since it helps to prevent a child's birth with hereditary or
    genetic diseases.

    Despite the fact that this is, unfortunately, an expensive pleasure (it
    costs $2-3 thsd on average), however, the PGD is a kind of a necessity
    for 35-38-year-old married couples since a risk of development of
    trisomy, Down's syndrome, Klinefelter's syndrome and other severe
    and incurable diseases at the child vastly increases during a late
    pregnancy. Moreover, the PGD allows to reveal "embryos-carriers"
    of diseases with late manifestation and genetic predisposition to
    severe diseases (oncology, Alzheimer's disease, etc.).

    Pre-implantation diagnosis at the age of 36-37 is substantiated in
    these cases, as a woman gives birth to a healthy child due to the
    "screening" of genetically abnormal embryos.

    - In your opinion, how much actual is the problem of sterility
    in Armenia?

    I must note with regret that sterility in the Republic grows
    younger, the reason of which are, first of all, hereditary diseases,
    transferred by genital tract. About 30% of Armenian families today
    suffer sterility. I think, definite steps are to be undertaken at a
    governmental level to increase the birth rate in the country. As of
    today, the operations for artificial fertilization are inaccessible for
    a considerable part of the Republic's population. Even despite the fact
    that the citizens of Armenia pay only for the necessary medicines and
    reagents in our Center, the IVF and ICSI cost 900,000 drams at best.

    However, I hope that definite programs will start to be implemented
    in Armenia, due to which the Republic's women-dwellers of moderate
    means, who suffer sterility, will also be able to feel the happiness
    of maternity.
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