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.