‘RENT A WOMB’: Women who make babies without uterus

Time was when women without wombs died childless. Today, the story is different, thanks to advancements in medicine. There are many mothers having biological children without wombs. This is made possible courtesy of Assisted Reproductive Technology, ART.

Twenty –eight year-old Nkechi Obi is intelligent, beautiful and hardworking. She studied economics and graduated with first class honours. As a young and attractive lady, she was the dream of every man but settled for Emeka Nmeso, an engineer.
Nkechi has a younger sister, Nkiru, while Emeka is an only child. The couple are from well-to-do families. They are comfortable and live in a mansion, and are in love. They have the world at their feet and are the pride of their families.
Nkechi and Emeka were engaged few months after they met at a wedding. They soon tied the nuptial knot. Their wedding was the town for weeks. Both had agreed they were going to have many children to make up for the few their parents had.
Emeka used to joke that he would not let Nkechi rest until she bore him six children. Three by three (three boys and three girls), he used to say. Nkechi was even more adventurous. She had her mind set on eight children – five boys and three girls. She actually prayed to have a set of twins first. So they moved in as husband and wife and enthusiastically settled down to build their expected large family.
The first few months of marriage were the most enchanting of Nkechi’s life. Emeka was the perfect husband. He was romantic, caring and loving to a fault. He spoiled Nkechi with gifts and attention. He told her she was his queen and treated her like one.
After six months of conjugal bliss, Nkechi took in, but, after a few weeks, began to bleed. She was admitted into hospital and placed on permanent bed rest, but the bleeding worsened and, despite all efforts, she lost the pregnancy. She and Emeka were devasted, but that was not the end of trouble for the couple.
For no reason that she could understand, Nkechi discovered she was still bleeding after the pregnancy loss. There were times the bleeding got so bad, she felt very weak and could not leave home. She stopped going to work and was forced to stay in bed permanently, only making frequent trips to the lavatory. She returned to hospital and had to undergo surgery after being transfused a couple of times without success.
When the doctor announced the final diagnosis after series of tests and examinations, it was a bombshell. Nkechi really did not understand what the problem was, but all she could make out of the diagnosis was that her uterus had been damaged during the failed pregnancy and the only way to stop the continuous bleeding was to remove the uterus.
She consulted other specialists and went through all kinds of tests, but the same recommendation came up. Her uterus was damaged beyond repair and needed to be removed(hysterectomy).
Nkechi found it very difficult to accept that her uterus was damaged. She had been hoping so much to have children, and hadn’t done anything bad to her uterus, so how come it was so damaged? What happened, she asked continuously?
She cried and screamed and rejectedthe verdict, but her husband persuaded her after they were made to understand she could still have babies even without a womb.
After some time, she finally agreed to have the surgery done. It was successful. She became a woman without a womb.

Options

Even after the surgery, Nkechi’s desire to have a child became stronger than ever, but it was obvious she required assistance to achieve that.
One of her close friends referred them to a fertility clinic in Lagos Island.
At the clinic, the couple was presented with alternative options to natural conception.
One of these options was In-vitro Fertilization (IVF) surrogacy – when another woman carries and gives birth to a baby for a couple that cannot have a child on their own because there is an issue with the woman.
The specialists at the clinic carefully explained the details including the pros and cons of surrogacy. After thorough explanation, Nkechi and Emeka settled for this “wonderful sounding surrogacy”. They liked the idea that money would not exchange hands apart from money needed to take care of the woman while carrying the baby. They were also satisfied thatthe intending surrogate had to be a married woman of their own choice that must have delivered a child herself.

‘Rent’ a womb

They were particularly encouraged because Nkechi had an aunt who fitted the role perfectly. Excitedly, they invited the aunt over and Nkechi burst into tears of joy when she agreed to ‘rent’ out her womb to the desperate couple. They wereoverjoyed to have someone willing to do it for them.
All the necessary tests were conducted even to ensure that the ‘rented’ womb and Nkechi’s cycle were compatible. After several tests, Nkechi’s eggs were collected and her husband’s sperms also collected and both fertilised through the IVF process.
After a few days, healthy embryos developed and two were implanted into her aunt’s womb. About three weeks later, a pregnancy test was done and it was positive. Nkechi’s aunt had a very stable pregnancy and, nine months later, a healthy baby girl was born. Nkechi was a mother!

Disorders

Janet Audu had a more complicated situation. The 25- year- old school teacher had lost her uterus from recommended hysterectomy due to obstetric disorders during her previous pregnancy. Her only option then to save her life was to remove the uterus. In the process of weighing options presented to her, it was discovered that she had ovarian cancer. Her world came crashing with this latest development.
However, her husband had healthy sperms and doctors explained there is viable solution only that they must have an open mind about the whole process.
Desperate to have their own child, they agreed to abide by the doctor’s advice. Surrogacy was recommended and they heartily embraced it after the doctor’s explanation.
Janet was now faced with providing an egg donor, and another person to provide the womb. Ethically it is not right for a donor to provide both eggs and womb. Luckily for Janet, her 46-year-old mother was still quite healthy.

Her mother was willing to serve as a surrogate uterus while her friend volunteered to donate her eggs. The mothers’menstrual cycles were synchronized with birth control pills so that day one of the mother occurred simultaneously with day one of her friend’s cycles.

Then the friend’s eggs along with her husband’s sperm were used to create two embryos in a culture dish. Both embryos were then placed in the uterus of the mother-to-be who became pregnant with her daughter’s child. Nine months later, she gave birth to her healthy grandchild whom she then immediately handed over to her daughter and son-in-law. So Janet’s mother gave birth to her own grandchild.
Nkechi and Janet have become mothers courtesy of IVF and egg donation.
Available information show that the first gestational surrogacy was in 1985 with a successful case of a woman with no uterusthatwas able to have her own genetic child.

Today, even without uterus, women looking for children can now have their own biological children, thanks to these landmarks.
According to experts, some of the medical conditions that might make surrogacy necessary for a woman include absence or malformation of the womb, recurrent pregnancy loss and repeated IVF implantation failures.

Meanwhile, Nigeria is not left out of this medical revolution. According to the Medical Director/CEO, Nordica Fertility Centre, Lagos, Abuja and Asaba, Dr. Abayomi Ajayi, whose centre carries out surrogacy, the procedure (surrogacy) is an arrangement whereby a woman agrees to carry a pregnancy for a couple. Ajayi explained that there are two types of surrogacy— natural (traditional surrogates) or IVF surrogate mother (gestational surrogate).
“Surrogacy is a situation in which a third party (woman) agrees to carry a pregnancy to term on behalf of an infertile couple. While a natural surrogate mother is genetically related to the child, apart from carrying the child, she has also gone through the procedure of insemination, with the use of her own eggs. On the other hand, an IVF surrogate is not genetically related to the child.
She carries a pregnancy created by the egg and sperm of the commissioning couple. Ideally, the surrogate should be under the age of 38 years, married or in a stable relationship. She should also preferably at least have previous live birth without complications.

The Medical Director stated that a prospective surrogate is thoroughly screened and counselled and such a person should not have medical disorders, such as diabetes or blood group incompatibilities and shouldn’t smoke, drink or abuse drugs.
He explained that the couples requiring IVF surrogacy is usually those in which the woman’s ovaries are producing good quality eggs, but her womb has been damaged or surgically removed. This can occur in stances whereby a woman had uterine cancer, severe haemorrhage for some reasons, or a ruptured womb from previous pregnancy.

Sometimes women who suffer medical problems such as severe diabetes, heart and kidney diseases put themselves at risk if they were to carry a pregnancy to term. But for others, surrogacy may be indicated because there is history of repeated miscarriage, due to some immunological incompatibilities i.e. Rhesus blood group incompatibility between mother and foetus. He said the success rates for traditional surrogacy are approximately 10-20 per cent per cycle if intrauterine insemination is done but with IVF, the chances depend on the age of the surrogate.

The fertility expert noted that due to some complications and the fact that the baby will have DNA of the surrogate when the surrogate’s eggs are used added that people now prefer IVF surrogacy.
“Surrogacy can be recommended to a woman who does not have a uterus or lost it from child birth. Also surrogacy can be an option for women that had badly performed fibroid removal, repeated abortions, including medical conditions such as severe hypertension and heart disease”.

On whether the baby could get attached to the surrogate, Ajayi said: “If the arrangement is well done it is not likely to happen and when it happens the court may be the last option because there must be a surrogacy contract before the process. She cannot return to say she wants to have the baby back. We just had one delivered recently.

“For IVF surrogacy, live birth rates are in the range of 35-40 per cent per cycle. “Surrogacy is a treatment of last resort in most places all over the world this is much more so in our environment. Proper legal and medical precautions should be taken at every step of the process.”

Who needs it?

Surrogacy may be appropriate if you have a medical condition that makes it impossible or dangerous to get pregnant and to give birth.

Success rates

It is quite difficult to determine a success rates for surrogacy, as many factors are relevant, including the surrogate’s ability to get pregnant, the age of the egg donor (if involved), the success of procedures such as IUI and IVF, the quality of gamete provided by the commissioning couple.
The age of the woman who provides the egg is the most important factor that affects chances of pregnancy.

Risks

The risks associated with surrogacy depend on the type of surrogacy undertaken. Generally, the risks associated with full surrogacy are similar to those for IVF.
There is also a risk of transferring HIV and hepatitis, and so screening of everyone involved in surrogacy involving IUI is recommended, and required in surrogacy arrangements involving IVF.
If a registered donor at a licensed clinic is used, the donor will automatically be screened.

Legal issues

Surrogacy involves complicated legal issues and it is recommended that couples seek their own legal advice before making any decisions. It is important to know that surrogacy arrangements are unenforceable.
It is also advisable to receive counselling before starting the surrogacy process, to help think about all the questions involved.