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Thursday, September 23, 2010

8.28 To Get Pregnant or Not/Artificial Insem./IVF/Cloning

Physician's Notebooks 8 - http://physiciansnotebook.blogspot.com - See Homepage


28. Getting Pregnant - Update 22 March 2018
Fertile women release one ovum from an ovary each month, and the signs, symptoms and tests become evident shortly after. The ovum must be fertilized very soon after ovulation; so sperm must be closing in at the far end of the uterine tubes at ovulation. In a fertile woman who has perfectly timed coitus, the leading sperms reach her distal uterine tube c.30 minutes after semen ejaculation onto the vaginal cervix. Sperms from an ejaculation before ovulation may remain in the tube capable of fertilizing ovum probably not more than 24 hours.
   Putting it together: That an ovum may only be fertilized within several minutes after ovulation, that it takes the leading sperm 30 or so minutes to arrive in vicinity of distal tube where an ovum may be located at the ovulation moment, that sperm may be capable of fertilizing an ovum up to a day or two after arriving in tube, and that the present sensitivity of detection of ovulation leaves margin of uncertainty of 1 day; I come up with a rule of estimating a monthly fertility (Getting pregnant from a coitus) period. It starts 1 week before you will detect ovulation and lasts until ovulation has become certain based on sign and/or test. Outside this interval, penis ejaculation into vagina (or artificial insemination) cannot get a woman pregnant.
   Normally a woman who wishes to get pregnant does not need to bother about timing because she is usually in no rush to succeed, and the timing of coitus (penis in vagina) should be enough for success within a few tries. But when a woman is having problem, she needs to pay attention to timing.
   In a woman wishing not to get pregnant, the prediction of ovulation and the ability to detect it is a must because poorly timed coitus can lead to unwanted pregnancy. My rule of preventing pregnancy is that the 1st 3 full days of a menstruation are safe from getting pregnant; but the safety should be considered ended at start (6AM) of day-4. From then, until ovulation is detected, the risk of getting pregnant should be considered higher than 0. Following the detection of ovulation, the risk drops over the ensuing 3-day interval to 0 at +72 hours after the detection. It then remains 0 until start of day-4, at , next cycle.
  
So far I deal with getting or not getting pregnant in relation to ovulation. After fertilization, the ovum-sperm combination, ie, the fertilized egg that may now be called ‘seed’, takes 4 to 5 days to get down a uterine tube into the uterine cavity, and it may bounce about there several hours before settling onto a surface gland to implant. If it does not implant, it is lost. The percentage of loss is not known but is not rare. It is the cause of infertility due to chronic late ovulation where the ovum is released so late in a cycle that the resulting seed reaches a uterus on verge of menstruation and is lost in the flow.
   The interval between fertilization and implantation is made use of in the morning-after-pill, where a hormone is given at time of or shortly after (up to 24 hours with decreasing success) the single coitus thought to risk a possible pregnancy. The intra-uterine device (IUD) works by stimulating the uterus to expel the seed. And Menstrual Extraction (ME) is a suction of uterus cavity just before expected menstruation or at time of missed menstruation.
   Assuming implantation takes place, the seed is now called “early embryo” and next stage of early pregnancy – early post-implantation – starts. Some implanted early embryos do not make it past the first 12 weeks because the implantation site becomes disrupted and spontaneous abortion (miscarriage) takes place. When done purposely as family planning, it is induced abortion.

Artificial insemination (AI) and in-vitro fertilization (IVF, literally ‘in glass conception'  In AI, the ejaculated semen with sperm, from a fertile man, is put into the vagina of a woman desiring to become pregnant but either not desiring coitus or having experienced difficulty becoming pregnant with her mate due to low sperm count or poor coital timing. Preliminary to it, one determines usual timing of ovulation. Then one plans five 24-hour-apart AIs starting 3 days before predicted ovulation.
   It is a must that no sign of ovulation be detected on day of first planned AI. If a sign is detected, the AI plan is rescheduled for next month. If signals are go, the AI begins 3 days before midpoint of menstrual cycle. The AI is continued once a day until sign of ovulation is detected or next menstruation starts. (More than 5 AI attempts a cycle are rare)
   Technical point: 1) Donor semen collection is by masturbation into clean, dry jar. It is important the jar has been well rinsed with clean tap water (No need for sterility or distilled water) so that no residue of soap or other contaminant remains, and that the jar is dry. Because of HIV risk, commercial AIs are strongly advised (in some places legally required) to be done with specially freeze-dried revivified sperms that have been ejaculated by donor more than 3 months before the AI so that tests can have been done to guarantee no HIV contamination. 
(But, practically, in extra-legal AIs the insemination can be done with freshly masturbated sperm. In such a case, of course, the utmost measures should insure no HIV contamination of the semen))
   There is a report of successful insemination with 17-year-previously freeze-dried and stored and thawed sperm. According to the report, sperm motility and abnormal forms seemed normal. It is 1 case and outcome in offspring not known.
   Semen insertion: The woman should get into gynecologic exam position (on table or bed or floor futon, on back, knees bent, up and apart) and with pillow under buttock so her body slopes backward and downward. Then insert a vaginal speculum under a good light. Draw up semen sample from jar in 5 cc clean syringe or glass-dropper tube and squirt full semen sample onto vaginal cervix at its opening.(For success, examiner should see clear mucus dripping from the inseminee woman's cervix; if not, the AI should be cancelled) After the insemination the woman should lie in the same position for 30 minutes and should not shower, bathe or wash out the vagina or have sex for next 24 hours. (Probably best not to have sex until next menses because orgasms may prevent implantation)
   The woman who is having AI takes her Basal Body Temperature and samples her cervical mucus every day before the AI and also, ideally, a urine ovulation test should be done during AI days. (But if one can’t do it, one does without) Success may be seen from continued elevation of BBT after day-26 and no menstrual blood by day-29, and pregnancy test positive after a few more days.
   If you are a layperson or with help of friendly nurse or MD, and plan to do AI, then best to keep it secret, because of possibility of blackmail by friend or family member who becomes unfriendly. Why persons might want to do AI extra legally: Lesbian couple and also male or female sibling one of which may be called upon and willing to serve as close DNA sperm donor for other sibling’s wife’s AI are two types of cases.  That is only tip of iceberg variation of “all in the family” type AI.
(For a fictional account of an artificial insemination done extra-legally at home, click 14.18 Brenda Gets Pregnant With a Little Help )

In Vitro Fertilization (IVF) is now frequent. After preliminary test determines ovulation timing, the woman is primed with ovulation medicine and a laparoscopy is done and an ovum harvested. Sperm from donor is standing by and the ovum mixed with donor sperms. The embryo is identified microscopically, grown for short time in test tube and then artificially implanted via vagina into the uterine lining of the woman who will gestate the pregnancy (May be surrogate mother or the woman who furnished the ovum if she has a uterus that can successfully gestate a pregnancy).
   Note, the embryo may be frozen at this point and kept for years and then thawed and implanted in a surrogate uterus. Thus a person conceived in a particular year, may live a life, perhaps, hundreds of years later.
   The IVF is ideal for the woman who is infertile because of uterine tube blockage or who has lost her uterus but retains functional ovary or for the woman too old to get pregnant by coitus or AI. And in future, cloning may be available, doing away with need for a sperm donor and fertilization. The IVF should be done at major medical center with experienced team.
 For info write or fax The Center for Surrogate Parenting & Egg Donation,
15821 Ventura Blvd Suite 675, Encino CA, USA
91436, Tel. 18187888288/Fax -9818287, and on east coast it is
9 State Circle Suite 302, Annapolis MD 21401, Tel. 14109909860/Fax -9862. As of 2014 the phone is answered from 9 to 4:30, Mon-Fri.
 
On 5 July 2006: a 62 y/o child psychiatrist had a normal, healthy IVF baby by Cesarean section; the oldest woman as of that date to become a new mother in the UK. As of my last check, the world’s record for older birth is age 66. (Report from India in 2008, age 70) Almost all such late births are due to the talented Italian IVF specialist, Dr. Severino Antinori who runs a fertility clinic in Rome Italy specializing in late age IVF pregnancies.

END OF CHAPTER. To read next now, click 8.29 Ovulation Prediction & Detection -Be Superwo...








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