Insight takes a look at the ins and outs of IVF treatment and its progress in Egypt, offering hope to unhappily childless couples…if they can pay for it. In vitro fertilisation (IVF), the process by which human eggs and sperm are united in a laboratory to form embryos, was developed in the UK and the first "test-tube baby" was born there in 1978. IVF treatment became available in Egypt 15 years ago, offering hope to unhappily childless couples… but only if they could afford it. We take a look at the ins and outs of the treatment today and balance it against the dilemmas faced by women with unwanted pregnancies.
One of the great joys of life is the ability to have children of your own. They make a marriage blossom and create a closer bond between a couple. But while some are lucky enough to have as many as 10 children or more, others are incapable of having even a single one.
At least that was the case until 15 years ago when in vitro [literally "in glass"] fertilisation was introduced to Egypt. This revolutionary new technique made it possible for many otherwise childless couples to experience the great joy of parenthood.
The reasons why some women have difficulty in conceiving are many and varied but it is usually because the woman has either blocked or ruptured fallopian tubes. IVF provides a meeting point for sperm and oocytes (eggs) outside of a woman’s body in the form of an incubator replicating the exact conditions of the human body.
Doctors wait for the woman to ovulate and perform what they call the "oval pick up". This means that they literally pick up the oocyte from inside the woman before it reaches its peak. This used to be a major surgical operation that lasted for almost an hour with full anaesthesia, now it is a 10 minute process with no anaesthesia necessary. The next step is to place about 100,000 sperms on one oocyte to give a good chance that one will actually manage to enter it.
This in itself might seem to many to be a medical miracle but the treatment has advanced even further over the last 15 years. In the beginning women were not given stimulants to produce more oocytes, but as time passed it was realised that more oocytes meant a higher pregnancy rate.
Even though IVF helps a lot of women conceive, in some cases, where the problem is with the male rather than the female, it is not so effective. Some men have either a very low or even zero sperm count, which makes finding sufficient sperm difficult. Consequently the Intracytoplesmic Sperm Injection (ICSI) was devised.
five star hotel in Hamburg The idea behind ICSI is very similar to the usual form of IVF although the results are a higher pregnancy rate. The same oval pick up procedure is followed but in the next step just the one sperm is needed because it is injected using a special needle directly into the oocyte. All this takes place in an incubator. Because this treatment only requires a minimal number of sperm it overcomes the problem of low sperm counts.
When men have a zero sperm count it does not necessarily mean that they do not produce sperm; they do, but for one reason or another it is not released from their bodies. Therefore doctors need to perform another type of operation to extract the sperm to use in ICSI.
Hormonal stimulants are also given to the woman in cases of ICSI to make it possible for several oval pick-ups to take place. Simultaneously each oocyte is injected with a sperm to create several embryos. These "pre-embryos" are then stored by cooling to the temperature of liquid air (-196C/-321F) in a process known as cryopreservation. They are then monitored in the labs to see if they develop to the two-cell and then the four-cell stage. It is usually up to five days before the embryos are implanted in the uterus of the woman, explained Dr. Mostafa El Sadek, Consultant of Assisted Conception, because it gives doctors the chance to select the best growing embryos.
He added: "If we move one single embryo at an earlier stage the cells might stop multiplying and then there would be no pregnancy." However, the ability to form several embryos can also cause multiple birth problems. "A woman may become pregnant with six or seven babies. The reason we have this problem is because of liberal embryo transfer in Egypt."
In Europe there are regulations which allow no more than two embryos to be transferred to the mother’s uterus. Although Egypt does not follow that same rule it too has its own guidelines for IVF and ICSI.
Neither of the two procedures can be performed on any unmarried couple and the procedure must be done while the mother and father are still married. As Dr. El Sadek explained, a woman cannot ask for her husband’s frozen sperm to be used in IVF after his death just because she wants a child from him. "This is illegal," he said.
Although it is great news that now more couples can conceive not everyone can afford the treatment. IVF can cost up to LE 4,000 without the hormonal stimulants which push the price up to LE 6,000. Meanwhile ICSI is even more expensive, going up to LE 7,000.
hotels in Helsinki Dr. El Sadek said that some of his patients are rich but others are very poor people who often sell their houses to raise the money for the treatment. "Children mean that much to them," he said. This is particularly apparent when you consider that the success rate of IVF ranges from 30-40 per cent for 30-year-old women per cycle treatment.
IVF was not a very popular concept when it was first introduced to Egypt. Dr. Bassam El Helw, consultant obstetrician and gynaecologist, explained that because of religious beliefs some couples were hesitant about the treatment. "They thought that anything that interfered with God’s will would be wrong. But now most people understand that it is perfectly OK to perform IVF or ICSI because there is no third party involved, it is still something that only involves the husband and the wife."
On the topic of whether it is religiously acceptable to undergo IVF or ICSI, Dr. El Sadek explained that when it was first introduced the Sheikh of Al Azhar declared it to be righteous. There was also interdenominational consensus that the treatment was permissible for Christians. The only requirements are that the oocyte and the sperm should belong to a married couple. At one time the idea of surrogate mothers was approved by the church in Alexandria but the decision was quickly reversed. The mufti also came out against surrogacy.
It’s funny how the world works, or doesn’t work. While some couples are so desperate for a child that they are willing to pay thousands of pounds for IVF, others are almost as desperate to abort the gift that God has granted them. The irony is that religious convictions also effect the issue in other ways. For instance the illegality of adoption must surely promote a demand for IVF, in that childless couples are unable to adopt otherwise unwanted children. At the same time the demand for abortion is surely pushed up by the fact that a woman cannot have a child adopted if she goes through with an unwanted pregnancy.
Abortion is illegal in Egypt but as Dr El Sadek put it: "It is very common and any woman can have one."
The problem with abortion comes from the fact that most of those who seek it are pregnant with illegitimate babies and just want rid of them. They have no safeguards if something goes wrong and abortions performed by non-professionals often do irreparable damage, leaving women unable to conceive again. In the old days, explained Dr. El Sadek, a midwife would make a sort of pessary from the mollokhya plant. This plant is very absorbent, so that it becomes increasingly enlarged with bodily fluids until the woman loses the baby. This procedure also usually results in the rupturing of the uterus.
According to Dr El Sadek: "Nowadays, abortion is increasing because of the great increase in orfi marriage." Dr El Helw agrees and said that the abortion rate is very high among college students.
The abortion question has always been a very debatable one. Some are definitely for and some definitely against. Dr El Sadek believes that a foetus "after four or five weeks is a living creature whose heartbeat can be heard. This is like killing someone." He believes that there can be no reason for abortion. "There is no such thing as a mistake, the woman had the chance to use contraceptives, why abort now?" he added.
On the other hand Dr El Helw believes that in certain situations it should be up to the mother to decide whether she wants to abort her pregnancy or not. "Sometimes a foetus is highly deficient and we know that it will not live longer than a few hours. I believe that the woman should have a choice of whether or not to keep the baby in this situation," he said. He recalls one of his patients, a 45-year-old woman who found out that her baby would be seriously deficient and would only live for a couple of hours when born. "She said ‘this is my baby and I will keep it’." She went through with the full term of pregnancy and her baby died two hours after its birth.
Dr. El Helw believes that abortion should be legal in certain conditions. If the pregnancy endangers the mother’s health; if the foetus is malformed in an incompatible way with life; and in cases where the mother has been raped. He feels very strongly about the last point because "in Egypt society does not accept babies born from rape and it does not accept abortion either!"
As the saying goes, no one is ever happy with what they’ve got. Some have a baby but don’t want it; others don’t but are willing to sell all they’ve got to get one; others face the double-edged sword of obeying the law, not having an abortion and giving birth to a child that will be rejected by society, or having a dangerous, secret illegal abortion to appease social conventions.
