Event, Possibly in Garden Grove, Would Be World’s Second Such Happening : Infertility Pioneer Awaits Birth of Special Twins
When acclaimed infertility specialist Dr. Ricardo Asch opens his offices in Garden Grove in November, one of his first tasks could be delivering twins to a woman with premature menopause who, after treatment by Asch, became pregnant with eggs donated by another woman.
It would be the second such birth in the world in which a woman received another woman’s eggs that were fertilized, not in a laboratory dish, but in the pregnant woman’s body. Worldwide, about a dozen women have become pregnant with donated eggs through in vitro fertilization in test tubes.
Asch’s technique, while revolutionary, is really “no different (in concept) from artificial insemination, only in reverse,” he said in an interview Monday at Medical Center of Garden Grove.
It also may make it possible for women to store eggs for future conception, as men now can do by storing sperm in sperm banks, Asch said.
Asch pioneered the Gamete Intra-Fallopian Transfer, or GIFT, procedure, developed in 1984 as an alternative to test-tube fertilization.
Formerly affiliated with the University of Texas Health Science Center, Asch is setting up research facilities at UCI Medical Center and will have his medical offices at American Medical International’s Medical Center of Garden Grove until AMI’s Irvine hospital opens in 1988. His new center will be called the UCI-AMI Center for Reproductive Health Care.
About 1,000 infertile couples worldwide have been treated and about one-third have conceived using GIFT, Asch said. The procedure involves extracting eggs from the woman’s ovaries and combining them with the man’s sperm. Minutes later, the egg-sperm mixture is injected back into the same woman’s Fallopian tubes, where the fertilization process is allowed to occur naturally.
(Asch’s prematurely menopausal women patients differ from other GIFT patients because they required donor eggs since their own ovaries produce none.)
The GIFT procedure differs from in vitro fertilization, in which the eggs and sperm are combined in a laboratory dish and implanted days later into the woman’s uterus after fertilization has occurred. Asch said the advantage of the new process seems to be that it more closely mimics nature. It has worked in some cases where in vitro fertilization has not.
Last March, Asch announced he had used the GIFT technique to impregnate two women who suffer from premature menopause by using eggs donated by other women.
One woman, from Ecuador, gave birth to a healthy, full-term baby boy about a month ago in Houston, Asch said Monday. The second woman, a resident of Mexico, will deliver twins at the Garden Grove hospital in early November if she carries the babies to full term, he said. If she delivers early--which is not uncommon for multiple births--Asch said he plans to travel to Mexico for the births.
Asch’s associate, Dr. Jose Balmaceda, said he believes the twins will be the first multiple births in the world achieved with donated eggs.
In the previous dozen or so births that have occurred with donor eggs worldwide since 1984, the ovum was fertilized by the husband’s sperm in a test tube. The embryo was then implanted into the woman’s uterus, said Asch, who was not involved in those cases.
For Asch’s prematurely menopausal patients, he said he used eggs taken from other GIFT patients who were “altruistic enough to donate.” In the GIFT procedure, Asch takes many eggs from the woman’s ovaries, studies them under a microscope and then extracts four mature ova to combine with the husband’s sperm, he said.
The conception of twins by the woman with premature menopause was not intentional, Asch said. However, about 25% to 30% of the pregnancies achieved with the GIFT technique are twins. The natural rate of twins is about one in 80.
‘Two for Two’
The two women were the only ones on whom Asch and Balmaceda have attempted the donated-egg technique. “We’re two for two,” Balmaceda said. Both women underwent the GIFT procedure twice before conceiving, Asch said.
Because menopause shuts down the production of female sex hormones, both women had to be injected with the missing hormones for several months before conception, and the hormone treatment continued for the first 100 days of the pregnancy, Asch said. After that, the placenta provided the proper level of nutrients to sustain the pregnancy, he said.
Asch said he finds no ethical problems with the donated-egg pregnancies. “It is nothing different from artificial insemination with donor sperm,” which is a widely accepted treatment for women whose partners have fertility problems, he said. “This should be equally accepted.”
Still, he acknowledged, the numbers of women impregnated with donated eggs have been so few that there has been little debate.
Asch missed the birth of the first GIFT baby conceived with a donated egg because he and Balmaceda were in Italy. There they met with Vatican officials and set up GIFT centers, treating 35 to 40 infertile women, he said. Asch declined to go into details about his meeting with Catholic Church officials but said they were “very much in favor” of the GIFT technique.
The church has been opposed to in vitro fertilizations because it is thought that the manipulation of the egg and sperm outside the human body violates moral, ethical and religious concerns, he said. However, Catholic officials consider the GIFT procedure to be an “assistance . . . it is not intrusive into the act of how people are reproduced. GIFT mimics nature closely,” he said.
A special operating room suite and 4,000 square feet of office space at the Garden Grove medical center are now under construction for Asch’s program. When the center opens in the first week of November, about 40 to 50 women from throughout the nation and a few foreign countries will converge there to begin the GIFT procedure, he said.
Many of the GIFT candidates are infertile for unknown reasons, while other patients have ovulation or tubal problems, he said. Some are married to men who have sperm problems, and the GIFT procedure allows the doctors to “wash” out all but the most active sperm, Asch said.
Asch and Balmaceda perform the GIFT technique in “series,” treating a group of women--as their individual menstrual cycles dictate--over a period of about two weeks, then waiting several months before treating another group, they said. During the respite, the team is able to determine how many women conceived babies. It also allows Asch and Balmaceda to pursue research and academic responsibilities, they said.
One of the difficulties of attracting a large waiting list, Asch said, is deciding “how to give priority to people. One way is first come, first served, but that is not completely fair.” A 28-year-old woman who has been trying to conceive for two years may seek Asch’s help ahead of a 39-year-old woman who has been trying for seven years, he said. Asch and Balmaceda decide the priority on a case-by-case basis, but because others are waiting for the treatment, they will not repeat treatment on a woman very often, they said.
While all but two of the GIFT-treated women have supplied their own eggs for the procedure, the success of the donated-egg treatment raises interesting possibilities, Asch said.
Technically, the procedure could be used to impregnate a menopausal woman in her 40s or 50s, Asch said, adding he has no plans to do so.
Could Store Eggs
But the technique could put women on an equal footing with men when it comes to storing gametes, or sex cells, for possible future use, he said.
For example, men with cancer sometimes make deposits in a sperm bank before they begin chemotherapy, which can destroy their fertility, Asch said.
Women might do the same by having healthy eggs harvested and then frozen for later use, he said. This technique might also be used by women who are postponing pregnancy but fear they may not be fertile when they want to start a family, or who want to be impregnated with eggs that were produced when they were younger, lessening the chance for genetic abnormalities, Balmaceda said.
