Early menopause pushes women to seek assisted reproduction

Women are born with approximately two million eggs and do not make new ones during their lifetime.

They lose about 11,000 eggs monthly before they begin puberty, and by the time they start menstruating, they have a reserve of about 300,000 eggs. 

About 450 eggs will be ovulated during menstrual cycles, with the others dying naturally and by menopause, the eggs have declined to 1,000.

However, men continue to make sperm and testosterone throughout their lifetimes. 

To conceive, a woman needs a healthy egg and a sperm. However, if she cannot produce eggs but has a healthy uterus, she can carry the pregnancy after getting an egg donor. 

To help women who are unable to produce healthy eggs, La Femme Healthcare Clinic is currently running an anonymous donation process for in-vitro fertilisation services.

Speaking to the Star during an interview, fertility specialist Dr David Thuo said the burden of infertility is unevenly yolked towards women. 

He said the biggest issue for women seeking the services is premature ovarian failing. 

“Here is where you find a woman is less than 40 years old but then her eggs fail to work," he said. 

VOLUNTARY POOL

Fertility specialist Dr Martha Kuruga, also a laparoscopic surgeon, told the Star the egg donation programme tries to recruit a huge pool of volunteer donors. 

"We have patients who do not have any egg reserve, either because of age, medical treatment, a surgery that has had an ovary removed or premature menopause," she said.

"You want a large pool of donors because we try to match as much as possible and of course the criteria have to be met. "

The programme is looking for young women of 25 years or younger who are fit and healthy, have a secondary school or university education and have not been breastfeeding or had a baby in the last nine months. 

The age limitations are because younger women have a huge number of healthy eggs, and miscarriages are higher with age because the eggs are also ageing. 

"If you are going to be a donor, you need to have a good pool so we pick the eggs that are normal. Even if you have 10 eggs, not all of them are great, we probably have only five or six that are good," Kuruga said. 

Education qualifications are because patients could request to have a donor with the same education status as them. 

"If you are a university graduate, you would want people who are also educated because that genetic will pass on to your child," she said.

Breastfeeding women already have a lot being taken from their bodies because their children are relying on them fully. They also do not ovulate (release eggs) during the breastfeeding period. 

"We also do a bit of screening, scans and tests for any medical issues that may be passed on," she said.

From the pool, they cut out who fits because not everyone in the programme will fit the desired profile.

"If someone comes in and they are a heavy smoker or they have medical issues or ongoing treatment, they cut off things we cannot use, and those who fit, we profile them and create a database," she said.

What the database does is when a client comes in, they look through the database and see who fits.

"Who fits your height, skin colour, eye colour, the few physical characteristics that we match so if you are 5'4", we won't get someone who is 4'4" to be your donor," she said.

The donor is only called in when they fit a specific profile.

"A donor programme is a filtering process to have a huge database so that when the person in need comes in, we can pick from that," the doctor said. 

EXTRACTING THE EGGS

The process involves hormone treatment because the natural menstrual cycle releases one egg, and about 10 eggs are required from a donor.

The hormonal treatment may have side-effects, such as bloating, occasional headaches, general tiredness and tummy aches. This is because of the high number of eggs the body is producing. 

"We do the health screen, run blood tests and scans to see if they are fit, then we start them on medication. This medication is usually hormonal injections daily for 10-14 days," Kuruga said. 

The hormonal injections push the ovary to make more eggs because only one is released per cycle. 

However, some people may start the hormonal treatment but are discontinued along the way.

"We will be monitoring as we give these injections because we are looking at number and size. There are some we start and cancel along the way," she said. 

"Because the response is not as good as we thought it would be, maybe because of underlying hormonal issues that affect the output of the number of eggs."

When eggs mature, they are usually between 1.8cm and 2.4cm, and the donor is placed under light anaesthesia for extraction.

"The anaesthesia is because the process of picking the eggs involves a needle prick through the vagina under negative pressure to suck the egg and the fluid so we get all the eggs," she said.

The eggs are then assessed in the lab and the good ones picked.

"Because we already know the couple then we are able to create embryos using the partner's sperm," she said.

The embryos are then transferred to the patient.

SERIAL DONATION

Women are advised not to be serial donors to reduce the risk of lowering their own egg reserve.

"You can be a donor once a year and not every year. Otherwise, by the time you want children yourself, the reserve is too low and you are the one looking for a donor," Kuruga said.

"We also check if someone has been donating and then we cut them out."

A woman will have between six and seven million eggs in a foetus, and by the time she is born, the number of eggs has declined to between one and two million.

"The number keeps dropping with age from the time the menstrual cycle begins, so people who start early are likely to get menopause early," she said.

"Every month that a period comes, there is a group that is taken and destroyed. Menopause just means that what you are born with is finished, so we have some that prematurely finish and these are ones that mostly come looking for donors."

Women who have performed abortions or gone through miscarriages can still donate because that is in the uterus.

However, those on hormonal contraception are not viable candidates because they are already suppressing the egg maturation (ovulation). 

The doctor adds they recommend lifestyle changes during hormonal treatments to ensure success. 

 "We want a healthy routine for the two week period, and advise donors not to smoke, drink or engage in sexual activity," she said.

The egg donation will not affect the girl should she make a decision to give birth in the future. 

"We do not affect the uterus, the tubes or the ovary as much, apart from the egg reserve," she said.

"This is because this is not a heat procedure, we do not burn the ovaries, and as every month goes, the egg releases on its own. If it was using heat then we may have effects later."

In IVF, patients are given a potential success rate of about 50-60 per cent.

"Reason is besides the egg, there are many other factors and we can only physically see the egg is okay. I can look and say it looks healthy but I cannot tell the genetic composition of the embryo," she said.

"If the embryo that is created is not healthy to grow, it won't grow, so you have a negative pregnancy test. "

Patients are given up to three trials because it is not 100 per cent guaranteed they will get pregnant in the first try.

"There are other people whose problem is the lining of the womb where the embryo is supposed to attach. If it is not ready, it will not attach," Kuruga said. 

If the second trial also fails, doctors see how to better improve the attachment process and increase chances.

"We usually transfer only two embryos because again we don't want multiples. Out of those if one is fine two it will implant, if two are fine they will implant and if none is fine they will not implant," she said.

After donors produce the 10 eggs, patients can choose to have spare embryos (those not used) reserved. 

"We are able to create spare embryos so even if we transfer two and we have four spares, we are able to preserve those in the same state so if it fails, you come back and we transfer again," she said.

The total cost to the patient, according to the specialist, is about Sh500,000. This is because the patient looking for the donor will also have to incur the costs of treatment for the donor. 

Last year, NMC Fertility Kenya partnered with Dubai Islamic Bank to offer personal financing to individuals seeking fertility services such as IVF at the centre. 

Patients will get a loan range of between Sh 100,000 to Sh 1 million and repay within a year. The loan applies to any employee, whether on a contract or permanent basis.