IVF clinics are always looking for a competitive advantage. “Tandem IVF” seems to be the latest suite of techniques to attract older women with low fertility to the clinics.
In many countries it would be banned, but where IVF is relatively unregulated some clinics offer this option even though it has a number of ethical complications.
The technique works like this. In treating a woman over 40, most clinics would first try to achieve a pregnancy using her own eggs. If this fails, they would offer the option of donor eggs. Clinics offering tandem IVF are able to offer a much cheaper service by combining the two procedures. One or more embryos created with the older woman’s eggs are combined with embryos created with a donor’s eggs. In this way, even if the mother’s embryos do not survive, the donor’s will. The rate of success will be much higher.
Two optional services are offered by some clinics in conjunction with tandem IVF.
First, “cytoplasmic tandem IVF”: the nucleus of the mother’s egg is injected into an enucleated donor egg to rejuvenate it. This has been banned in the United States by the Food and Drug Administration.
Second, foetal reduction. If all of the implanted embryos implant and develop, there could be a problem. The mother might only want the baby from her own embryo. If this is the case, as a back-up plan, some clinics offer to abort the baby, or babies, created with donor eggs. Ethically, this is an extremely controversial way of dealing with the issue of multiple births.
An internet search came up with several clinics around the world which offer tandem IVF: IVF Mexico, IVF Spain, the Malpani Infertility Clinic in Mumbai, India; EmBio Medical Centre in Greece; and several clinics in the Turkish Republic of Northern Cyprus.
Judging from the clinics’ websites, it is in Cyprus that tandem IVF seems to be most developed. We requested information from two of the clinics, but neither replied. One clinic’s website says that tandem IVF has become a “popular method”, although BioEdge was unable to get any figures.
The website of the British Cyprus IVF Hospital explains how foetal reduction works:
Reduction is performed in week 11-12 of pregnancy not sooner or later. The mother’s womb is entered with a needle, assisted by an ultrasound; potassium chloride is injected into one or two of the weakest foetus` to stop the heartbeat. The aim of this intervention is to leave one or at most two healthy babies in the womb to carry to a healthy and full term pregnancy.
North Cyprus IVF Clinic proudly announces on its website that it offers “’outside the box’ treatment options”, including "Cytoplasmic Tandem IVF". It explains:
we not only improve your chances of IVF success using your own eggs, but we also allow you to fertilize the rest of the donor eggs (the ones that are not used for their cytoplasm) with your partner's sperm sample. The embryos created by donor eggs can be frozen and preserved for a future date in case your treatment cycle fails and you decide to use donor eggs in the future. This way, you can have an IVF treatment where your personal success likelihood is maximized using your own eggs and where you are also given a back-up plan with donor eggs in a future IVF cycle should things don't work out as planned - All for a single cost of treatment!
Northern Cyprus seems to offer an excellent setting for experimental techniques like tandem IVF. Government regulation is light. The doctors speak English; some have been trained in Britain; and, Turkey, where most of them were educated, has a large IVF industry. Plus, the republic, tiny as it is, with a population of only about 320,000, has a large number of tertiary institutions. One clinic says that most of the donors are “international university students studying at universities in [North] Cyprus”.
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