The oocyte paradox; a compelling cause for continued ART surveillance in a developing country

Gbolahan O. Obajimi; Oluwaseun O. Saanu; Adewale Adeniyi; Faosat O. Jinadu

doi:10.51496/jogm.v5.251

Authors

Gbolahan O. Obajimi Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria; and Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria
Oluwaseun O. Saanu Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria; and Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria
Adewale Adeniyi Department of Obstetrics and Gynaecology, University Hospital of Wales, Cardiff, United Kingdom
Faosat O. Jinadu Department of Radiology, Eko University of Medicine and Allied Sciences, Lagos, Nigeria

DOI:

https://doi.org/10.51496/jogm.v5.251

Keywords:

ART, Developing Country, Oocyte, Paradox, Surveillance

Abstract

The introduction of assisted reproductive technology (ART) has revolutionised the management of infertile couples. ART is available in many developing countries, but only to those who can afford the service. This inequity in access has resulted in an unmet need amongst those who are economically vulnerable. Late presentation is common in developing countries due to the enormous cost of ART, resulting in a disproportionately larger cohort of older women seeking ART. Oocyte donation is in high demand in many developing countries, but there is often a lack of regulations and enforcement capabilities. This may inadvertently subject the oocyte to the law of supply and demand with consequent exploitation. Altruistic gamete donation has gradually been superseded by compensated donation, paving the way for commercialisation in contrast to the concept of ‘a true gift’. The value of the human oocyte becomes a function of its designation either for research or treatment during ART.

In many developing countries where research in human reproduction is minimal and altruistic donation extremely low, the oocyte paradoxically attains a commercial status and is available to the highest bidder. There is a compelling need to strengthen regulatory agencies in developing countries to discourage the commodification of gametes. An important strategy involves the development of policies and guidelines for donor compensation rather than the current practice of discretion. Gamete sharing will reduce the pressure on ART recipients and, if properly implemented, will minimise desperation and discourage exploitation. In developing countries, Oocyte banking should be explored to allow equitable distribution of scarce gametes.

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References

Rienzi L, Balaban B, Ebner T, Mandelbaum J. The oocyte. Hum Reprod 2012; 27(Suppl. 1): i2–21. doi: 10.1093/humrep/des200 DOI: https://doi.org/10.1093/humrep/des200

Tukur HA, Aljumaah RS, Swelum AAA, Alowaimer AN, Saadeldin IM. The making of a competent oocyte – a review of oocyte development and its regulation. J Anim Reprod Biotechnol 2020; 35: 2–11. doi: 10.12750/JARB.35.1.2 DOI: https://doi.org/10.12750/JARB.35.1.2

Keefe D, Kumar M, Kalmbach K. Oocyte competency is the key to embryo potential. Fertil Steril 2015; 103(2): 317–22. doi: 10.1016/j.fertnstert.2014.12.115 DOI: https://doi.org/10.1016/j.fertnstert.2014.12.115

Hartshorne GM, Lyrakou S, Hamoda H, Oloto E, Ghafari F. Oogenesis and cell death in human prenatal ovaries: what are the criteria for oocyte selection? Mol Hum Reprod 2009; 15(12): 805–19. doi: 10.1093/molehr/gap055 DOI: https://doi.org/10.1093/molehr/gap055

Polani PE, Crolla JA. A test of the production line hypothesis of mammalian oogenesis. Hum Genet 1991; 88(1): 64–70. doi: 10.1007/BF00204931 DOI: https://doi.org/10.1007/BF00204931

Keefe DL, Liu L, Marquard K. Telomeres and aging-related meiotic dysfunction in women. Cell Mol Life Sci 2007; 64(2): 139–43. doi: 10.1007/s00018-006-6466-z DOI: https://doi.org/10.1007/s00018-006-6466-z

Howe K, FitzHarris G. Recent insights into spindle function in mammalian oocytes and early embryos. Biol Reprod 2013; 89(3): 71. doi: 10.1095/biolreprod.113.112151 DOI: https://doi.org/10.1095/biolreprod.113.112151

Tarín JJ, García-Pérez MA, Cano A. Assisted reproductive technology results: why are live-birth percentages so low? Mol Reprod Dev 2014; 81(7): 568–83. doi: 10.1002/mrd.22340 DOI: https://doi.org/10.1002/mrd.22340

Liu KE, Case A. No. 346-advanced reproductive age and fertility. J Obstet Gynaecol Can 2017; 39(8): 685–95. doi: 10.1016/j.jogc.2016.12.004 DOI: https://doi.org/10.1016/j.jogc.2016.12.004

Keefe DL. Telomeres, reproductive aging, and genomic instability during early development. Reprod Sci 2016; 23(12): 1612–15. doi: 10.1177/1933719116676397 DOI: https://doi.org/10.1177/1933719116676397

Vander Borght M, Wyns C. Fertility and infertility: definition and epidemiology. Clin Biochem 2018; 62: 2–10. doi: 10.1016/j.clinbiochem.2018.03.012 DOI: https://doi.org/10.1016/j.clinbiochem.2018.03.012

Obajimi GO, Saanu O, Ilesanmi AO. Expanding access to assisted reproductive technology in a developing country: getting more for less. Afr J Med Med Sci 2021; 50: 171–5.

Obajimi, GO, Saanu OO, Adeyanju AS, Olutoye AS, Adeyeye MM. Characteristics of infertile clientele attending a public in vitro fertilization clinic: appraising priorities in a low-income country. Open J Epidemiol 2024; 14: 343–52. doi: 10.4236/ojepi.2024.142024 DOI: https://doi.org/10.4236/ojepi.2024.142024

Englert Y. Ethics of oocyte donation are challenged by the health care system. Hum Reprod 1996; 11(11): 2353–5. doi: 10.1093/oxfordjournals.humrep.a019113 DOI: https://doi.org/10.1093/oxfordjournals.humrep.a019113

Englert Y, Govaerts I. Oocyte donation: particular technical and ethical aspects. Hum Reprod 1998; 13(Suppl. 2): 90–7. doi: 10.1093/humrep/13.suppl_2.90 DOI: https://doi.org/10.1093/humrep/13.suppl_2.90

Gunning J. Oocyte donation: the legislative framework in Western Europe. Hum Reprod 1998; 13(Suppl. 2): 98–102; discussion 103–4. doi: 10.1093/humrep/13.suppl_2.98 DOI: https://doi.org/10.1093/humrep/13.suppl_2.98

Kool EM, Bos AME, van der Graaf R, Fauser BCJM, Bredenoord AL. Ethics of oocyte banking for third-party assisted reproduction: a systematic review. Hum Reprod Update 2018; 24(5): 615–35. doi: 10.1093/humupd/dmy016 DOI: https://doi.org/10.1093/humupd/dmy016

Neri M, Turillazzi E, Pascale N, Riezzo I, Pomara C. Egg production and donation: a new frontier in the global landscape of cross-border reproductive care: ethical concerns. Curr Pharm Biotechnol 2016; 17(4): 316–20. doi: 10.2174/1389201017666160118103418 DOI: https://doi.org/10.2174/1389201017666160118103418

Shenfield F, de Mouzon J, Scaravelli G, Kupka M, Ferraretti AP, Prados FJ, et al. Oocyte and ovarian tissue cryopreservation in European countries: statutory background, practice, storage and use. Hum Reprod Open 2017; 2017(1): hox003. doi: 10.1093/hropen/hox003 DOI: https://doi.org/10.1093/hropen/hox003

Rienzi L, Romano S, Albricci L, Maggiulli R, Capalbo A, Baroni E, et al. Embryo development of fresh ‘versus’ vitrified metaphase II oocytes after ICSI: a prospective randomized sibling-oocyte study. Hum Reprod 2010; 25(1): 66–73. doi: 10.1093/humrep/dep346 DOI: https://doi.org/10.1093/humrep/dep346

Gil-Arribas E, Blockeel C, Pennings G, Nekkebroeck J, Velasco JAG, Serna J, et al. Oocyte vitrification for elective fertility preservation: a SWOT analysis. Reprod Biomed Online 2022; 44(6): 1005–14. doi: 10.1016/j.rbmo.2022.02.001 DOI: https://doi.org/10.1016/j.rbmo.2022.02.001

Wallace SA, Blough KL, Kondapalli LA. Fertility preservation in the transgender patient: expanding oncofertility care beyond cancer. Gynecol Endocrinol 2014; 30(12): 868–71. doi: 10.3109/09513590.2014.920005 DOI: https://doi.org/10.3109/09513590.2014.920005

Cromack SC, Walter JR, Smith KN, Elvikis J, Bazzetta SE, Goldman KN. Oocyte cryopreservation in transgender and gender-diverse individuals with or without prior testosterone use. Obstet Gynecol 2024; 144(6): e121–4. doi: 10.1097/AOG.0000000000005749 DOI: https://doi.org/10.1097/AOG.0000000000005749

Osaah M, Damalie FJMK, Amoah VMK, Senaya CM, Dankluvi HE, Yeboah B, et al. Fertility knowledge, childbearing intentions and attitudes towards social egg freezing: a study of female students of a private university in Kumasi, Ghana. BMC Womens Health 2024; 24(1): 553. doi: 10.1186/s12905-024-03387-3 DOI: https://doi.org/10.1186/s12905-024-03387-3

Khan SZ, Arecco L, Villarreal-Garza C, Sirohi B, Ponde NF, Habeeb B, et al. Knowledge, practice, and attitudes of physicians in low- and middle-income countries on fertility and pregnancy-related issues in young women with breast cancer. JCO Glob Oncol 2022; 8: e2100153. doi: 10.1200/GO.21.00153 DOI: https://doi.org/10.1200/GO.21.00153

Archary P, Potgieter L, Elgindy E, Adageba RK, Mboloko J, Iketubosin F, et al. Assisted reproductive technologies in Africa: the African Network and Registry for ART, 2018 and 2019. Reprod Biomed Online 2023; 46(5): 835–45. doi: 10.1016/j.rbmo.2023.01.014 DOI: https://doi.org/10.1016/j.rbmo.2023.01.014

Lutjen P, Trounson A, Leeton J, Findlay J, Wood C, Renou P. The establishment and maintenance of pregnancy using in vitro fertilization and embryo donation in a patient with primary ovarian failure. Nature 1984; 307(5947): 174–5. doi: 10.1038/307174a0 DOI: https://doi.org/10.1038/307174a0

Melnick AP, Rosenwaks Z. Oocyte donation: insights gleaned and future challenges. Fertil Steril 2018; 110(6): 988–93. doi: 10.1016/j.fertnstert.2018.09.021 DOI: https://doi.org/10.1016/j.fertnstert.2018.09.021

Li X, Kodithuwakku SP, Chan RWS, Yeung WSB, Yao Y, Ng EHY, et al. Three-dimensional culture models of human endometrium for studying trophoblast-endometrium interaction during implantation. Reprod Biol Endocrinol 2022; 20(1): 120. doi: 10.1186/s12958-022-00973-8 DOI: https://doi.org/10.1186/s12958-022-00973-8

Kool EM, van der Graaf R, Bos AME, Fauser BCJM, Bredenoord AL. Fair allocation of cryopreserved donor oocytes: towards an accountable process. Hum Reprod 2021; 36(4): 840–6. doi: 10.1093/humrep/deaa356 DOI: https://doi.org/10.1093/humrep/deaa356

Okonta PI, Ajayi R, Bamgbopa K, Ogbeche R, Okeke CC, Onwuzurigbo K. Ethical issues in the practice of assisted reproductive technologies in Nigeria: empirical data from fertility practitioners. Afr J Reprod Health 2018; 22(3): 51–8. doi: 10.29063/ajrh2018/v22i3.6 DOI: https://doi.org/10.1097/GRH.0000000000000013

Osaikhuwuomwan JA, Aziken ME. Pregnancy in older women: analysis of outcomes in pregnancies from donor oocyte In- vitro fertilization. J Hum Reprod Sci 2021; 14(3): 300–6. doi: 10.4103/jhrs.jhrs_209_20 DOI: https://doi.org/10.4103/jhrs.jhrs_209_20

Okafor NI, Ikechebelu JI, Joe-Ikechebelu NN, Okpala BC, Odo CC. ‘Gift with a price tag’: Nigerian egg donors’ knowledge, experiences and motivations. Afr J Reprod Health 2022; 26(6): 64–79. doi: 10.29063/ajrh2022/v26i6.8

Ezeome IV. Gamete donation – a review of ethical and legal issues. Afr J Reprod Health 2022; 26(3): 124–35. doi: 10.29063/ajrh2022/v26i3.14

Ibrahim W, Christopher D, Mohamed C. Live birth following preimplantation genetic testing to prevent sickle cell disease in a low resource setting: a case report. Afr J Reprod Health 2020; 24(4): 218–20. doi: 10.29063/ajrh2020/v24i4.22

Practice Committee of the American Society for Reproductive Medicine and Practice Committee of the Society for Assisted Reproductive Technology. Repetitive oocyte donation: a committee opinion. Fertil Steril 2020; 113(6): 1150–3. doi: 10.1016/j.fertnstert.2020.03.030 DOI: https://doi.org/10.1016/j.fertnstert.2020.03.030

Practice Committee of the American Society for Reproductive Medicine and the Practice Committee for the Society for Assisted Reproductive Technology. Guidance regarding gamete and embryo donation. Fertil Steril 2021; 115(6): 1395–410. doi: 10.1016/j.fertnstert.2021.01.045 DOI: https://doi.org/10.1016/j.fertnstert.2021.01.045

Cobo A, Remohí J, Chang CC, Nagy ZP. Oocyte cryopreservation for donor egg banking. Reprod Biomed Online 2011; 23(3): 341–6. doi: 10.1016/j.rbmo.2011.05.014 DOI: https://doi.org/10.1016/j.rbmo.2011.05.014

Balkenende EME, van Rooij FB, van der Veen F, Goddijn M. Oocyte or ovarian tissue banking: decision-making in women aged 35 years or older facing age-related fertility decline. Reprod Biomed Online 2020; 41(2): 271–8. doi: 10.1016/j.rbmo.2020.04.017 DOI: https://doi.org/10.1016/j.rbmo.2020.04.017

Ethics Committee of the American Society for Reproductive Medicine. Ethical issues in oocyte banking for nonautologous use: an Ethics Committee opinion. Fertil Steril 2021; 116(3): 644–650. doi: 10.1016/j.fertnstert.2021.06.051 DOI: https://doi.org/10.1016/j.fertnstert.2021.06.051