María (pseudonym) made a very important decision before dying several years ago. She reconsidered her future after a terminal illness diagnosis and in doing so she saw her desire to be a mother.
The woman, who was in her late 20s, went to a fertility clinic, where, after receiving advice she opted for cryopreservation, a fertility treatment allowing for the freezing and preservation of eggs to be potentially used in the future.
María died and as her genetic material was sleeping the sleep of the just, last year her parents decided to fulfill her daughter's wish.
"We want to fulfill my daughter's desire to have a child," said José (pseudonym), who asked not to be identified because the baby is still developing.
Years after María died, a young woman, not related to the family, agreed to undergo the surrogacy process and carry the baby to term, which was possible by fertilizing María´s frozen eggs with the sperm of a donor.
The seven-weeks pregnancy is the first case in Puerto Rico, Latin America and possibly in the United States of a pregnancy achieved with a dead woman´s frozen eggs, said Dr. Rosa Ileana Cruz Burgos, a specialist in reproductive endocrinology. Cruz Burgos is treating the case, which has an additional peculiarity because those who will raise the baby will be his or her grandparents.
“I consulted the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology, but, until November, there was nothing about such a case reported in the medical literature,” said Cruz Burgos, who warned that there have been cases of frozen sperm used after a man died.
According to the doctor, at the medical level, there were no problems to work in this case, since there are cases of frozen eggs fertilized with donated sperm, but there were no cases of a dead woman´s frozen eggs. In 2015, Cruz Burgos treated the first case in Puerto Rico of a pregnancy with frozen eggs of an anonymous donor.
“The issue here was legal and psychological. That’s why the first thing I said (to the grandparents who will also be the child’s parents) was: "Here we are not going to substitute one life for another," she said.
María's parents went to Cruz Burgos’ office last year to discuss the possibility of retrieving and using her daughter's frozen eggs to be fertilized.
"It was not only about the medical evaluation but also about a host uterus, a sperm donor, the psychological aspect and the legal evaluation," she said.
Among the psychological considerations, she mentioned the importance of María’s parents understanding the dimensions of the process.
“We have to understand that the person who died is gone. And also, that the process (assisted reproduction) is not 100 percent effective. It is important to close chapters and complete the mourning process, as well as to prepare for failure and success (of the process). And, if achieved, what will the circumstances of the environment (parents-grandparents), and the support group be,” she said.
Leading the way
After the necessary evaluations, they took María's frozen eggs to Cruz Burgos´ office, as the woman had the procedure at another local fertility clinic. And also, María´s parents were granted the legal custody of her eggs.
“There is a lot of debate and discussion over post-mortem fertilization. There are opinions from gynecology, obstetrics and assisted reproduction organization on the matter. The important thing is what the person wanted,” said the specialist, who explained that, in this field of medicine and given the lack of precedents, there are many processes opening the way to the legal level.
A viable embryo was created by fertilizing half of the 12 frozen eggs, and that embryo was also frozen. Months later, the rest of the eggs were fertilized and they got another embryo that is now developing in the surrogate uterus. In both cases, fertilization was achieved under a micromanipulation process, an assisted reproduction technique consisting of the microinjection of sperm into an egg.
“Humans go through many stages and we understand that their desire (that of grandparents-parents) is a real and viable one. Now, this pregnancy opens a window. Fortunately, (the process) was successful. Now this baby may have babies and those babies may have others and that lineage continues,” said Cruz Burgos, who explained that the other frozen embryo can be stored for up to five years and, in that term, it can be used, donated to another couple, discarded or donated for research purposes.
"We are excited"
On the other hand, José and his family are "excited, hopeful and looking forward to the birth," in the first months of 2020.
"We are happy. We have overcome so many obstacles. We are excited about science letting us have this opportunity. Whether we are the first or not, it´s like being touched by fate. Now we are happy to have been able to fulfill my daughter's wishes,” he said, expressing his gratitude to Cruz Burgos and the team that made the pregnancy possible.
Meanwhile, the other frozen embryo created with Maria's frozen eggs is in storage. Cruz Burgos anticipated the possibility of another potential pregnancy in the future if these grandparents were interested.
"I think this is a miracle," concluded the reproductive endocrinologist.