The ROPA method allows couples of women to conceive a child thanks to the donation of eggs within the couple
The concept of family has been changing in recent decades, from the traditional model, configured by marriage or heterosexual couple, to very diverse ones with different incidence and legal frameworks according to the countries. Among these new family models, the couples made up of two women stand out for whom the theme developed today was devised.
According to the gynaecologist of FIV Ochoa, Luis García, the acronym R.O.P.A. refers to the Reception of Oocytes from the Couple, and it is a very advantageous assisted reproduction technique in lesbian couples. One of the women provides the uterus and the other the eggs that will be fertilized with sperm from an anonymous donor.
The one who provides the eggs would be the «genetic» mother, while the one who provides the uterus would be the «gestational» mother.
According to Doctor García, the legal part of this R.O.PA. is complex, being in a situation of a-legality, since Law 14/2006, of May 26, on assisted human reproduction techniques is not foreseen in ROPA, nor is there an official public pronouncement of the National Commission for Assisted Human Reproduction (CNRHA).
As there are no regulations, two basic problems arise:
On the one hand, the donation of gametes (eggs in this case) in Spain is regulated as anonymous, this assumption not being fulfilled, obviously, in lesbian couples. This aspect has been ignored, equating the donation of eggs to the couple, with the contribution of semen by the male, in the heterosexual couple.
The other problem is the filiation of the born child, which seems to be resolved in the couples of married women. In this way, for marriages of women, the norm determines that when the woman is married, and not legally or de facto separated, with another woman, the latter may state, in accordance with the provisions of the Civil Registry Law, that she consents that the filiation with respect to the child born to their spouse is determined in their favour (art. 7.3 in its wording given by Law 19/2015, of July 13).
However, the situation changes in the case of couples of unmarried women. When the law refers only to marriages, the truth is that there is a legal vacuum with respect to couples of unmarried women, which means that the child or the latter can only be registered in the name of the pregnant woman. Subsequently, to ensure that the couple is also recognized as a mother, a judicial adoption procedure would have to be promoted through the procedures of Law 15/2015, of July 2.
So, there is a situation of «legal tolerance» based on the concepts, legal and constitutional, of equal rights and prohibition of any discrimination.
In my understanding, this lack of regulations has a serious consequence, and it is the non-offer of this Method to lesbian couples in the catalogue of benefits in the public health system.
Phases of the ROPA method
According to the gynaecologist of FIV Ochoa, Juan Manuel Marín, the phases of the ROPA method are very similar to those of any in vitro fertilization treatment.
1.- First consultation: We will carry out a gynaecological evaluation and the medical history of both. We will request the necessary analyses and tests, and we will assess the suitability of the role that each one wants or can play.
2.- Ovaric stimulation of which it provides the eggs and simultaneous preparation of the uterus which will gesture: The first by subcutaneous injections, and the second by tablets or patches of oestradiol and progesterone ovules for the next step. Several visits for an ultrasound control will be necessary for both.
3.- Ovarian puncture: Once the woman who provides the eggs has been stimulated, they will be extracted in the operating room, under anaesthetic sedation.
4.- In Vitro fertilization: The eggs are fertilized with sperm from a suitable donor on the same day as the ovarian puncture. The next day it will be possible to determine how many eggs have been fertilized, and their development will be observed during the next 3 to 5 days.
5.- Embryo transfer: A painless procedure in which one or two embryos of the best available quality will be transferred to the gestating uterus (depending on the choice of the partner and under medical advice). This step will take place 3 to 5 days after the ovarian puncture. If more quality embryos become available, these can be preserved by vitrification for possible future use.
6.- Pregnancy test: Usually performed about two weeks after embryo transfer.
Method success rate and ROPA method price
The ROPA method has the same conditions as IVF, although the male factor is excluded, since donor semen of proven quality is used.
So, the main factors to achieve success are:
The age of the woman who provides the eggs. The number of eggs that she can provide. The quality of the uterus of the woman she will gestate.
It is difficult to give an indicative pregnancy rate, since each couple is totally different, but globally considered these couples, the pregnancy rate per embryo transfer will be around 40%, and 60% per complete cycle (normally one cycle gives rise to more of an embryo transfer).
The embryologist of IVF Ochoa, María José Figueroa, explains that it can be said that the pregnancy rate, all things being equal (age, eggs, uterus), will be higher than that of IVF in heterosexual couples, since these obviously have a sterility problem, and couples of women go for this method purely for a biological issue, not for sterility, and they will also use good quality semen.
In this sense, the embryologist of FIV Ochoa, Lourdes Fernández, explains that in order to achieve the best results, it is very important that the ovules provide the best quality / quantity, and that the partner providing the uterus (in this the age factor is secondary) does not have any pathology or abnormality issues.
Obviously, this may conflict with the wishes of the couple, who usually come with a pre-established role, which may not be the ideal one from a medical point of view. In any case, the wishes of the couple will always be respected, informing them, as accurately as possible, of the possibilities of pregnancy according to their characteristics.
The economic cost of this treatment in IVF Ochoa is about 4,700 euros, including the treatment of both partners and donor semen, a figure to which should be added the cost of the medication, which is around 1,000 euros.