Wednesday, 4 February 2015

Testicular Feminisation Syndrome / Baby through surrogacy .



At Gift IVF, we are proud to have helped many intended parents realize their dream through IVF and Surrogacy. This is the unique story of a couple, whose aspiration to become parents were fulfilled at our clinic.  Well, this is not a story, it is a true happening however, the names and places have been changed to conceal the real identity.

Ram & Laxmi were childhood friends, they lived and studied in the same village and school. They used to walk along the same path near to the paddy fields, through the mango grooves to the school every day and soon they fell in love. Nobody took it seriously as everybody thought this was just another teenage infatuation. Years went by and these children grew to adolescence and into adulthood and their bond grew stronger with time. Ram grew to be a strong handsome young man and Laxmi turned to a beautiful curvaceous young lady. Little did they realize what was in waiting for them.

As Ram and Laxmi turned 27 and 25, it was time to get married as was the custom. There was no  obstacle, as the families knew each other and wedding went on smoothly with splendor and grandeur. Towards the end of the celebrations the young couple was led into their nuptial bedroom for their first night together with the traditional glass of milk. It was then that Ram came to a shocking realization that Laxmi was suffering from a disease called Testicular Feminisation Syndrome.

Testicular Feminisation Syndrome,  more appropriately called the complete Androgen insensitivity syndrome (AIS),  is a genetic disorder that makes XY (male) fetuses insensitive (unresponsive) to androgens (male hormones). When a baby is conceived the male gamete or sperm decides if the baby should be a boy or a girl. If the sperm  fertilizes the egg that has XY chromosome the baby is a boy and if it is with an XX chromosome the baby is a girl. It is in their adolescent stage the differentiation of males and females happen, till then boys and girls are very similar. In puberty they develop the Gonads (The primary sex organ) ovaries in girls and testicles in boys. The males, born with the XY Chromosome have testicles and starts to produce a hormone called the Androgen from the puberty stage which gives them the male characteristics – such as musculature, broad shoulders, facial hairs, bass voice etc… and the baby with XX Chromosome is born a girl and from puberty produces female hormones namely Estrogen and it is this hormone which gives women the feminine secondary sexual characters – curves, breasts, soft smooth skin, long hair, etc…

People with this syndrome cannot be diagnosed easily as they have no symptoms. They are born looking externally like normal girls, whereas geno typically they are males and are infertile. Socially they are considered as neither male nor female. Internally there is a short blind-pouch vagina and no uterus, fallopian tubes or ovaries. For some even the vaginal orifice is absent. There are testes in the abdomen or the inguinal canal which is usually mistaken for ovaries and during adolescence they produce high amount of Androgen but as the name of this syndrome signifies – the cells in the body are insensitive to Androgens and these get converted to Estrogen. Hence, a person with AIS will look externally like a beautiful woman, as in the case of Laxmi. As this is not a common condition and since discussing sex is considered a taboo in our culture, these conditions often go unnoticed and undiagnosed. The complete androgen insensitivity syndrome is usually detected only at puberty, when a girl should but does not begin to menstruate. Many of the girls diagnosed with this syndrome have no pubic or auxiliary (armpit) hair. They have luxuriant scalp hair without temporal (male-pattern) balding. As they do not have uterus or ovaries, they are sterile and cannot bear children.

Recorded descriptions of the effects of androgen insensitivity syndrome dates back to hundreds of years, although significant understanding of its underlying histopathology would not occur until the 1950s. This syndrome was formally identified in 1950. There are about 7,500 people affected with AIS in USA alone. The testicles in these patients produced a hormone that had a feminizing effect on the body, a phenomenon that is now understood to occur due to the inaction of androgens, and subsequent aromatization of testosterone into estrogen. In this condition, an organism is born with primary sex characteristics of one sex but develops the secondary sex characteristics that are different from what would be expected on the basis of the gonadal tissue (ovary or testis).

Coming back to our story, Laxmi had not disclosed this to anybody until now. Ram, who was truly in love with Laxmi, being a very kind hearted and understanding person, decided to face the consequences together. They visited various hospitals and clinics in India and in USA, where Ram was working. But they got the same reply everywhere that, Laxmi is a typical complete AIS candidate who did not even poses a vaginal orifice and they cannot have children. A vaginoplasty was done which improved their sex life, but they were not happy as they craved for a child. This was when they approached us. I was able to explain to them about surrogacy and availability of donor egg. This was a turning point in their life. Using Ram’s sperm and a donor egg, IVF was done and successfully the embryo was transferred to a surrogate mother. 36 weeks later a baby girl was born and their happiness cannot be described. Ram and Laxmi were shedding tears of happiness and she could not take her eyes off their baby and she was holding her close to her bosom for hours together.

These are the moments worth living for, to see the joy in the eyes of those who had lost all hopes of having their progeny. We are also content that we could aid in fulfilling their dreams, when they had no hope of completing their family. Now they have flown back to the USA, a happy and complete family.

All of us had a prayer on our lips “May they live happily ever after”……………………

Dr. Mani
Surrogacy Specialist
Director - GIFT IVF Centre

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