IVF Patients

[dgelagay]

We have a patient who become pregnant using Assisted reproductive technologies. The patient used an Egg donor, a surrogate and her husbands sperm to make her dream a reality.

 

1. Surrogate                          Blood Type O Positive,  Antibody Screen Positive ( Anti C and Anti e ), Antibody titer <1 anti-Ce and <1 anti e
2. Sperm Donor                    Blood Type B Positive,  Antibody Screen Negative, Antigen ID   C Negative, e Positive
3. Egg Donor                        Blood Type O Negative,  Antibody Screen Negative, Antigen ID  D Negative, C Negative, E Negative, c Positive, e Positive

The surrogate is 11 5/7 weeks pregnant. 

 

My questions is what is the risk of the fetus for HDN.

 

Thank you

Desta

[galvania]

Dear Desta

If this is a real case, then I am always amazed that clinics practising IVF don't look into the aspect of antibodies more closely.  I knew of a case recently where a woman with anti-U was advised not to have any more children, so went to a clininc for IVF (from sperm from a U+ donor) and was an absolute nightmare for the local transfusionservice who had to cope with the inevitable damage.

I think in this case, you might get away with it as anti-e does not usually cause severe HDN - but on the other hand, the baby will have to be homozygous for the e antigen, so this is not a normal situation.  Also, as the surrogate has already formed 2 antibodies she could easily form more to blood groups from other systems.  I hope at least that neither of the donors is K+!

I would say - keep an eye open for developing antibodies and boosting of the existing ones.

[Malcolm Needs ☆]

I could not agree more Anna.

We had a case in the UK where a lady with a strong anti-D had two fertilised eggs implanted. One was D-, but the other was D+, with the predictable outcome for the D+ foetus.