What’s New in Infertility Treatment?
New technologies to help couples achieve pregnancy continue to evolve. We look at three.
You may be surprised to learn that infertility affects one out of eight couples in the United States. This means one in eight couples has been unable to achieve pregnancy after one year of trying or after six months if the woman is over 35.
Perhaps less surprising is that a woman’s fertility peaks in her 20s and decreases as she ages. Since many women delay starting a family until their mid-30s—deciding to pursue a career, continue education, find the right partner—it’s not only more difficult to achieve pregnancy then, but the chance of miscarriage also increases. This higher miscarriage rate is because older women have fewer eggs and a greater percentage of those eggs become chromosomally abnormal as a woman ages.
The good news is that new technologies to help couples achieve pregnancy continue to evolve.
Here’s a brief overview of three new assisted reproductive technologies—egg freezing to preserve fertility potential, pre-implantation genetic screening (PGS) of embryos, and time-lapse videography of embryo development after in vitro fertilization (IVF).
Premenopausal women can now freeze their eggs and virtually stop the biological clock at any age. And women diagnosed with cancer can preserve their fertility by freezing their eggs before radiation and chemotherapy.
Freezing eggs has been perfected over the past five years through a new lab technique called vitrification. This technique has become increasingly widespread, with many celebrities—like Sophia Vergara of the television show Modern Family—publicly extolling its virtues.
The Process:The process begins with a woman taking fertility medications to stimulate her ovaries to produce multiple follicles, each containing an egg. When her eggs are ready for harvesting, the woman’s physician performs an egg retrieval, done while the woman is under anesthesia. Next, the eggs are frozen in an embryology laboratory and stored in a liquid nitrogen tank. Theoretically, eggs can remain preserved by this method for many years.
When she’s ready to have a baby, the woman has her eggs thawed and prepared for in vitro fertilization (IVF). The woman’s eggs are fertilized with her partner’s or donor sperm, and the resulting embryos are cultured in an incubator. After three to five days, the embryos are transferred into the woman’s uterus to achieve pregnancy.
When is the right time to freeze eggs? Some reproductive specialists recommend freezing eggs by the time a woman turns 35 or even earlier. To help decide when it’s best to freeze eggs, a woman may want advice from a fertility specialist, and she may consider having a blood test for the hormone anti-mullerian hormone (AMH). AMH decreases as a woman ages and its concentration is an estimate of ovarian reserve. In other words, the test measures the capacity of a woman’s ovaries to provide eggs capable of fertilization and resulting in a healthy pregnancy.
Is it too late?Fortunately, today’s technology allows fertility specialists to offer a variety of methods to overcome many causes of infertility. Unfortunately, one thing physicians can’t do is make older eggs younger and healthier.
Many infertile women who have poor quality eggs still have the option of using donated eggs from a young, healthy woman to reach their ultimate goal of having a child.
New egg freezing technology has enabled fertility centers to offer frozen donor egg banks. Couples can select a young egg donor based on many characteristics—medical history, physical characteristics, ethnicity and even religion.
Preimplantation Genetic Screening (PGS)
By the time a woman is in her mid-30s, up to 40 to 60 percent of her embryos may have chromosome abnormalities—a condition called aneuploidy—and the number of abnormal embryos increase each year. Some aneuploid embryos fail to grow and implant, others may result in miscarriage, and still others result in having a baby with Down syndrome.
Even though all of a woman’s embryos can look the same, some are usually aneuploid. Preimplantaion genetic screening (PGS) is a new technique to identify embryos that are chromosomally normal. In this screening process the outer layer of the embryo that eventually develops into the placenta is biopsied, and the biopsies are sent to a genetics lab for chromosomal testing. (Note that no part of the future fetus is compromised or missing because of the removal of cells.)
PGS allows the doctor to identify which embryos have the correct number of chromosomes and then select the healthiest for transfer back to the uterus (or freeze for later use) to improve the chances of a positive outcome. This screening also allows the couple to learn the gender of the embryo, if desired.
Time-Lapse Videography of Embryo Growth
A new FDA-approved technology—the Early Embryo Viability Assessment (Eeva) System—provides quantitative information that can be combined with more traditional visual review assessment of embryos to aid in deciding which to transfer for IVF. The Eeva system uses a time-lapse camera and proprietary software that analyzes the timing of important changes in embryo development to differentiate among embryos that look, but are not, equally healthy.
The new non-invasive Eeva Test is based on ground-breaking research and innovation licensed from Stanford University. News of this breakthrough was published in Nature Biotechnologyand was recognized as a “Top 10 Medical Breakthrough” by TIME magazine.
Researchers are collecting imaging data on embryos and correlating Eeva parameters with Pre-implantation Genetic Screening, described above, to increase healthy outcomes even more.
Five million additional babies have been born worldwide since 1978 as a result of assisted reproduction technologies. Advances like those discussed here will help keep that number growing.
If you’re having trouble getting pregnant, or if you are considering preserving your fertility potential, don’t wait until it’s too late. Seek advice from a specialist in reproductive endocrinology and infertility who can offer the latest assisted reproductive technologies.
Sharon Anderson, Ph.D., is Lab/Scientific Director for Main Line Fertility Center in Bryn Mawr. She earned a Ph.D. in Reproductive Physiology from Penn State University and is a board-certified high complexity laboratory director (HCLD) in embryology and andrology. To learn more, visit MainLineFertility.com.
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