Eyear, tens of thousands of people in the US try to conceive using In Vitro Fertilisation (IVF), a process by which an egg is fertilized in a laboratory, then transferred into a patient’s uterus. Although IVF has become relatively common, it is still uncertain that: About 70% of people under 35 who were first-time IVF patients in 2019 and using their own eggs had a baby within two years, According to a report by the reproductive industry. Success rates decrease as the patient ages.
Given the physical, financial, and emotional costs of failed cycles, researchers around the world are working to make IVF more effective. “In medicine, no one can guarantee success,” says Dr. Zev Williams, chief of reproductive endocrinology and infertility at Columbia University Irving Medical Center. “The question is, how close can we get?”
Baby step by step towards better tests
Some of those efforts focus on how to improve screening tests to help patients optimize their chances of having a healthy baby through IVF. One of the most common tests is called preimplantation genetic testing for heterozygotes (PGT-A). After the egg is fertilized to create an embryo, your doctor will perform a biopsy to look for an aneuploidy, or chromosomal abnormality that may increase your risk of IVF failure, miscarriage, or genetic disorders at birth. Proponents of PGT-A argue that it increases the likelihood of success by identifying embryos that are more likely to result in a healthy pregnancy.
But these trials are controversial. Some learn suggests that PGT-A does not increase fertility and the result is enough false positive that surviving embryos are often discarded — potentially making it harder for people to get pregnant because they have fewer embryos to work with. Genetic tests even add extra fees for an already expensive process.
Nearly 10 years ago, Dr. Norbert Gleicher, founder of the Center for Human Reproduction in New York City, become bored with PGT-A that he began to receive patient permission to implant embryos whose tests had been marked as having a high probability of failure. “Hey, we’re starting to see healthy, chromosomally normal pregnancies,” he said.
Gleicher and colleagues from Rockefeller University have shown that some embryos with certain chromosomal abnormalities correct themselves during pregnancy. a little research published last year. Of the 32 women in the study, only 5 had given birth — but the results demonstrate that at least some imperfect embryos can lead to a normal pregnancy, Gleicher said. That’s especially important for older IVF patients, who often have fewer embryos to start with and therefore need as many embryos as possible to maximize their chances of conception. “Imagine how many embryos are currently not being transferred,” says Gleicher.
That question haunted California resident Lital Gilad-Shaoulian, who was undergoing the PGT-A test when she decided to try for her fourth child at the age of 39. She was surprised to learn that the test had split. The removal of all her embryos was abnormal, especially when she was three. older children are all conceived through IVF. “I remember saying to myself,[The results] is wrong,” she said.
For years, she repeated the emotional and expensive process of harvesting and fertilizing eggs, only for most of the resulting embryos to be considered abnormal. Finally, after consulting with clinicians at the Center for Human Reproduction, she convinced the local doctor to proceed with one of the abnormally high-grade frozen embryos. her best — a scary decision, but she felt it was worth the try.
She became pregnant, which Gilad-Shaoulian recalls shocked her doctor. Additional chromosomal testing at 10 weeks of pregnancy returned normal. And about 18 months ago, she gave birth to a baby girl. Her daughter had some unrelated health problems following a birth complication, but Gilad-Shaoulian says she is developing normally and is “perfect” and “very smart”.
While genetic testing may be appropriate for some, Gilad-Shaoulian wishes she would never do it. “There can be tens of thousands of good embryos thrown away from people who are working hard and desperately wanting to have children,” she said. “I’ve been there. I know.”
Experts like Williams, however, stand by the utility of testing. While some embryos that fall in the gray zone between viability and non-viability can produce a healthy baby, he says pre-implantation testing can identify embryos that are very unlikely to succeed, which can can provide significant benefit to the patient.
In 2022, Williams’ team at Columbia new technology development to provide genetic test results in hours rather than days or weeks, potentially allowing viable embryo transfers on the same day they are tested. While the test couldn’t fix any of the problems it detected, Williams said quickly identifying a patient’s best embryo could help them get pregnant faster, with fewer costly failure cycles. and emotionally difficult miscarriage. “The big difference would be how long the pregnancy was, and how much loss did she have to go through before getting pregnant?” Williams said.
Other researchers are also trying to tweak PGT-A to make it more effective. Today, clinicians take biopsies from what becomes the placenta, so “you really don’t know what goes on inside the cells that form the baby,” says Kylie Dunning, a biological biologist. at the University of Adelaide in Australia, said. Dunning recently co-author an article describes a new approach: molecular imaging of embryos to assess fetal cells, rather than those that form the placenta. She believes that will clarify which embryos are truly non-viable. “Hopefully that will lead to more patients taking their babies home,” she said.
Another research group, this one led by scientists from Australia’s RMIT University and Monash IVF, has published a research pair in 2021, describes another possible target for IVF testing. They describe a “golden window” for treatment: a period of several days in a woman’s natural reproductive cycle when levels of a molecule known as PCX are lowest. PCX makes the surface of the uterus slippery, potentially preventing the embryo from attaching. Theoretically, if clinicians could determine when PCX levels are lowest and transfer embryos when they are, that could improve the chances of pregnancy.
Study co-author Guiying Nie, a reproductive biologist, said her team is still working to validate her findings, so there is currently no such trial for patients. The challenge was to find a quick, non-invasive way to test PCX levels. She says some kind of imaging test could work, but it’s too early to tell.
A similar screening technique, called endometrial sensitivity analysis, analyzes tissue from a uterine biopsy to try to determine the best time for an IVF cycle, but some studies suggest see it’s not exactly as promised.
Look beyond the tests
There’s a limit to any test, says Williams, so his lab is trying to find other ways to increase the success rate. For example, his clinic uses a robotic arm to prepare small trays where embryos grow to eliminate human error.
Other companies are also delegating some tasks to robots. Start up TMRW created automatic tanks for storing frozen eggs and embryos, ideal removal Risks like broken refrigerator. Sensors in the tank detect changes in storage conditions, then notify staff so they can correct problems before they become serious.
Artificial intelligence is also promising for fertility. Research teams are trying to teach AI systems to choose the best embryos for implantation by analyzing their images, and various consumer apps use AI to help women determine when they’re likely to be. Peak conception is based on fluctuations in hormone levels and other factors.
Make fertility care more convenient
Improving fertility care logistics is also important. New Hope Fertility based in New York offers a program called “IVF at home,” “Make the process as remote as possible. A patient begins with an online consultation, then, when appropriate, has fertility drugs delivered to their home. Patients only need to come to the clinic for key appointments such as egg collection and embryo transfer.
Some clinics, including New Hope, also offer “mini” IVF, a procedure similar to traditional IVF but with fewer medications or lower doses to keep costs down. Because patients receive less stimulant medication, they may produce fewer fertilized eggs – but mini IVF could be the right choice for patients with limited budgets or health conditions. certain health, According to the Cleveland Clinic.
Williams’ lab has also been working to make IVF more convenient for couples. They have developed a new transport technique, which uses a substance that keeps the sperm warm and survives the sperm samples for several hours, to allow men to produce samples at home and then have them shipped to the clinic, rather than conducting procedure at the medical office. It may seem like a small change, but Williams says sperm samples tend to be of higher quality when they are collected at home, possibly because men are more comfortable.
Every screening counts when it comes to fertility care. “We’re really fighting for a percentage improvement in success rates, because every single person can be life-changing for families,” Williams said.
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