eEach year, tens of thousands of people in the United States try to get pregnant using In vitro fertilization (IVF), a process by which eggs are fertilized in a laboratory, and then transferred to the patient’s uterus. Although IVF has become relatively popular, it’s not a sure bet: About 70% of people under 35 who were first sick in 2019 and used their own eggs had a baby within two years, According to the Fertility Industry Report. Success rates decline as patients age.
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. Ziv Williams, chief of endocrinology and infertility at Columbia University Irving Medical Center. “The question is, how close can we get?”
Baby steps towards better tests
Some of these efforts focus on how to improve screening tests aimed at helping patients improve their chances of having a healthy baby through IVF. One of the most common tests is called a preimplantation genetic test for aneuploidy (PGT-A). After eggs are fertilized to create embryos, doctors take biopsies to look for aneuploidy, or chromosomal abnormalities that may increase the risk of IVF failure, miscarriage, or genetic disorders at birth. Proponents of PGT-A argue that it increases the odds of success by identifying the embryos most likely to lead to a healthy pregnancy.
But these tests are controversial. some studies indicate that PGT-A does not increase the likelihood of childbirth and It results in a sufficient number of false positives Viable embryos are routinely discarded – making it difficult for women to get pregnant because they have fewer embryos to work with. Genetic testing also adds more fees to Really expensive process.
Nearly 10 years ago, Dr. Norbert Gleicher, founder of the Center for Human Reproduction in New York City, They became very frustrated with PGT-A That he began to seek patients’ permission to implant embryos, as testing indicated there was a high chance of failure. “We’re starting to see healthy, chromosomally normal pregnancies,” he says.
Gleicher and colleagues from Rockefeller University in small study Posted last year. Of the 32 women in the study, only five gave birth — but the results showed that at least some incomplete fetuses can lead to normal pregnancies, says Gleicher. This is especially important for older IVF patients, who have fewer embryos to start and therefore need as many as possible to increase their chances of conceiving. “Imagine how many embryos are out there that haven’t currently been transferred,” says Gleicher.
This question haunts California resident Littal Gilad Shaolian, who underwent a PGT-A test when she decided to try for a fourth child at age 39. I was surprised to learn that the test classified all of her fetuses as abnormal, especially since she was three. All older children were conceived through IVF. “I remember saying to myself,”[The results] wrong.
For years, she repeated the emotional and costly process of egg harvesting and fertilization, only for most resulting embryos to be considered abnormal. Finally, after consulting with doctors at the Human Reproduction Center, she convinced her local doctor to proceed with one of her top-rated but abnormal frozen fetuses—a frightening decision, but one she felt was worth a try.
She did get pregnant, which Gilad Shaolian recalls shocked her doctor. The extra chromosomal test at the 10th week of pregnancy is back to normal. And about 18 months ago, she gave birth to a baby girl. Her daughter had some unrelated health issues after birth complications, but Gilad Shaolian says she is developing normally and is “perfect” and “very smart.”
While genetic testing may be appropriate for some people, Gilad Shaolian wishes she had never done so. “There are likely tens of thousands of good embryos being discarded from people who are hardworking and eager to have a baby,” she says. “I’ve been there. I know.”
However, experts like Williams stand by the usefulness of the test. While some embryos that are in the gray area between viable and non-viable embryos may result in a healthy baby, he says pre-implantation testing can identify those that are unlikely to succeed, which can bring significant benefits to patients.
In 2022, the Williams team in Colombia New technology development To deliver genetic test results within hours rather than days or weeks, which could allow viable embryos to be transferred on the same day they are tested. While the test can’t fix any problems it detects, Williams says that quickly identifying a patient’s best embryos can help them get pregnant faster, with fewer expensive failed cycles and emotionally difficult miscarriages. “The big difference is how long does it take to get pregnant, and how many losses do you have to go through before you get pregnant?” Williams says.
Other researchers are also trying to modify PGT-A to make it more effective. Currently, doctors take biopsies of what has become the placenta, so “you don’t really know what’s going on inside the cells that make up the baby,” says Kylie Dunning, a reproductive biologist at the University of Adelaide in Australia. Recently ordered Co-author a paper Describe a new approach: taking a molecular image of the fetus to assess the fetal cells, rather than those that make up the placenta. She believes this will clarify which embryos are really not viable. “Hopefully this will result in more patients taking a baby home,” she says.
Another research team, led by scientists from Australia’s RMIT University and Monash IVF, published a pair of studies In 2021 he describes another possible target for testing before IVF. They describe the “golden window” of treatment: the period of many days in a woman’s normal reproductive cycle when levels of a molecule called PCX are at their lowest. PCX makes the surface of the uterus slippery, which may prevent embryos from attaching. In theory, if doctors can determine when PCX levels are at their lowest and transfer the embryos, it could improve the chances of pregnancy.
Study co-author Guiying Nie, a reproductive biologist, says her team is still working to validate the results, so no such test is currently available to patients. The challenge is to find a fast, non-invasive way to test PCX levels. She says some type of imaging test can work, but it’s too early to say.
A similar screening technique, called endometrial receptivity analysis, analyzes tissue from a uterine biopsy to try to determine the best time for an IVF cycle, but some research suggests It’s not as accurate as promised.
Looking beyond tests
Williams says there is a limit to what any test can do, so his lab is trying to find other ways to increase success rates. For example, his clinic uses a robotic arm to set up small trays where embryos grow to eliminate human error.
Other companies are also shifting some tasks to robots. start TMRW Create automated cabinets to store frozen eggs and embryos, and eliminate them perfectly Accidents like freezer failure. Sensors in the cabinets detect changes in storage conditions, then alert personnel so they can fix problems before they become critical.
AI also bodes well 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 are likely to become pregnant based on fluctuations in hormone levels and other factors.
Make fertility care more convenient
It is also important to improve the logistics of fertility care. New York-based New Hope Fertility offers a program calledAt home IVFThis makes the process as easy to use remotely as possible. The patient begins with an online consultation, and then, when required, fertility medication is delivered to their door. Patients only need to come to the clinic on key appointments such as egg harvesting and embryo transfer.
Some clinics, including New Hope, also offer what’s known as “mini” IVF, a process that’s similar to traditional IVF but uses less or less fertility drugs to cut costs. Because patients receive fewer stimulating drugs, they may produce fewer eggs that can be fertilized – but mini IVF can be the right option for patients with budget constraints or certain health conditions, According to the Cleveland Clinic.
The Williams lab is also working to make IVF more suitable for couples. They have developed a new transfer technology, using a material that keeps sperm samples warm and viable for several hours, to allow men to produce samples at home and then deliver them to the clinic, rather than undergoing the process in a medical office. It may seem like a simple shift, but Williams says sperm samples tend to be of higher quality when collected at home, possibly because men feel more comfortable.
Every refinement is important when it comes to fertility care. “We really struggle for every improvement in success rates,” Williams says, because each one can change families’ lives.
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