Since the first test-tube baby in 1978, fertility medicine has made incredible advances. But there is still a lot to uncover. According to the most recent statistics from the Canadian Fertility and Andrology Society, there were more than 27,000 cycles of in vitro fertilization (IVF) in Canada in 2012, but of those, only 5,971 resulted in live births. Scientists around the world are diligently researching the intricacies of infertility treatments in the hopes of making them more successful. From something as simple as squeezing an embryo to see if it’s resilient to ideas as mind-boggling as using DNA from three parents to form a baby, their work gives hope to parents everywhere who are struggling with infertility. Here’s a roundup of some of the latest infertility treatments and research.
1. Follicle-stimulating hormone Typically, during in vitro fertilization, doctors give high doses of follicle-stimulating hormone (FSH) to a woman to encourage follicles in the ovaries to grow into a plethora of eggs that can be harvested all at once. These are then combined with sperm in a petri dish. But it turns out that too much FSH (typically produced in variable amounts by the pituitary gland during the menstrual cycle to result in one egg being released) can actually make it less likely for a woman to get pregnant during IVF.
A study published in the journal Fertility and Sterility in 2015 looked at 650,000 IVF cycles in the U.S. and found that the more FSH a woman was given, the less likely she was to deliver a live baby, with the likelihood dropping by as much as 15 to 20 percent. The scientists hope these results will fuel more research into just how much FSH is optimal to produce a successful pregnancy.
2. DNA Fragmentation Index Couples who choose to have their egg and sperm mixed in the lab have two options: in vitro fertilization (in which a harvested egg is placed in a petri dish with a large number of sperm in the hopes that one will fertilize the egg) and intracytoplasmic sperm injection (a more technologically advanced procedure in which the sperm with the most potential is injected right into the egg). Intracytoplasmic sperm injection (ICSI) adds about $1,500 to the cost of IVF and is typically recommended for couples for whom the sperm quality is very poor or the egg has a hardened exterior, making it difficult to penetrate.
Now, research out of Sweden shows that analyzing the sperm using a specialized process called the DNA Fragmentation Index (DFI) gives couples a clearer indication of whether paying the extra money for ICSI is the way to go. This DFI process looks at whether there are any chromosomal breaks in the sperm that could decrease fertility. The study, conducted on more than 1,600 couples, found that when the sperm had many chromosomal breaks, the couple was more likely to conceive using ICSI rather than with traditional IVF.
3. Squeezing embryos Researchers are constantly looking for better ways to determine which embryos will have the best chance of implanting in the uterus and resulting in the birth of a baby.
Currently, embryologists assess the embryos after a few days in the lab to see which ones look the best. Some clinics have a relatively new photo technology that actually records an embryo’s development for a more accurate view. Others offer services where they biopsy the egg and send the sample away to have the chromosomes counted.
But scientists at Stanford University say they’ve discovered a much simpler way of determining the viability of an embryo: squeezing it. They first tested their theory on mice and found that if the embryo exhibited “push back” at one hour old, it was far more likely to be healthy at the blastocyst stage. Half of these healthy embryos went on to produce live baby mice.
The scientists transferred their knowledge to human embryos and were successfully able to predict which embryos would be healthy at the blastocyst stage with 90 percent accuracy. More testing is needed, but if squeezing an embryo ends up being an accurate way to determine the viability of an embryo, it could go a long way towards a higher success rate of IVF.
4. INVOcell In a typical in vitro fertilization scenario, the embryo develops in an incubator in the lab before implantation three to five days later. But a U.S. company says its product, called the INVOcell, is just as effective as an incubator and has the potential to be much cheaper. The reason? The woman carries the embryo around with her, in her vagina.
The INVOcell, which has been approved for use in infertility treatment in Canada and the U.S. but is only available at select clinics, uses the woman’s own body temperature to regulate the embryo’s environment. The sperm and egg are mixed in a lab, then placed in the INVOcell, a tiny capsule that is inserted into the vagina. After five days in the capsule, the embryos are removed and one or more is implanted into the uterus as usual.
In February, the company announced results from a Phase 4 trial that showed that the INVOcell was just as likely as traditional IVF to produce a successful pregnancy and a live baby.
5. Augment with egg precursor cells Low-quality eggs are one of the biggest impediments to a successful fertility treatment. OvaScience, a company based in Cambridge, Massachusetts, hopes to change that with a new treatment that it says will make a woman’s eggs more viable.
This experimental treatment targets the mitochondria, the tiny structures in cells that use food and oxygen to make energy for the cells. As a woman gets older, the mitochondria in her eggs get tired and become less effective, potentially leaving her with lower-quality eggs that are less likely to be successfully fertilized.
Scientists for OvaScience have discovered something called egg precursor cells, cells that line the ovaries but would not normally become eggs. In this treatment, called Augment, healthy mitochondria from these precursor cells are combined with sperm before being added to the egg. This procedure is still new and investigational and only available at a few clinics in Canada.
OvaScience is also using its egg precursor cell technology, called EggPC, to develop more technologically advanced fertility treatments, including actually growing eggs from the precursor cells.
6. Mitochondrial replacement techniques This cutting-edge research is also targeted at the mitochondria (those energy-producing structures in our cells), but it gives hope to families in which the mother has a mitochondrial disease, an inherited disease where a problem with the mitochondria results in less energy being converted and causes the cell to stop working properly or even die. There are a myriad of mitochondrial diseases and, depending on what cells are affected, they can cause everything from poor growth and liver disease to muscle weakness and seizures.
Mitochondrial replacement techniques (MRT) create an embryo using DNA from the nucleus of the mother’s egg and mitochondrial DNA from a donor to prevent the mitochondrial disease from being passed on to the child. This new egg is then mixed with the sperm to form an embryo.
But don’t expect this treatment to arrive at a fertility clinic near you anytime soon. While MRT are legal in the U.K., governments on this side of the pond are more cautious. In Canada, the procedure is banned outright under the Assisted Human Reproduction Act. However, in the U.S., the Institute of Medicine concluded in February that it was ethically OK to conduct clinical research on MRT but with many stipulations for safety and monitoring.