- 5. 5. 2019
- Reproductive health
COUPLES EXPERIENCING PROBLEMS CONCEIVING A CHILD AND DEALING WITH THE CHALLENGES OF INFERTILITY EXPERIENCE THE SAME LEVEL OF STRESS AS GOING THROUGH THE TREATMENT OF A LIFE-THREATENING ILLNESS.
FORTUNATELY, MODERN FERTILITY TREATMENT METHODS ARE GIVING THEM A BETTER CHANCE THAN EVER OF ACHIEVING THEIR DREAM OF BECOMING PARENTS.
WHAT IS IVF?
IVF is a medical and surgical approach to conception involving fertilising eggs outside a woman’s body – in a dish.
Women produce one egg a menstrual cycle, but for IVF several eggs are needed to increase the effectiveness of each procedure. Women, therefore, take stimulating medications to “boost” egg production.
Matured eggs are collected using a minor surgical procedure in an IVF clinic and fertilised in the embryology laboratory with the partner’s sperm.
After prolonged cultivation (five days), one or two of the best developing embryos are inserted into the woman’s uterus. If there are more good quality embryos available those are frozen for future use.
IVF treats infertility caused by various factors, including damaged or blocked fallopian tubes, male problems (such as low or no sperm count), endometriosis, anatomic abnormality or unexplained infertility.
More and more often IVF is being used to preserve fertility by egg, sperm and embryo freezing.
INNOVATIONS IN IVF
The most important advances in IVF are embryo biopsy and genetic analysis (PGS/PGD). Those methods help address the challenge of embryos that seem to look good in the laboratory, but turn out to be chromosomally abnormal. Having too many or too few chromosomes increases miscarriage rates.
Embryologists choose the best developing embryo for embryo transfer according to a grading system based on their appearance. Unfortunately even top-rated embryos can have chromosomal abnormalities. However, we can now safely biopsy a few cells from each embryo, do genetic screening, and freeze the embryos while waiting for results. Then we are able to select only chromosomally normal embryos for transfer, rather than relying on their appearance alone. This reduces the risk of miscarriages by about half.
Also, those couples at risk of having a baby with a genetic disease, such as Tay-Sachs, cystic fibrosis, or sickle-cell anemia, may undergo IVF to have their embryos genetically diagnosed and reduce the odds of transmitting the disease to their children.
Another great advantage of chromosomal screening is single-embryo transfer. It was standard practice for many years to transfer two or more embryos at a time in order to maximise the chance of a successful pregnancy. This resulted in a rise in women carrying multiples, which increases the risk of serious maternal and foetal complications.
Since genetic screening provides us with information about which embryos are more likely to lead to healthy pregnancies and babies, in many cases we are able to select just one chromosomally normal embryo to transfer. Thanks to genetic screening even women over the age 40 can achieve an approximate 60 percent pregnancy rate with single-embryo transfer — about the same as with two embryos, but with significantly less risk of twins.
With the shift to chromosomal screening, embryos are increasingly being frozen and then thawed and transferred in a later monthly cycle. A recent study published in the Journal of Assisted Reproduction showed that transferring frozen-thawed embryos to a woman’s uterus during a normal monthly cycle is more likely to result in pregnancy and live birth than fresh embryos placed into a uterus stimulated with fertility medications.
Among other IVF advances is the medication used to increase the production of eggs and speed up their maturation. Ovulation is triggered through injections of the pregnancy hormone human chorionic gonadotropin (hCG). However, hCG can be problematic for some women, as its use can lead to potentially dangerous condition – ovarian hyperstimulation.
Modern fertility centres more often use gonadotropin-releasing hormone agonist (GnRHa), stimulating the brain’s own luteinizing hormones (LH). LH is the body’s natural trigger for egg production. It circulates long enough to prepare the eggs for harvesting, but not enough to activate ovarian hyperstimulation.
The Sooner, the Better
If you have fertility issues, or are worried you might have, the best thing you can do is to seek out a fertility specialist. Since you are born with all the eggs you will ever produce, and this egg supply decreases as you age, the sooner you seek assistance, the more likely a fertility specialist will be able to help you.