|
|
|
|
 |
|
|
There have been incredible advances
in IVF therapy since the first days of the “test tube baby” and
the pace of these technical advances have picked up exponentially
in the last ten years. No where is this more evident than
with respect to male infertility.
In 2006 it was estimated that fully 20% of infertility is due male factor alone. In the early to mid 1990’s
a technique known as intra-cytoplasmic sperm injection
(ICSI) was developed for male factor infertility, in which
a single sperm can be microscopically selected and directly
inserted into an egg. As a remedy for male infertility,
ICSI has had a revolutionary effect. Before ICSI the only
option for men with poor semen parameters was to adopt
or to use donor sperm.
|
Besides ICSI, the expanding IVF repertoire includes a host of other cutting edge technologies that were developed and perfected over the last 10 years. One of the most exciting developments in IVF is preimplantation genetic diagnosis (PGD). This technology enables embryos to be tested during an IVF cycle for genetic or chromosomal conditions (such as Cystic Fibrosis or Down Syndrome) prior to the embryos being placed back into the uterus.
PDG is based on the ability of human preimplantation embryos to continue their development into pregnancy after embryo biopsy of a blastomere at the six to eight cell stage, usually three days after fertilization. Over the past several years, there has been a dramatic increase in the number of patients at La Jolla IVF who wished to utilize PGD. Patients of advanced maternal age are interested in having the chromosomal integrity of their embryos analyzed because chromosomal abnormalities in the offspring of older women are more likely to occur. Strangely enough, at La Jolla IVF we have also found that the embryos of older men are also more likely to have abnormalities as well as men with very poor semen parameters. Patients who have had multiple miscarriages and multiple failed IVF cycles are also candidates for PGD. There are also an increasing number of patients who are interested in doing PGD for sex-selection. As a by-product of testing the embryos for abnormalities the sex of the embryos is also ascertained. Although PGD was originally designed to diagnose inherited single gene defects, today it has expanded far beyond that narrow focus and is as we speak being even further expanded to include being able to look at the full complement of chromosomes. Within the next ten years, a full array PGD will probably become the standard of care for all IVF cases.
|
Another great technological advance in improving IVF success rates while reducing the multiple birth rate is our ability to transfer day 5 embryos as opposed to the older method of transferring day 3 embryos. Research throughout the late 1990’s identified that as the embryo develops, its nutritional requirements change due to metabolic factors. This research lead to the development of markedly improved laboratory culture media that is tailored to the embryo’s specific developmental stage. There is now abundant evidence that transferring blastocyst embryos into the uterus results in higher implantation rates per embryo transferred. At La Jolla IVF, for example, when placing two blastocyst embryos (regardless of the age of the woman) we have found that our pregnancy rates are far superior than they were just a few years ago.
|
Over the past decade the use of third party reproduction
has more than quadrupled. Third party reproduction includes all cycles where
there is an egg donor or sperm donor (or both), embryo donation or the use
of a surrogate to carry the baby (gestational surrogacy has far outpaced the
older method known as traditional surrogacy). Patients requiring these types of treatments are usually somewhat down the road in terms of their understanding of traditional IVF treatments so they tend to be more proactive in seeking out information via the internet and surrogate and egg donor agencies. Many such agencies have sprung up since the mid 1990’s and their internet presence has expanded the information available for people researching these options. With the use of IVF technology it is actually possible to have as many as five people involved in the process of having a baby. These are the genetic mother (either an egg donor or the intended mother who contributes the oocyte), the genetic father (either a sperm donor or the sperm of the intended father), the biological mother (the woman who has the embryo transfer and who is then pregnant, carries the baby and delivers the child), the recipient mother (the intended mother of the child ), and the recipient father (the intended father of the child). Needless to say, all of this sounds confusing but at La Jolla IVF, for example, the clinic specializes in third party reproduction performing hundreds of egg donor and surrogate cycles per year. The key to having good success rates with these types of cycles is to go to clinics who perform many of these cycles and are experienced with these types of treatments. In our hands the success rates are upwards of 70% per embryo transfer (in cycles where the egg giver is 42 and under). Third party reproduction is obviously the treatment of choice for gay and lesbian couples and some single people as well. With the changing mores of society this group of participants in third party reproduction has grown dramatically over the past decade and will probably continue to grow in the future.
|
About ten years ago a new technology known as egg freezing produced its first baby. Despite the knowledge that eggs do not last forever, many women are still waiting until later to start their families. For a small but ever-increasing group of women, the answer to this dilemma is egg freezing and subsequent banking of these frozen eggs. However, until recently the technique was still considered experimental and was used primarily for patients who had cancer and who were about to undergo chemotherapy that would damage their eggs. Recent breakthroughs in egg freezing techniques have enabled embryologists to better cryopreserve the unfertilized egg and now several hundred babies have been born around the world from this technology. With the latest developments in oocyte freezing, a growing number of women are defying their biological clocks and putting their eggs on ice until they are ready to start a family. An increasing number of women are choosing to freeze their eggs as an investment for their future fertility.
|
Over the past several years the staff of La Jolla IVF has noticed a growing tendency amongst patients who require unusual solutions for their fertility problems, to criss-cross the globe in search of the appropriate infertility treatments. The main reasons for people to seek fertility treatments in countries other than their own are that certain types of treatments are forbidden by law to be performed in their own country, certain categories of patients are not eligible for assisted reproductive treatments in their own country and in some countries the waiting lists to obtain treatments are just too long. This increase in “reproductive tourism” has resulted in enabling many more patients to avail themselves of treatments than would have otherwise been possible.
The field of infertility has been a flurry of activity over the past three decades. Since the first IVF baby was born in 1978, assisted reproductive treatments have been transformed both in their technological advancements and in their effectiveness. Once an improbable game of chance, IVF and its related treatments now offer people battling to have children a refined and largely successful route to parenthood. We have come so far in such a relatively short time. In the grand scheme of things, people who were once considered intractable infertility cases can now experience the joy of a family.
|
|
|
|
|
