Each year, more than 50,000 children are born because of in-vitro fertilization. It's a technique that has revolutionized how doctors treat infertility, but it's not perfect. Three technologies are making the process safer and more successful.
Being a mom is what Valerie Simpson always wanted. At 37, she got pregnant, but the baby died during birth.
"The cord was wrapped around my son's neck, and I lost him," Valerie said.
Valerie struggled to get pregnant again, but had a miscarriage. That's when she decided to try in-vitro fertilization. Doctor William Schoolcraft offered Valerie a new procedure known as ccs. It screens embryos for chromosome problems before they're transferred to the patient allowing doctors to implant only healthy embryos.
"We can get pregnancy rates similar to younger women when we transfer these normal embryos back," said Dr. Schoolcraft, founder and medical director of the Colorado Center for Reproductive Medicine.
Dr. Schoolcraft said with ccs, women 35 to 37 have a 78-percent chance of pregnancy. Those 38 to 40: a 68 percent chance. And women up to 42 have a 62 percent chance. Another technique known as Vitrification is making IVF more effective when embryos have to be frozen.
"You put it in a cooling solution, and very, very rapidly, so it cools within seconds," said Dr. James Goldfarb, reproductive endocrinology and fertility specialist at Cleveland Clinic.
With conventional, slow freezing, about 30 percent of embryos do not survive. With the rapid freezing -- embryos have more than a 95-percent chance of surviving.
Another method called ICSI is making in-vitro a possibility for more men. Instead of placing thousands of sperm around the egg and hoping one will fertilize it, doctors take just one sperm and inject it into each egg. It's about 75 to 85 percent successful.
After having the chromosome test, one of Valerie's eight embryos tested healthy.
"We have a perfect baby boy," she said.
The new technologies aren't cheap. They run between $1,000 and $5,000. That's in addition to the cost of IVF, which typically runs about $13,000 or more per cycle.
RESEARCH SUMMARY
BACKGROUND: Infertility refers to not being able to become pregnant after years of trying to do so. If a woman has multiple miscarriages, it is also called infertility. About one-third of the time, infertility can be traced to the woman. In another third of cases, infertility is due to the man. About two-thirds of couples that are treated for infertility go on to have children. (SOURCE: National Women's Health Information Center)
IVF: In vitro fertilization (IVF) is a procedure to treat fertility problems. During IVF, a woman's mature eggs are retrieved from her ovaries and fertilized by sperm in a lab. The fertilized egg, which is known as an embryo, is then implanted in the woman's uterus. One cycle of IVF takes about two weeks. It is the most effective form of assisted reproductive technology available. According to a New York Times article, more than 50,000 children are born each year to parents who undergo IVF. (SOURCE: Mayo Clinic)
IMPROVING IVF: There are several new techniques doctors are using to improve the success of IVF. These include:
- CCS: Comprehensive chromosomal screening (CCS) is a new method doctors are using to screen embryos before they are transferred to the patient via IVF. The procedure allows doctors to implant only healthy embryos, thus allowing women, especially older women, to achieve higher pregnancy rates. The technique also helps women who suffer miscarriages due to chromosomal abnormalities.
- Vitrification: Sometimes, embryos are frozen before they are transferred to a patient. Doctors used to slowly freeze the embryos, but now, they have seen better results by performing a rapid freeze, which is known as vitrification. With this technique, embryos have more than a 95 percent chance of surviving.
ICSI: Intracytoplasmic sperm injection (ICSI) is a method developed to help couples with severe male factor infertility. The technique involves very precise maneuvers to pick up a single, live sperm and inject it directly into the center of a human egg. The method is about 85 percent successful.
INTERVIEW
William Schoolcraft, M.D., Founder and Medical Director of the Colorado Center for Reproductive Medicine, talks about a new chromosome screening test.
What effect does age have on women trying to get pregnant?
Dr. William Schoolcraft: Age affects primarily the eggs, women are born with all their eggs in so as they get older, their eggs get older along with them. Around 35, there is quite a decline that starts in the egg. By age forty-two to age forty-five, most women can no longer conceive children. So it's a very rapid decline between age thirty-five and age forty-five.
What is the screening process with CCS and how can that change a women's ability or possibility of getting pregnant at a later age?
Dr. William Schoolcraft: The biggest risk of age is that is causes chromosomal abnormalities in those eggs. In older women, if we can do In Vitro Fertilization and create multiple embryos, we can test those embryos and find the embryos that are genetically normal. We can replace just those normal embryos avoiding a bad pregnancy, a miscarriage or a later trimester loss.
They've been doing that for some time, correct?
Dr. William Schoolcraft: The concept of testing has been around awhile, but unfortunately it actually didn't work very well. There were eleven randomized trials involving testing the embryo by taking a cell out on day three and using an older method of chromosomal testing. All eleven randomized trials showed it didn't improve outcomes for patients. We here at CCRM have pioneered a new way to test the embryo. We wait until it's a sixty cell day five blastocyst and then remove a cell or two from the placenta. This doesn't harm the embryo. We then look at all forty-six chromosomes. Much like women would do when she has an amniocentesis that checks her pregnancy at sixteen weeks. Those two steps are really the revolutionary part of this screening. We showed in our published papers that it markedly improves the outcome, the live birth for patients partially in these older age groups.
It's taken from the placenta, not from the embryo?
Dr. William Schoolcraft: The embryo is just four to six cells on day three and that's where the biopsy actually hurt. If you took a six cell embryo and removed one cell, you remove one sixth of the embryo. You don't know if that's a key cell to developing the baby. On day five, it's a sixty cell embryo and the cells around the outside form the placenta, the cells of the interior form the inter cell mass or the baby. So you can take a cell or two from this placenta layer, this outer layer of cells called the trophectoderm which is going to form the placenta, not touching the inner cell mass or the baby. At that stage we've developed a way to do the biopsy which doesn't impact the embryo. It doesn't hurt the embryo, but it does allow us to get the same genetic result as to whether the embryo is normal.
What's the next step?
Dr. William Schoolcraft: The embryos are frozen because it takes about ten days to get the results back, learning with all the embryos we tested and froze, which ones are in fact normal. It's not uncommon for a patient this age to have five or six embryos and just one normal embryo. It's almost like looking for a needle in a haystack. We can then transfer that one embryo and allow the patient to get pregnant. If we had put those embryos back one at a time, she would have out of six embryos five bad pregnancies, perhaps five miscarriages and one baby. We can simply avoid transferring those five embryos that are all going to lead into an abnormal pregnancy. Just transfer quote, "the good embryo".
How much time can you extend women at an older age to have children? Are we talking about age fifty?
Dr. William Schoolcraft: We are still stuck with the fact that the woman needs to be able to produce a normal embryo. We can identify which embryos are normal but if we get to an age where all the embryos are genetically abnormal time and time again, then the testing would only identify that all the embryos are abnormal and the patient wouldn't be having a transfer. Now she wouldn't miscarry or have a bad outcome, but she certainly wouldn't get pregnant. Past age forty-five we're still relying on egg donation. Up to forty-five this has been able to reverse the biological clock in the sense that we can get pregnancy rates similar to younger women when we transfer just these normal embryos back. It used to be that the older patients doing IVF had dramatically lower pregnancy rates. If we can rule out the genetically abnormal embryos, we can avoid that decline in the pregnancy rate that the older women saw as well as avoid bad pregnancy outcomes like miscarriage which are never good for the patient or the couple.
Is CCS utilized only with IVF?
Dr. William Schoolcraft: Yes, it's only with IVF at the present time. If one's going to have an intrauterine test like an amniocentesis, more traditional standard chromosomal testing methods are still used.
Do you see looking down the road any future application for CCS that's not being utilized today; for example younger women that are having difficulty getting pregnant?
Dr. William Schoolcraft: Even now we are applying this to younger women who suffer from recurrent miscarriage. If a women that is in her late twenties or thirties but she's miscarried three or more times, and we've ruled out the other causes of miscarriage and we believe this is due to chromosomally abnormal embryos, then with three bad pregnancies in a row we feel like screening the embryos ahead of time and just putting back the normal embryos is highly effective. In fact, we have shown that the miscarriage rate in those women falls from over fifty percent to around six percent. It's quite an effective way to help women with recurrent miscarriage. In addition to the older women.
FOR MORE INFORMATION, PLEASE CONTACT:
Sarah Stavros
Marketing/Public Relations
Colorado Center for Reproductive Medicine(303) 761-0579
sstavros@colocrm.com
http://www.colocrm.com
