In some quarters, fertility continues to be seen as a contentious medical issue, which in turn leads some patients to approach treatment with trepidation. Whilst it remains true that fertility treatment can be a complex process, as a scientist in the field, I feel that as a medical speciality huge strides have been made in recent years and there is much to celebrate about IVF treatment in the UK both now – and for the next generation.
In fact, IVF science has advanced so rapidly in recent years that people have every reason to feel optimistic about the outcome, because in my mind, there’s never been a better time to undertake assisted conception.
However, with so many options now available, working with a fertility expert to “navigate” the treatment pathway is vital, as is the adoption of a wholly personalised approach. Essentially, advanced techniques can only be applied successfully if they are tailored individually and patients are given time to understand the benefits – and if appropriate, the risks – of new procedures and are able to make their own, informed decision on which treatment to proceed with.
So, where do we stand with next generation IVF and which of these treatments provides the best chances of success?
The Personalised Approach
The personalised approach can be used to assess the activity of genes in the womb lining to pinpoint a woman’s optimum time for treatment which significantly boosts success rates. There are more than 60,000 IVF cycles in Britain each year, but just 24% of these treatments lead to live births1. However, by using the personalised approach doctors can plant the embryo in the womb at the woman’s most fertile time.
Time-lapse embryo images allows us to safely monitor embryos and observe their developmental patterns closely. Time-lapse images are precise and significant and are able to predict which embryos have the highest potential for a successful pregnancy. In addition we can now spot developmental anomalies that we did not even know existed, and we now understand limit or prevent the chance of the embryo making a baby; we have now published an atlas of such anomalies. Alongside colleagues at Care Fertility, we pioneered this procedure and have since had over 2,000 babies born using time-lapse technology.
Testing your Ovarian Reserve
Testing ovarian reserve is an increasingly important and beneficial way to explore a patient’s fertility before proceeding with IVF treatments. The test will help to clarify what type of IVF is needed, the dosage and how current fertility levels. However, the test will only determine how fertile a patient is at that point in time and is currently unable to predict the future.
For women who are already going through fertility treatment and have a good ovarian reserve, it is advised that they should consider freezing their eggs. This helps to prevent secondary infertility, if the patient wants more than one child, and can be a pragmatic approach to utilising left over embryos from treatment. The industry is also publishing data suggesting that not only are frozen embryos as good as fresh, but they may actually do better when transferred to the woman some time after stimulation; better for the pregnancy and the baby!, Encouraging women to have their ovarian reserve tested at a younger age is also really important if there has been a history of fertility problems within the family. It may be that patients are fertile at the time of the test, but it can be prudent to freeze your eggs to use in the future.
Preimplantation Genetic Screening
The most common reason why IVF fails is chromosomal abnormality (known as ‘aneuploidy’). Approximately 70% of embryos produced, either through natural conception or IVF, are lost before birth. A major cause of embryo loss, including miscarriage, is aneuploidy, where there is either a loss or gain of a single chromosome, or complex abnormalities.
Chromosome Screening is suitable for all patients. It is particularly suitable for the following groups: women who are aged over 37; men who have been shown to have sperm at risk of carrying abnormal chromosomes; couples who have had several miscarriages or several attempts at IVF but failed without explanation. But, knowing that even the younger female is at risk of up to half her eggs carrying a chromosome anomaly, it could be argued that using Chromosome Screening to effectively eliminate all such eggs or embryos will increase the chance of success for those couples. Many clinics even include it for egg donation to improve the chances of egg donation even further.
Professor Simon Fishel will be presenting his seminar at The Fertility Show, Olympia, London on 5th November at 11.45, and available to discuss all the technologies currently promulgated in the IVF arena.