Changes in IVF? How Far We Have Come!
Recently we saw the world wide celebration of the birthday of Louise Brown the first ever IVF baby born on 25th July 1978.
Originally called test tube babies as the eggs when collected were placed in small test tubes with liquid media and then the sperm was later added to these tubes. From test tubes we went to using petri dishes and then from petri dishes to culturing embryos in droplets of liquid media under an oil overlay.
Incubators that are used to house embryos and keep them warm have gone from huge units the size of fridge freezers, to smaller desk top units with individual gas chambers and now having video cameras to record embryo development which can then be sent to mobile apps.
Embryo transfers are performed via ultrasound guides with special tipped catheters to view the actual deposit of embryos into the uterine cavity.
Originally embryos were transferred on Day 2 and Day 3, after the development of specialised medias, the extended culture to Day 5 and Day 6 blastocyst became the normal time to transfer.
Embryos are photographed not only during their development over the course of 5 days they are pictured just prior to transfer, giving a very unique start to those baby photo albums and scrapbooks!
When I first started in IVF 20 years ago, we offered the GIFT procedure. Gamete Intrafallopian Transfer which has now been relinquished to the history books. For these transfers the eggs were collected, the sperm was prepared and then both the eggs and sperm were loaded into a long catheter and deposited into the fallopian tubes whilst the patient was still sedated. The most mature oocytes were assessed quickly during the oocyte pick up to determine the best 2 which would be transferred and returned back to the tubes.
The Kremer Test is one test that I am thankful not to have to prepared for many years. This test looked at the mucous during mid cycle and tested the receptive nature to sperm. Mucous was loaded into flat pipettes, which would be placed in a well containing the sperm sample. Sperm would be checked at time intervals to see how far it had travelled up the pipette.
Technology has changed and so have the options available to couples, previously we saw only donor sperm on the options list, with many donors opting to donate to heterosexual couples and not single and same sexed relationships. Donors had the power of choice. Now we see sperm banks with huge selections and ethnicities available to clients needing this option.
Donor oocytes (eggs) is now common place. Known and unknown donors and overseas clinic specialising in shipping these gametes around the world.
There are clinics which have been established for ‘medical holidays’ where you travel to the Donors country at a timed scheduled, after the donor oocytes have been collected you can have your own sperm sample collected on the day and embryo transfer on day 5, returning to your home country and awaiting the outcome of pregnancy testing. These overseas donor cycles are cheaper than bringing in donor oocytes from overseas for treatment in Australian clinics and are becoming very popular accordingly as an alternative treatment option.
One fascinating development I have read about recently is Facial Recognition Technology for prospective clients wanting to use donor eggs. Wondering if your future child will look like you has never been easier. Use the app, take a selfie and get matched with donors that will look like you! Normally you would just get height, hair and eye colour and skin tone of the donor as known parameters.
Of course with male factor accounting for 50% of the problems, it is fascinating to see how far this area of andrology has advanced. Previously if you didn’t have the numbers or swimming sperm, you would have to use donor sperm. Now with the invention of the technique of ICSI, intra cytoplasmic sperm injection, giving any male with male factor issues the chance to conceive using his own sperm. Post Vasectomy is not a problem with the development of PESA and TESA procedures.
PESA stands for Percutaneous Epididymal Sperm Aspiration and TESA stands for Testicular Sperm Aspiration.
These procedures mean the sperm is simply extracted straight from the epididymis or testes, so even the men who decided to have a vasectomy can still have children long after their procedure for contraception years before. Men who have suffered infection or have congenital absence of the vas deferens a pathway for ejaculating sperm, are able to achieve fertilisation using their own sperm.
New technology and advances in the field mean that there are so many more options to clients to undergo treatment and work around many factors that might present in their way.
Oncology patients both male and female can preserve their fertility and have chemotherapy and radiotherapy in the comfort of knowing that they have a ‘Plan B’ for future parenting. The freezing protocols, equipment and media used have advanced significantly to allow for much better survival rates post thawing. Pregnancies have been created and ongoing after these therapies, giving comfort to many people faced with cancer treatment.
Advances in all areas of the laboratory, clinical regimes, medications for stimulation, blood testing and urine test for ovulation and pregnancy have all enhanced the options for would be parents.
Surrogacy brings a whole new realm of possibility to the fertility table, although the laws surrounding this process vary state to state in Australia and Internationally. So generally speaking where there is a will there is a way to move forward and become a parent, finances aside naturally!
The biggest factor for many people is not so much what they can do but when will they stop, as the price can be exceptionally prohibitive. One study looking at the main reason clients stop having fertility treatment ranked finance as the number one reason to stop treatment.
Even here though we are seeing areas of development, with Bulk Billing Clinics opening up a service for regular cycles, a ‘No Frills’ option, so if you are just requiring a standard IVF cycle or IUI without the need for extra services, you can attend and have that cycle for as little as $1500 AUD. You do not get to choose your Doctor and if you require anything like PGD embryo testing, Donor Gametes or anything else a little more involved, you will not be able to attend these clinics. Still it is a viable option for some people and worth considering if there is one close to you.
In the field of Embryology the new development is – Artificial Intelligence – the New Embryologist.
AI has been used in a first ever trial by the US Company Ovation Fertility ™ and Australian company Life Whisperer to determine the best embryos for transfer.
Analysing embryos is traditionally done by highly skilled Embryologists. Images of embryos are taken with a microscope camera and sent to the new AI technology tool, to obtain an instant report on the best embryo to transfer. Results showed a 50% improvement in predicted implantation rates!
If you have a Genetic condition, no problem, you can screen the embryos and only transfer and use only unaffected embryos.
Poor sperm sample or post vasectomy, or no sperm, not a problem, sperm can be removed directly from the testes under local anaesthetic and ICSI will offer fertilisation as a possibility without swimming sperm required.
Poor responder, low AMH, too old, no problem- you can use Donor Oocytes and have the same chance as that younger donor woman to achieve that pregnancy.
So many options and ways to achieve pregnancy now after 40 years of IVF treatment, we have indeed come a very long way.
If you would like any further information or would like to send me any questions please head to my website –
www.ivfcoachingclinic.com.au or my Facebook page
https://www.facebook.com/ivfcoachingclinic/ or you can follow me on Instagram
@sophiabaseotto or @ivfcoachingclinic
Kind Regards, Sophia