Medical Director, Eric A. Widra, M.D., reveals the latest promising trends for fertility treatment in 2017, including preimplantation genetic screening (PGS) and three-parent embryo techniques, while issuing caution for other techniques such as sperm generation, stimulated egg production, and in vitro maturation (IVM).
Shady Grove Fertility, the largest fertility center in the nation with more babies born than any other center, continues to stay on the cutting edge of fertility research and technology to provide the most effective treatments available for patients. In doing so, the practice makes research studies and practice refinements among its top priorities.
“But not every new idea or new technique that you see on television or read about in a medical journal is a practical solution for couples trying to conceive a baby,” reminds Shady Grove Fertility Medical Director, Eric A. Widra, M.D. With new fertility innovations taking place all the time, how do you know what’s really available to you—or what will be available to you soon?
While not a new practice, “people are increasingly using PGS,” says Dr. Widra. He continues, “Because of this screening, we’re no longer putting abnormal embryos into the uterus and can therefore increase pregnancy success rates.” Dr. Widra continues, “Preimplantation genetic screening often results in a reduction in the pool of embryos from which a couple has to select. While this can be seen as a disadvantage, it is mitigated by the fact that the embryos that remain, while fewer in number, have a greater chance of successful implantation and eventual live birth.”
On the topic of sperm generation, in 2016, researchers from the National Institute of Child Health and Human Development (NICHD) explored the feasibility of sperm development.While their findings seem promising—particularly for the approximately 30 percent of couples experiencing male-factor infertility, NICHD’s research has proven successful only in laboratory settings, not in real-world application.“While it would certainly be beneficial to artificially produce sperm outside of the body, this technique won’t be coming to market soon and is not yet a dependable solution for patients seeking solutions for male infertility,” advises Dr. Widra.
A technique to watch, according to Dr. Widra, is mini-IVF, or mini in vitro fertilization. Mini-IVF, or low-dose IVF, is an alternative that results in reduced costs and fewer injections. “Because a woman is given less medication when using mini-IVF, she will produce fewer eggs per IVF cycle for extraction. Shady Grove Fertility does not recommend mini-IVF as a front-line therapy for most as it is only truly beneficial for a select group of women,” adds Dr. Widra.
“We do think that there’s a role for mini-IVF for women who are low responders, however,” says Dr. Widra. “Many naturally low responding women, or those who mature only a small number of eggs, will produce the same number of eggs no matter the dose of medication. Because the medication quantity makes no apparent difference in these women, the lower dose, which is part of the mini-IVF treatment, is more appropriate,” says Dr. Widra.
When it comes to stimulated egg production and improvement, Dr. Widra also weighed in. Egg quality can be an impediment standing between many couples and their dream of parenthood. Traditionally, the only solution for these women has been to seek an egg donor. Some reproductive medicine specialists have been working to create another option, dedicating their time to exploring potential methods of either inducing egg production in older women or improving the quality of aging eggs. “Unfortunately, there have yet to be any positive findings to suggest that either is possible. Like medically-induced sperm production, most fertility experts believe that egg production or improvement as a viable fertility treatment is far from practical application,” says Dr. Widra.
Another technique that’s showing positive results, however, is three-parent embryos. “Through the use of three-parent embryo techniques, clinicians have been able to help women with mitochondrial diseases reproduce without worry. Doctors can fortify the women’s eggs with healthy mitochondria and, in doing so, prevent mothers from passing their potentially debilitating diseases on to their children,” adds Dr. Widra. “While life-changing for those dealing with mitochondrial diseases, these diseases are quite rare, so the application of this technique is relatively limited,” Dr. Widra advises.
While some researchers have theorized that three-parent embryo techniques could also be used to improve the quality of older eggs, though this theory hasn’t been proven true. Additionally, the FDA does not support the use of this procedure for this purpose.
When it comes to in vitro maturation (IVM), Dr. Widra issues a word of caution, as the research is inconclusive. Through IVM, doctors extract immature eggs from a woman’s ovaries and create an environment outside of the body in which the eggs can develop to maturity. Gathering immature eggs departs from typical egg retrieval procedures. Generally, women are given medication that encourages eggs to mature in the body. The mature eggs are then retrieved and used for embryo development within a fertility center. “Because medication can induce egg maturation within the body, however, this particular piece of reproductive technology is largely unnecessary. Additionally, while some research suggests that IVM is possible, many studies employ medications to stimulate the eggs to mature before removal. The use of these medications hampers the validity of the studies,” advises Dr. Widra.
“Proponents argue that IVM could be a cost-saving alternative to IVF, but we consider those cost savings to be minimal as the money saved on maturation-inducing medication is instead spent on lab procedures. Additionally, IVM is a cumbersome procedure for both women and fertility doctors,” adds Dr. Widra. “Given advancements within the fertility community, inducing egg maturation within a woman’s ovaries is not particularly difficult. As a result, IVM, while theoretically possible, is more of a regression than a step into the future,” says Dr. Widra.
“While the medical community has yet to refine techniques to the point where we can help every couple experiencing infertility successfully conceive, scientific advancements and medical technology continue to bring us much closer to this goal. As research continues into 2017 and beyond, we expect the frequency of success of fertility procedures in general, and the birth rate in particular, to continue to rise,” Dr. Widra adds.