With Michelle Obama writing about her own fertility struggles and the use of in vitro fertilization to conceive her girls in her new book "Becoming," it made us think about how far fertility treatments have come since the Obamas were trying to get pregnant.
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We've done a lot of stories about fertility treatments and the advances in science doctors have made.
Last November we published this story:
Couples trying to get pregnant, there’s even more hope on the horizon. At the recent American Society for Reproductive Medicine Scientific Congress & Expo in San Antonio, doctors and scientists presented their research. Seven of those studies were being done here at Texas Fertility Center.
“We’re excited about what we’re doing,” says Dr. Kaylen Silverberg. He likens getting accepted to present so many of findings to getting all of your college admittance letters back with a “yes.”
He walked us through some of what they’ve found. Sometimes, he says, “It reinforces that what we’re doing is right.” Other times, with the advancement of science, they find a better way of doing things.
In an international study, they looked at the value of doing genetic testing on embryos. Could they see before implanting an embryo if it would be chromosomally normal? Yes. By doing a preimplantation genetic screening, they determined they could see all 23 pairs of chromosomes and rule out abnormalities.
Does that mean those embryos will grow up to be normal, healthy babies? Not necessarily, he says. There are many things we still don’t have a genetic test for, but parents who have lost babies or a family member to a chromosomal abnormality now have a chance to screen for that abnormality and only have embryos implanted that don’t have that abnormality.
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Another study also looked at the embryos to determine which ones were viable. Sometimes after the embryo has been sitting in an incubation solution for 18 hours, lab technicians won’t like what they see. They’ll be looking for two pronuclei in that embryo to signify that it’s a healthy embryo. “Sometimes is not so clear-cut,” Silverberg says. “It doesn’t have two pronuclei. It has one or zero.”
Up until this point, they would throw those embryos away. In a study, researchers kept cultivating those embryos to see if anything would happen.
What they found was that 40 percent of embryos that would have been thrown away actually grew into normal embryos, he says. They just needed more time.
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Another study helped doctors determine when the right time to implant an embryo into the uterus during in vitro fertilization will be. For years, doctors were arbitrarily choosing the sixth day after beginning progesterone as the day to implant the egg. “Why does that make sense?” Silverberg says they began asking.
Now they can better determine when the embryo and the endometrium will be in sync by doing a biopsy of the endometrium in advance.
Doctors have a woman go through the hormonal cycle for in vitro one month before actual implementation. They will then take a biopsy during that cycle on day six and send it to a lab in Barcelona to analyze her endometrium to see if it was ready to accept the egg. If it was, the next month, they would implant an egg on day six. If it wasn’t, based on the endometrium’s levels, they might try to implant on day five or give her more progesterone and implant on day seven or eight.
Through this study, they determined that only 40 percent of the endometrium were ready on day six.
Doing the extra cycle and biopsies might cost an additional $700, but that’s well worth it, Silverberg says, if it ends in a pregnancy and not a wasted embryo because the woman’s body wasn’t ready to receive it.
In another study, they looked at the luteal-placental shift — that’s when the placenta takes over progesterone production to sustain the pregnancy. Before that, the corpus luteum, the part of the egg’s follicle that remains after ovulation, is the main supplier of progesterone.
A woman who has been implanted with an embryo rather than becoming pregnant on her own receives progesterone and estrogen during the first trimester to make her body able to carry the embryo. Doctors were wondering when it is that the body will take over.
By monitoring hormonal levels in 262 women who had a frozen embryo transfer, they were able to determine when the luteal-placental shift happened and make recommendations of how long to give each hormone. They found that women should receive estradiol replacement until at least seven weeks gestational age and progesterone replacement until at least eight to nine weeks gestational age.
This knowledge can help reduce miscarriages in women whose babies were perfectly normal but where the moms had a low progesterone level, Silverberg says.
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All of this research is helping more women become pregnant, Silverberg says. It’s also cut down on the multiple pregnancy rates because now they feel more confident about the quality of the embryo and the readiness of the woman’s body to receive it and nurture it for nine months.
“Our patients are anxious to enroll in any study,” he says. They see it as a way for them to give back to the progress that is being made.
“It’s a great time to be doing infertility medicine,” Silverberg says. “There’s so many advances.”
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