fitness articles

,  Font size

fertility & pregnancy

Latest Researches in the field of IVF Treatment around the World 

IVF is the original 'test-tube' baby technique. It was developed more than 30 years ago for the treatment of women with damaged Fallopian tubes, and this remains an important reason for treatment today.

All IVF treatments begin with a course of hormone therapy to stimulate the development of several follicles in the ovary. These are collected as eggs, which are then fertilised in a test-tube ('in vitro') to create several embryos. After between two and five days in an incubator, one or two of these embryos are transferred through the vagina to the uterus, where implantation occurs and pregnancy begins. However, in IVF as in natural conception, not every embryo implants to become a pregnancy, which is why surplus embryos are frozen - so that a subsequent transfer might be tried if the first one fails. Freezing is now an essential part of every clinic's IVF programme.

The most widely reported 'side effect' associated with IVF is a multiple pregnancy. There is also a very small risk that some women (1-2%) will over-react to the hormone drugs used to stimulate the ovaries, but ultrasound and hormone monitoring during this drug treatment phase usually ensures that any over-reaction is foreseen and any risk avoided. Egg collection can be uncomfortable, and is often performed with a local anaesthetic.
 

As with other type of fertility treatment, success rates in IVF decline once patients reach the age of 35 or so. Before that, IVF pregnancy rates are generally around 50% per cycle.

Latest researches are continuously happening around the world in the field of IVF treatment in different countries. Women Fitness brings to you a resource at one place of these latest happenings.
 

Research Published in ACS Journal of Proteome Research: New approach to improve IVF treatment

Women who have difficulty getting pregnant often turn to in-vitro fertilization (IVF), but it doesn't always work. Now scientists are taking a new approach to improve the technique by studying the proteins that could help ready a uterus for an embryo to implant in its wall. Their report could help researchers develop a new treatment that could potentially increase the success rate of IVF. The study appears in ACS Journal of Proteome Research.

Chen Xu, Hu Zhou and colleagues note that nearly 50 million couples worldwide require some kind of medical intervention to conceive. Among the most common procedures is IVF, but on average, only about one-third of all attempts lead to pregnancy. In the majority of cases that fail, the embryo doesn't attach to the uterine wall. Why this happens has largely remained a mystery. To address this knowledge gap, Xu and Zhou's team looked at the proteins that could play a role in this process.

The researchers tested samples of the inner uterine membrane called the endometrium from twelve women. They identified more than 2,000 proteins and found that the levels of more than 300 of them varied significantly depending on whether the endometrium was ready for embryo implantation. Boosting or reducing the levels of some of these proteins may increase the possibility that an embryo would implant and therefore increase the IVF success rate. The researchers say the findings could also help them improve treatment of endometrium-related diseases.
 

Imperial College London Research: New potential treatment mean safer IVF

�Dozen babies born using 'safer' IVF treatment,� reads today�s headline in The Independent. This headline was based on a new study providing proof of concept that the natural hormone kisspeptin-54 could be used to stimulate egg maturation in women requiring in vitro fertilisation (IVF).

The modified IVF treatment on trial, which is hoped to be safer than standard IVF, led to 12 healthy babies being born from 53 women undergoing a single IVF treatment.

Kisspeptin research: a six-minute summary

The researchers at Imperial College London have published a helpful video explaining their kisspeptin research and its implications.

One of the main hopes is that using kisspeptin-54 could lead to a safer version of IVF by reducing the need to use human chorionic gonadotropin (hCG), which has a small risk of causing ovarian hyperstimulation syndrome (OHSS). This can be potentially fatal. However, this study was much too small to prove kisspeptin-54 was safer. Much larger trials are required to prove this, and are the logical next step for this early stage research.

The study looked mainly at different doses of kisspeptin-54, but did not compare it with current IVF treatment. It will be vital for future clinical trials to include a control group, so that the effectiveness and safety of the new IVF treatment can be directly compared to the existing treatment, to see which is better overall.

The study was carried out by researchers from Imperial College London and Hammersmith Hospital, and was funded by the Medical Research Council, Wellcome Trust and National Institute for Health Research.

The study was published in The Journal of Clinical Investigation, a peer-reviewed medical journal. The media�s reporting of this story has been generally accurate, with the BBC including important quotes at the end of their piece, illustrating some of the research's key limitations. The Independent�s coverage did not highlight the limitations inherent in the study, and instead focused on the potential positives of the finding, leaving readers with a less balanced account.
 

This was a randomised clinical trial (RCT) investigating whether a new hormone could be used in the early stages of IVF to potentially improve its safety. IVF is one of several techniques available to help couples with fertility problems have a baby. During IVF, eggs are surgically removed from the woman's ovaries and fertilised with sperm in a laboratory. The fertilised egg is grown for a few days in the lab, and the best one or two embryos are then returned to the woman's womb to implant, grow and develop.

IVF starts with women being given hormones to suppress their natural monthly cycle. They are then given fertility-stimulating hormones to increase the number of immature eggs produced in the ovaries. These are too immature to be collected, so a second hormone is injected, typically human chorionic gonadotropin (hCG), to stimulate these eggs to mature. These matured eggs can then be collected for fertilisation in the laboratory.

However, hCG tends to linger in the body and is associated with a small risk of the ovaries being stimulated too much, causing the condition OHSS. The researchers wanted to see if there was a safer way of stimulating women�s ovaries to produce mature eggs for the IVF process, but without the increased risk of OHSS.

In previous research, the group had come across a naturally occurring hormone called kisspeptin-54, which when faulty makes a person infertile, as they cannot go through puberty. They thought there was a chance it might stimulate egg maturation over a shorter period of time, lessening the chance of the ovaries being overstimulated, theoretically reducing the risk of OHSS. They designed a clinical trial to investigate whether it was possible to use kisspeptin-54 instead of hCG in the IVF process, specifically to stimulate egg maturation.

The researchers randomly allocated 53 women who had opted for IVF to different doses of kisspeptin-54 treatment. They wanted to see whether it could partially replace the hormone normally used to stimulate the maturation of eggs during IVF.

All of the women were given follicle-stimulating hormone (FSH) to stimulate the ovaries to produce lots of immature eggs. They were also given gonadotropin releasing hormone (GnRH) antagonist injections to prevent the eggs from leaving the ovaries too early. They were then given different doses of kisspeptin-54 to trigger egg maturation. When at least three ovarian follicles (immature eggs) of 18 mm or greater diameter were visible on an ultrasound scan, the women were given an injection of kisspeptin-54 to trigger egg maturation.

The women were recruited from a list of women requiring IVF treatment at Hammersmith Hospital, London.
 

The inclusion criteria were specific and included:

• age 18-34 years

• early follicular phase level of serum FSH ≤12 mIU/ml

• serum anti-Mullerian hormone of 10-40 pmol/l (1.4-5.6 ng/ml)

• both ovaries intact, regular menstrual cycles of 24-35 days duration

• body mass index (BMI)18-29 kg/m2 (this includes women of a healthy weight and overweight, but not those who are obese or underweight)

Women were excluded if they:
 

• had moderate or severe endometriosis

• had poor response to, or more than one previous cycle of, IVF treatment

• had clinical or biochemical hyperandrogenemia (an excess of androgens)

• had polycystic ovarian syndrome

The researchers primarily wanted to know whether a single treatment of kisspeptin produced egg maturation. They assessed this by looking at the number of mature eggs, and the percentage of all eggs collected that were mature. Secondary outcomes included the later stages of IVF, such as fertilisation rates, successful implantation rates, pregnancy rates and healthy births.

Importantly, there was no control group of women who received normal IVF with gonadotropins to act as a comparison, so only the relative effects of the different doses of kisspeptin were under investigation. The study did not compare the effect of the experimental kisspeptin IVF treatment with regular IVF treatment.

Basic results

Egg maturation was observed in response to each tested dose of kisspeptin-54, and the average (mean) number of mature eggs per woman broadly increased in a dose-dependent manner.

Fertilisation of eggs and transfer of embryos to the uterus occurred in 92% (49/53) of patients treated with kisspeptin-54.
Clinical pregnancy rates using the technique were 23% (12/53) overall. 10 of the 53 women gave birth to healthy babies (12 babies in total, as two women had twins) following the kisspeptin IVF. Two women who initially became pregnant had a miscarriage.

In terms of safety and side effects, kisspeptin was reported to be well tolerated by all of the women. Five negative events were recorded in the group, but these were related to established complications of IVF, rather than the new hormone treatment. Two patients experienced an ectopic pregnancy, one had a heterotopic pregnancy (where an ectopic pregnancy and a viable intrauterine pregnancy occur at the same time) and two had miscarriages.

Researchers interpretation the results

They said the study "demonstrates that a single injection of kisspeptin-54 can induce egg maturation in women with subfertility undergoing IVF therapy. Subsequent fertilisation of eggs matured following kisspeptin-54 administration and transfer of resulting embryos can lead to successful human pregnancy.�

Conclusion

This study provided a �proof of concept� that the naturally occurring hormone kisspeptin-54 can be used to stimulate egg maturation in women requiring IVF. The modified IVF � which is hoped to be safer than standard IVF � led to 12 healthy babies being born from 10 mums. Out of the 53 women undergoing a single IVF treatment, this gave a 19% success rate.

Researchers hoped that using kisspeptin-54 could lead to a safer version of IVF by reducing the risk of OHSS. Although theoretically plausible, this study was much too small to prove that the new technique was safer; much larger trials will be required to prove this. What this study does prove is that it is possible to achieve IVF success to stimulate egg maturation by using kisspeptin-54.

Another factor limiting the interpretation of the results is the fact that there was no control group. The study did not compare the effect of the experimental kisspeptin-54 treatment with regular IVF treatment. Therefore, the study told us about the relative effects of the different doses of kisspeptin, rather than how they stacked up against the current IVF treatment. This is something fully acknowledged by the research authors, but much less clear in the media's reporting. Future studies will need to examine not only whether the new treatment is safe, but also whether it leads to the similar success rates in terms of fertilisation and healthy births as the current technique.

The BBC carries a quote indicating that the next clinical trials will take place in women with polycystic ovary syndrome (PCOS), who are more vulnerable to overstimulation. This will be a useful way to investigate the potential safety benefits of this technique in this higher risk group.

Australian Research: New hope for couples wanting to become parents � SNP array embryo genetic testing

Couples who have experienced the heartbreak of miscarriage or the disappointment of numerous failed IVF cycles are among those now being offered new hope of realising their dream of having a healthy baby. Leading Australian infertility treatment provider Monash IVF is offering �at risk� couples the chance to access the latest form of preimplantation genetic screening (PGS) that includes a full chromosome count of embryos to ensure only the healthiest are implanted.

Monash IVF geneticist and PGS coordinator, Dr Elissa Osborne, explained that PGS is available to couples at risk of passing on a chromosome abnormality or a specific genetic disease to their children. She said the test could be useful for older women, couples who have suffered multiple miscarriages, couples who have experienced repeat IVF failure, as well as those who know they have a specific gene disorder such as cystic fibrosis in the family.

Through testing, embryos can be screened for a range of genetic conditions including Down Syndrome, Huntington�s disease and Spinal Muscular Atrophy before pregnancy is established, Dr Osborne said. �Until the development of array testing, PGS tests could only analyse several genetic sites at a time, therefore limiting the diagnostic capability of PGS,�� Dr Osborne said. SNP (single nucleotide polymorphism) arrays represent a further advancement in genetic testing of IVF embryos.

SNP array testing is performed on cells that have been sampled from an IVF embryo that is 5 or 6 days old. The testing involves analysis of more than 300,000 different DNA sites within those cells. A blood sample is taken from each parent and is screened in parallel with the cells from the embryo.

By using parent DNA as reference data to compare to the embryonic DNA, it is possible to produce results that are far more precise than conventional testing methods. �The breakthrough with the latest SNP array testing is that in addition to screening all 23 chromosome pairs, it detects a far wider range of chromosome abnormalities and can determine the genetic source of any additional or missing chromosomes. It can also detect whether these abnormalities occurred before or after fertilisation.
 

�With the old testing we couldn�t tell whether the chromosome abnormality came from the egg or the sperm. Now that we have this information through SNP array testing couples can make informed decisions and potentially consider whether they want to use donor eggs or donor sperm,�� Dr Osborne said. �We�re very excited to be the only provider in Australia offering this test and there�s a lot of interest among the scientific community as well as couples looking at IVF.��

The process is capable of screening all 23 pairs of chromosomes with results that are typically more than 99 percent accurate. Other PGS methods that miss certain types of chromosome problems or that only test some of the chromosomes, are at risk of missing important genetic information. �Each embryo is precious and accuracy is critical to avoid discarding normal embryos or transferring abnormal embryos,�� Dr Obsorne said.

Video

Dated 28 April 2015