How many times have you heard someone say about their children, “They’re growing up too fast.”? Or, “I wish they could stay this way forever.”?
It’s a common sentiment, but personally, I’ve never really felt that way about my kids. It’s been fun to see what they do next, to watch them grow, to watch them learn, to become better and ever more interesting and competent people.
In the same way, it’s been fun to be a part of TRM and watch the same kind of growth over the last 10 years.
It seems just like yesterday when we came to town, without an established base of referring physicians, but armed only with the idea that we were on a mission: to provide the highest quality fertility care to Chattanooga and the Southeast, to offer a multiple range of options and collaborate with patients on selecting the very best treatments for them.
From the start, we were very picky about the people we hired. We wanted them to be mission-driven, as well. And while, over time, circumstances have led to a few new faces over the years, most of the people who started the practice with us are still with us – dedicated as ever before to their patients.
Since our inception, we have grown a bit, we now have more nurses and a second embryologist, and we offer an ever-expanding array of fertility options and tests for women and men, and have more and more tools available to help couples achieve their dream of starting a family.
In the next few paragraphs, I’d like to go over some things that have changed around here, other than a few more gray hairs on my head.
Recent significant changes in fertility medicine
At TRM we have been recommending elective single embryo transfer (eSET) for a number of years. This process involves choosing only one embryo created through in vitro fertilization (IVF) to implant, even if there are more embryos available.
Before eSET, transferring a higher number of embryos was acceptable and common practice. According to the National Institutes of Health, in the mid-1980s there was a success rate of 40 percent pregnancy per IVF with a transfer of four embryos. At the time there was only a 20 percent success rate with one embryo transfer.
But with continual improvements in IVF, physician knowledge & skill, and preimplantation genetic testing (see below), we have been able to select a single high-quality embryo for transfer with very good success. The American Society for Reproductive Medicine (ASRM) has established that the goal of IVF is a single healthy pregnancy. With eSET we can accomplish that goal.
Oocyte cryopreservation, or egg freezing and storage, has been used in IVF since the early 1950s, but there have been significant advancements in recent years. In 2013, ASRM and the Society for Assisted Reproductive Technology (SART) published a joint document, which stated that cryopreservation of eggs should no longer be considered experimental. The American College of Obstetricians and Gynecologists states that in, “the past ten years, methods for ultrarapid freezing of oocytes have been refined that optimize oocyte survival after cryopreservation.”
PGS & PGD
Preimplantation genetic screening (PGS) and preimplantation genetic diagnosis (PGD) are the testing of embryos created during the IVF process for genetic abnormalities. This type of testing has been around since 1968 when two scientists successfully identified the sex of rabbit embryos. But in more recent years there have been significant changes in PGS & PGD, also collectively called PGT or preimplantation genetic testing.
PGS allows physicians to identify chromosomal abnormalities that can cause such birth defects as Down syndrome. PGD evaluates embryos for single gene disorders, some of which can result in a baby born with congenital diseases, like cystic fibrosis or Fragile X.
Another significant development in performing PGT is next generation sequencing (NGS). This sequencing makes DNA genome evaluation more accessible. This is a less expensive and faster method of analyzing DNA. This allows scientists the opportunity to gather and interpret large amounts of genetic information.
These types of testing have raised ethical concerns. Should physicians be able to know all of those details and act upon them? What happens to the embryos deemed not good enough?
In vitro fertilization, in general, has seen many improvements. From diagnosis to medication to preservation, IVF has come a long way in recent years. In the past, when egg quality was an issue, we had few ways to improve it. Today, with the help of nutritional supplements and ancillary medications, we can often dramatically improve the quality of a woman’s eggs.
Minimal stimulation (mini-IVF) has also become something we have performed with increasing frequency. It can deliver high pregnancy rates at a lower cost for many women. And it may be ideal for women who don’t like the idea of having unused frozen embryos or for women who simply won’t produce many eggs, no matter how much medication they take.
Implantation defects are more and more commonly being diagnosed. In the past, when a woman didn’t get pregnant from IVF, we often were just at a loss, and chalked it up to bad luck. Now we know that there are a lot of women who have implantation defects, and we have tests that we can employ to diagnose and guide treatments, which radically transform a patient’s chance of success.
These changes are making treatments more available and more successful to a wider range of patients who would previously not be good candidates for IVF.
Looking to the future
There will be many questions to answer in the next few years. Some of the techniques that are advancing now will create more specialized options for those experiencing infertility, as well as more ethical concerns.
Some of the incredible opportunities in the future of assisted reproductive medicine include the following.
- Three-parent babies: This controversial procedure involves combining portions of eggs from different women with a man’s sperm. The technique was recommended to the Food and Drug Administration by an expert panel in 2016.
- Womb transfer: In December of 2017 a woman in the United States who was born without a uterus gave birth. This was accomplished after she received a uterus transplant.
- Artificial ovaries: In 2018 scientists have engineered the “scaffold” of the ovaries. This could be beneficial in preserving fertility for those undergoing cancer treatments.
- Tissue freezing: In 2015 a baby was born to a woman who had her ovarian tissue frozen when she was 13. The tissue was grafted back into her body at age 25 and she gave birth at 27. ASRM still considers this technique experimental.
I really look forward to seeing what the future holds for our field. There are so many innovative approaches from gene therapy, refined culture techniques, and embryo selection. And we are learning more and more about how our environment may play a role in reproduction.
We look forward to continuing to grow, not only our practice, but our understanding of the underlying issues causing infertility, and then implementing new treatment to overcome this devastating, and soul-crushing diagnosis.
I, for one, don’t want us to stay the way we are forever. Let’s keep getting better.