They said it couldn’t be done. But here we are, forty-plus years later, and Robert Edwards – the doctor who pioneered in vitro fertilization (IVF) – has won the Nobel Prize in Medicine.
This major medical advance has given couples worldwide who struggle with fertility the opportunity to try to have children. It is believed that 12- 13 percent of couples have trouble getting pregnant.
As many as 4 million IVF babies have been born since the first “test-tube” baby arrived in 1978, thanks to techniques Edwards developed, together with Patrick Steptoe.
The technology has come a long way, baby! Between one and two percent of babies born in the Western world are conceived through IVF methods.
“Prior to IVF, half of couples with fertility problems were unable to be treated,” said Dr. John Schnorr, medical director of the Southeastern Fertility Center in Charleston, South Carolina. “And today these patients – ones with male factor infertility and tubal factor infertility problems – contribute to some of our highest pregnancy rates. These parents are now biological parents, when before such a result was impossible.”
Every year new developments help increase the odds of healthy, live IVF births as doctors around the globe build on the techniques Edwards and Steptoe pioneered.
Looking forward: top two trends in fertility treatment
Currently there are two trends in fertility treatment that will shape the next 5 to 10 years. One allows for genetic screening. The other allows women to harvest and freeze their unfertilized for future use with no real limit on how long the eggs can be frozen. The former is called pre-implantation genetic diagnoses (PGD) combined with metablomics, and the latter is a cutting edge cellular freezing process called vitrification. These two advances when combined together could allow a woman to preserve her eggs at a younger age and then allow chromosome testing of the resulting embryos further improving pregnancy rates.
Combined pre-implantation genetic diagnoses (PGD) and metablomics
PGD – routine screening tests that assess embryos and/or oocytes (unfertilized eggs) – tell doctors if an egg or embryo is genetically normal before it is selected for implantation in the uterus. The tests can identify genetic irregularities in an embryo or oocyte ranging from Down syndrome and cystic fibrosis to muscular dystrophy, sickle cell anemia, Tay-Sachs, Gaucher’s disease and more.
Metablomics is a way of testing embryos for viability. Researchers think that embryos which result in live births have specific metabolic rates that can be used to identify normal from abnormal embryos. By passing light waves through the culture in which embryos are stored, researchers are able to score each embryo’s metabolic rates and rank its viability.
The embryo with the highest viability potential – the star embryo – would then be implanted in the uterus, giving the pregnancy the best shot at success.
Scientists are hoping that by combining these two screening tests IVF will be much more precise. Doctors will be able to identify and select genetically healthy embryos using PGD. And then, assess the remaining embryos to determine the one that seems most likely to survive to term.
“Once you put these two processes together we hope to be able to implant a normal embryo with a nearly 100 percent chance of success,” Schnorr said. He added that single-embryo implantation reduces the risks associated with pregnancies involving multiples.
“A multiple pregnancy results in a several-fold increased risk of preterm labor, pre-term delivery and many other complications increasing the risk of delivery of an unhealthy baby or babies,” he said.
A third of successful IVF births include multiples, compared with roughly 2-3 percent of spontaneously conceived births. Doctors hope to use these processes to implant a single embryo with incredibly favorable odds of the woman having a successful pregnancy.
It’s the holy grail of IVF, he added, “One embryo, one live birth.”
Vitrification
Vitrification technology is enabling women to freeze oocytes with high success rates (unfertilized eggs), something that was not possible until very recently. During vitrification, eggs are plunged in liquid nitrogen and instantly frozen, ensuring that this largely water-based cell does not form crystals that would expand and disrupt the egg’s membrane.
Eggs can be harvested from post-pubescent women and can be stored without harm for decades.
Dr. Schnorr predicts that within the next three-to-four years about 25 percent of all fertility preservation will utilize vitrification.
“Oocyte vitrification is a new promising technology that opens the door to assisting women who anticipate delaying reproduction or are faced with chemotherapy treatments to fight cancers,” Schnorr said. “It’s a transformative technology.”
Looking forward
The future of IVF is a bright one. And as the tools reproductive endocrinologists have at their disposal increase, the odds of the successful implantation of pre-screened, chromosomally normal embryos and the resulting delivery of healthy babies may reach astonishing success rates.
Robert Edwards unleashed a brave new world of possibility. And the more than 4 million people born through the technique he pioneered (IVF) are proof positive of the marvels of his vision. Every day, IVF is helping couples who struggle with infertility make their baby dreams come true.
Sources: The Los Angeles Times, http://www.latimes.com/news/science/la-sci-nobel-medicine-20101005,0,5822420.story; NIH, http://www.nlm.nih.gov/medlineplus/ency/article/007279.htm; CBS News, http://www.cbsnews.com/8301-504763_162-20018544-10391704.html
