Exciting things are happening in the world of fertility medicine. It is early 2017 and the field of infertility has seen some incredible new methods of egg maturation and DNA testing. With the right medicine, information and treatments become more precise and personalized. Now, so much more information concerning genetic content of an embryo is available to potential parents.
Currently, Samitivej utilizes two cutting-edge methods. These methods collect data on the amount of energy in cells required for egg fertilization and maturation, and the ways to utilize that energy in selecting only the healthiest of cells. These methods were pioneered by Boonsaeng Wutthiphan, MD and his team, and are called Modulator IVM and Mitochondrial DNA testing.
Modulator IVM takes the process of in-vitro maturation a step further. To understand the amazing lengths to which doctors have gone to improve IVM, one must first understand the process of traditional IVM.
IVM is the maturation of eggs through their removal during an immature stage, where they are taken to a lab and fertilized before implantation. With Modulator IVM, the primary focus is ensuring that the cells surrounding the egg are giving it the proper energy to fertilize. This energy is called adenosine triphosphate (ATP), and it functions as energy transportation to all living organisms.
The goal of Modulator IVM is to assist in the energy transfer from the surrounding cells into the egg. The higher the ATP, the better the quality of the eggs. This process is accomplished by using a special isobutyl/methylxanthine (IBMX) solution on the egg for 15 minutes in the lab, which allows for energy to be driven into it from the surrounding cells. In this way, the egg is getting the energy it needs to successfully thrive. This method has increased pregnancy success rates to 30 to 40 percent.
In addition to Modulator IVM, endometrial receptivity analysis (ERA) is being used to determine whether or not a woman’s endometrium is ready for embryo implantation. Women are receptive to embryo implantation during days 19-21 during their menstrual cycle. This is a delicate window of time, and if a woman’s receptivity is out of sync with an embryo’s readiness for implantation, the success of conception drastically decreases.
An ERA is done with a biopsy and a sequencing of 236 genes. The test predicts whether or not the endometrium is receptive or non-receptive. If receptive, the implantation can take place with higher chances of success.
Mitochondria are the source of energy inside of an egg, as opposed to ATP which, as stated previously, is the energy inside the embryo. While ATP is necessary in the transportation of energy to an embryo, the mitochondrial energy, if higher, means the embryo is in energetic stress. Using a MitoScore®, a doctor can assess the quality of the embryos. If an embryo is good, it will have a low mitochondrial energy. If an embryo has a higher mitochondrial score, that means it is exhausting itself in the attempt to implant.
Knowing your mitochondrial score (levels of mitochondria) is very useful when determining which embryos are viable, and the best way to increase the chances of pregnancy. Not only that, but samples can be taken as early as three days following embryonic development. The MitoScore® plays an important role in IVF and IVM, leading the process by first isolating only the most viable of embryos.
Five embryos are sent overseas to be tested, the results are available in one to two weeks. The embryos with the highest mitochondria are not used. In the case that all embryos have very high mitochondrial energy, the option of using your own eggs is no longer viable and a donor must be used.
If an embryo is deemed viable, transfer takes place five days following embryonic development. If receptivity is 25% (an abnormal result) the chance of pregnancy is lower, and chance of miscarriage is 100%. If this happens, a sample from the lining of the womb is sent overseas and tested to see if the lining has changed or if it remains the same. If the results prove to be abnormal, adjustments must be made. Results can be taken naturally by performing a biopsy during ovulation, or by using hormone stimulation to push the body into ovulation, so that a sample can be taken.
Another important aspect of genetic testing that must be taken into consideration is the potential for passing along an autosomal recessive genetic disease. With next generation genetic sequencing, we can access the genetic content of the father and mother, and discover whether or not an embryo will carry a disease passed along from the parents. Everyone carries 2,000 autosomal recessive genes. With procedures for genetic sequencing, 600 genes can be analyzed for potential active or carrier qualities. With IVF and alternative IVF procedures, autosomal recessive babies cannot be protected from potentially harmful genetic diseases. These diseases can be cleared in the baby by screening the parents for autosomal recessive genes.
Energy plays a vital role in the successful implantation of embryos. With the development of the techniques for mitochondrial DNA testing and Modulator IVM, measures can be taken now that haven’t been available before, to increase the likelihood of pregnancy. It is important that parents know testing their genetic makeup before implantation of an embryo is vital. It can prevent the trauma of giving birth to a child with a genetic disease or condition, which, if caught earlier, would not be present. These DNA tests and procedures make for healthier babies.
M.D., Faculty of Medicine, Prince of Songkla University Faculty of Medicine Prince of Songkla University , 1979