When we think of cutting-edge technology, especially in the field of reproductive medicine, IVF promptly comes to mind. But as recent as this medical advent might seem, the truth is that IVF or in-vitro fertilisation is over 40 years old. And in these past four decades, science has moved ahead by leaps and bounds.
In fact, in the past few years, science has evolved so much that IVF is no longer the most advanced technology out there. Many new techniques suited for couples who can’t be helped by traditional IVF exist. And that’s exactly what we’re exploring today with the help of fertility specialist Dr S.Vyjayanthi, who has more than 20 years of experience and has performed more than 10,000 cycles of IVF. She has also several publications to her credit and has been providing fertility services at KIMS Fertility Centre, Secunderabad for more than a decade. Here, she’s shedding light on some of the latest technological interventions in the field of fertility and IVF that you need to know about.
Think of ICSI or intracytoplasmic sperm injection as a technique that is a notch more advanced than traditional IVF. Explains Dr Vyjayanthi: “In IVF, we mix the sperm and egg in a dish in the lab, and the sperm gets inside the egg on its own to facilitate the process of fertilisation. Whereas in ICSI, one single sperm is injected into the egg using a big machine called micro-manipulator.”
While in both cases the embryo is fertilised outside the womb, in a lab, the difference might not seem like much to laypeople. But in certain cases, ICSI can be a godsend. “ICSI is mainly meant for men who have a very low sperm count—anything less than 10 million per ml. In these men, fertilisation doesn’t happen with straightforward IVF,” she adds. For men with azoospermia—where there is no sperm in the ejaculate and sperm has to be extracted surgically from the testes—ICSI process is used to make the embryo.
But male factor isn’t the only indication for the use of ICSI. Dr Vyjayanthi suggests that in couples presenting with unexplained fertility (where all tests are normal, and yet the couple can’t conceive), this technique can help achieve pregnancy too.
That said, with ICSI you also need to move ahead with caution and choose the doctor and clinic. “Because it is a highly technical process, it involves a lot of expertise of the embryologist. So he/she has to be really very good to get good results with ICSI,” she stresses.
Also known as intracytoplasmic morphologically selected sperm injection, IMSI is the more technologically advanced version of ICSI. “Here, the sperm is magnified six thousand times as opposed to ICSI where we magnify the sperm four hundred times to be able to put the most viable sperm inside the egg,” explains Dr Vyjayanthi.
Much like ICSI, IMSI is employed for couples where the male partner has poor quality sperm to get better results. “Whenever we surgically retrieve sperm from the testes, we prefer IMSI so as to make a better sperm choice,” she adds.
3. Egg freezing
Egg freezing isn’t unheard of. With celebrities like Diana Hayden opting for egg freezing—and using their frozen gametes to get pregnant—there is much that has been said and done about this technique. But before you write off egg freezing as a celebrity-driven trend, know that it has plenty of real-world benefits.
“Egg freezing is usually done for two purposes. First, for oncology purposes where women who are unmarried and are going to undergo chemotherapy are advised to opt for it so as to preserve fertility,” explains Dr Vyjayanthi. Then there is social egg freezing that most of us are already aware of. “Women in their late 20s or early 30s who are unmarried can have their eggs frozen. But this has to be done at the right time to get the benefits. If you opt for it in your late 30s or early 40s, you’ve already missed the boat,” she stresses.
4. Embryo freezing
Not just eggs and sperm—embryos can also be frozen to be used for later use. And when it comes to freezing technology in IVF, the science—called vitrification—has advanced enough in the past decade to guarantee 95 to 99% success (when it comes to embryo quality) upon thawing.
But is there any need for frozen embryos in IVF? Well, explains Dr Vyjayanthi: “Frozen embryos are definitely beneficial for a specific group of women, especially women with polycystic ovaries who have lots of eggs. When these women are stimulated with drugs, they produce more eggs and run the risk of hyperstimulation. So when we freeze their embryos and put them back in the next cycle, that risk is reduced.”
Embryo freezing also provides an efficient solution for surplus embryos. “Let’s assume someone has made four good embryos and we have implanted two. The remaining two can be frozen, so that they can come back again, later on, to use the embryos for later on to complete their family,” the expert explains.
5. Genetic testing of embryos
To rule out the risk of hereditary diseases, genetic testing of embryos is done—with technology so advanced that the embryo is not disturbed or damaged one bit. Explains Dr Vyjayanthi: “There are two types of genetic testing. PGT-A or pre-implantation genetic testing for aneuploidy, where the embryos are checked to see whether they are chromosomally normal or not. We offer this to women who have had frequent miscarriages and/or are of advanced maternal age.”
Yet another type of testing that is employed is PGD or preimplantation genetic diagnosis. “This is used when either the male or female partner has a genetic disease in the family. So, we screen the embryos and implant only the normal ones,” she adds.
While traditional PGT-A and PGD are tried-tested methods that have been used for years, the latest advancement in the field of genetic testing of embryos is minimally invasive. “For the past few months we have been using PGT-A on spent culture media of the embryos. Simply put spent culture media is the solution in which the embryos are cultured in the lab for five days before being placed in the womb. While sitting in that media, embryos shed some cells which are then tested for chromosomal defects. The advantage with this technique is that it is non-invasive and causes no damage to the embryo,” concludes Dr Vyjayanthi.