Fertility treatment has come a long way over the last few decades. The number of fertility techniques and the possibilities is huge. One out of every six couples discovers that they are not able to conceive a child or are not able to hold the pregnancy ending up with repeated miscarriages.
Infertility is a problem that concerns families, especially in countries like India, where having a child is almost mandatory. The Indian population suffers from male and female infertility. The two most common causes of infertility among the younger generation are low sperm count and ovulation disorder. Many young couples have to deal with these infertility challenges.
IVF treatment has enabled a large number of couples to have children. However, IVF is not a 100% successful treatment by itself and may require several attempts before a couple can get pregnant. The success rate for IVF during the first attempt is around a measly 30%. With repeated tries, the success rate goes up to about 70% by the 3rd cycle. There are many couples who have been trying for a countless number of times hoping that each cycle will be the one, but it doesn’t happen. To improve the success rate of the IVF treatment researchers have come up with a number of advanced techniques. These advanced fertility techniques have been devised to address the problems that have been diagnosed as the possible causes that lead to the failure of the IVF cycle.
The first successful IVF baby was born in 1978. For the IVF conception, the sperm and the egg are fertilised in the lab after the egg is retrieved from the ovaries. While the basic concept of IVF remains the same, there have been many changes to the way these procedures and techniques are conducted to ensure a higher implantation success rate.
Certain tests are conducted to ensure receptivity of the uterus as well as to check the quality and the development of the embryo, as far as possible. Fertilisation techniques have improved, and now men can have biological children even with few sperm. Azoospermia and oligospermia is no longer a major hindrance to male fertility.
An advanced fertility technique is not an independent treatment by itself but is carried out in conjunction with the general IVF treatment. There are different fertility techniques which are used at different stages of the treatment.
Advanced fertility techniques are not used for all the patients but only in cases where required. Some of these techniques come at an additional cost. Most fertility clinics discuss the options with the couple and allow them to make the final decision regarding how they would like to proceed with the treatment. Some couples may opt for advanced procedures if they are very eager for a child. Some couples decline the option and are willing to take the risk of doing without because they do not want to add to the cost of the treatment or they do not feel that this technique will help them.
Assisted fertility techniques are optional and most reputed fertility clinics offer them to patients to increases their odds of having a successful IVF pregnancy. There is no compulsion to have any of the advanced fertility techniques along with the IVF treatment.
Once the embryo is placed inside the uterus, it has to break out of its outer protective covering. This is like a shell and called the Zona pellucida. Scientists believe that in some cases the embryo’s outer covering maybe a little too thick and this inhibits the embryo from being able to break out of its covering easily. Patients with advanced maternal age are more likely to have a thicker zonapellucida making hatching difficult and hence preventing the embryo from implanting in the endometrial lining.
Failed implantation has quite often been linked to the inability of the embryo to hatch from its shell. To eliminate this problem and make it easy for the embryo, doctors perform what is known as assisted hatching.
A small hole is made in the zona pellucida before it is placed inside the uterus. This is a very delicate process and is conducted under high precision by a skilled embryologist. Researchers believe that the hole will give the embryo some leeway as to where to start breaking out since the shell has already been weakened in one area.
There are different types of assisted hatching that are used for weakening the zona pellucida. The most common technique is chemical assisted hatching. A minuscule amount of chemical solution is placed on the outer covering on the embryo which reacts with the shell and weakens it forming a small hole. This is an intricate procedure, and the embryo is held in place using a hollow needle while a pipette is used to administer the chemical.
The mechanical assisted hatching is a technique in which the doctor manually makes a hole in the zona pellucida using a micromanipulator machine. A glass needle is used to grind away a tiny section of the outer layer until a small hole is visible.
Another technique used by some doctors is laser-assisted hatching. This is known to be the safest technique and is performed with the help of a high precision laser. It is also a very quick method and requires very little manual intervention.
Assisted hatching is recommended for women over the age of 35 as the zona pellucida has a likelihood of being thicker and inhibiting implantation.
IIn a few occasional cases, assisted hatching has resulted in damage to the embryo. However, this depends on the skill and experience of the embryologist.
The probability of monozygotic twins is higher with assisted hatching, especially with laser-assisted hatching. This is the reason that laser-assisted hatching is the safest method, but it is not used very commonly due to the risks of twins.
Usually, the embryo is transferred to the uterus on the third day after fertilisation in the lab. By this time the embryo has become into an 8 cell structure. Scientists have found that by keeping the embryo in the lab for longer, they can culture a blastocyst structure which they believe has a higher probability of implantation. An embryo becomes into a 200 cell blastocyst by the 5th or 6th day.
It has also been found that by the 5th day the endometrium is more receptive to having the embryo. This is probably due to the fact that in natural conception the embryo remains in the fallopian tube for a few days after fertilisation and only enters the uterus around the 4th or 5th day. Likewise, the uterus is more receptive around this time when it is expecting the embryo, as per the natural cycle.
The disadvantage of the blastocyst is that not all labs can culture the blastocyst, and quite often all the embryos die before they become blastocysts - the infrastructure and facilities of the lab influence the successful formation of the blastocyst. The culture of the blastocyst needs to be changed after 3 days as the blastocyst required a different type of culture to develop. Some embryologists are not able to cater to the requirement of the embryos and the changes in the culture etc. ending up with multiple embryos arrests. Culturing the embryos from 8 cell structures to 200 cell structures involves a lot of care and attention.
Some fertility clinics advise their patients to have a 3-day transfer as they are not sure that they will be able to culture the embryos to blastocysts.
Anyone can have a blastocyst transfer as this increases the probability of implantation and IVF success. Women who are older than 35 should opt for blastocyst transfer. Women who have undergone multiple failed IVF cycles have a better chance of getting pregnant with a blastocyst transfer.
It has been found that there is a slightly high risk of multiple pregnancies with a blastocyst transfer. The embryo tends to split in two resulting in monozygotic twins. However, the increased risk is about 2% as compared to the usual probability of multiple pregnancies in general.
Many IVF patients go through the whole process of IVF treatment. The different stages all lead up to the IVF procedure. This is the moment when the embryo is transferred to the uterus. 2 weeks later, you find out that the embryo did not implant. The doctors determined this was because the uterus was not very receptive. The ERA test helps to determine when the embryo is the most receptive.
The receptivity of the uterine lining is very crucial for the successful implantation of the embryo. It has been found that among the women who face implantation failure, around 25% was due to an unreceptive uterus.
For conducting the ERA, a biopsy of the uterus lining is taken, and the genes in this tissue sample are analysed in the lab. Through the changes in these genes, it can be determined whether the uterus is pre-receptive, receptive or post receptive.
The Endometrial receptivity is studied in accordance with the menstrual cycle. This helps the doctors to calculate on which day of the menstrual cycle, the uterus will be most receptive for implantation. The ERA test is conducted on a cycle prior to the IVF procedure so that the transfer can be made according to the ERA test results during a subsequent cycle.
Women who have IVF failure due to lack of endometrial receptivity can have ERA test few days prior to their transfer to find out just how receptive the uterus is and get an idea of when it will be most receptive.
Even women who had repeated IVF failure due to other reasons could also have ERA test to check the receptivity of their uterus, thereby increasing the likelihood of implantation. IVF transfer with the Endometrial Receptivity Array test results is done preferably with frozen embryo rather than culturing fresh embryo in the lab till the uterus is ready. This may result in having to culture the embryos for longer than 5 or 6 days in the lab while waiting for the uterus to be receptive, and it is not advisable.
Time-Lapse imaging is a technique in which pictures are taken of the embryo at regular intervals. It helps to study the development of the embryo. Embryos that have an abnormal development pattern are likely not to implant or have a higher probability of resulting in a miscarriage. The images taken of the embryo while it is developing helps the embryologist to study the way the embryo has been progressing and accordingly determine which embryo is good and has a better possibility of implantation.
By observing the images of the embryo, the embryologist can identify which embryos have chromosomal abnormalities. These embryos will most probably not implant or end up as a miscarriage. For avoiding this, the time-lapse imaging technique is used.
All the embryos appear the same on the 3rd day when the transfer is to be made, and it is almost impossible to tell which embryo has chromosomal abnormalities or developmental defects. Since it is not possible for the doctor to monitor the embryos constantly, the cameras are used. The images from the time-lapse imaging procedure can help the embryologist to study the cell division and see if there were any abnormalities in the process or if the cells developed as it normally should.
The time-lapse imagining has been very helpful for women who have responded poorly to previous IVF attempts. This technique requires additional equipment and a change in the lab setup but is being used by many fertility clinics as it helps in a better selection of the embryo and a higher IVF success rate as well as a greater percentage of live birth rates.
Meera and Kumar had attempted IVF several times. Due to damaged fallopian tubes, Meera had been unable to conceive. IVF was their only ray of hope, but somehow thing had not worked out favourably for them. Every attempt ended in a miscarriage during the first month or implantation failure. Meera was 30 and Kumar 33 when they visited Medicover fertility. They had learnt that advanced fertility treatment could help improve their chances of getting pregnant. The doctor suggested time-lapse imaging to check the development of the embryos at each stage. During the first month, Meera had an Endometrial Receptivity Array test to check when her uterus would be most receptive. The time-lapse imaging detected that several embryos did not go through the development stages, normally indicating that there was a possibility of chromosomal abnormality in the embryo. Defective embryos may appear the same as the others but have a reduced chance of implanting, and even if they do implant would lead to a miscarriage. In this case, the good embryos were selected and transferred to Meera’s uterus on the day her uterus was most receptive. The couple were overjoyed when the test results showed a positive pregnancy. 9 months later, they had a fully healthy baby.
A weakness in the embryo causes implantation failure or a miscarriage. Embryo weakness, to a large extent, is caused by chromosomal abnormalities. Aneuploidy is a condition when the number of chromosomes in the embryo is not correct. It is usually one or two in excess or a few less. Embryos with a chromosomal abnormality will result in a failed IVF.
To overcome this, hurdle doctors perform a PGS test. For this test, one or two cells of the embryo are removed and checked for their chromosome count. The PGS test checks the cell for the normalcy of the chromosomes.
PGS is recommended when a couple are over the age of 37. Researchers believe that the percentage of chromosomal abnormalities in the eggs and sperm increases after this age. Couples who have had multiple failed IVF treatments which have been attributed to weak embryos are also recommended PGS.
PGS is basically a safe procedure, and there are no major risks associated with it as such. In a few cases, there has been damage to the embryo while removing the cells. This is a high precision procedure, and occasionally things can go wrong, but in general, the procedure is risk-free.
Chromosomal abnormalities are the leading factor for IVF failure. With the genetic screening process, it increases the probability of implantation multi-fold.
The thought of having the embryo glued to your uterus may be discomforting. However, it is not exactly what it sounds like. This is not the conventional glue that we are used to using for sticking stuff. Anything that goes inside the body should be acceptable to the body and as far a possible made from substances found in the body. Researchers always work on imitating the body’s functioning whenever they come up with some new technology.
The main components of the embryo glue are hyaluronan and recombinant human albumin. It comprises of the blastocyst culture base, which is packed with the required nutrients for the embryo. Hyaluronan is a substance that is naturally secreted by the uterus, ovaries and fallopian tubes. This helps the embryo to stick onto the wall of the uterus, which then results in implantation.
The embryo glue prompts the embryo to stick itself onto the uterus wall when it is transferred to the uterus. Once the embryo is attached to the uterus wall, the embryo fuses with the endometrial lining and implantation take place. Implantation is a crucial stage and defines the success of IVF treatment.
Embryo glue is especially recommended for those patients who have experienced multiple failed IVF due to implantation failure.
Some doctors feel that embryo glue is all hype and does not help the implantation. There are no health risks associated with using the embryo glue as it is made of natural substances. The only drawback is that some clinics may charge extra for the embryo glue.
Medicover is always looking to break new ground to provide their patients with the best and the latest treatments. Medicover remains of the forefront of by keeping up to date with the most recent happenings and scientific advances. Implantation failure is the borderline and Medicover fertility makes every resolve to head in the opposite direction with astounding success rates.
Medicover aims at providing patients with tailor-made treatments specific to their individual case. This leads to a high success rate as each case is dealt with distinctly rather than generally.
Are Advanced Fertility Treatments Available In India?
Yes, most leading fertility clinics and hospitals offer advanced fertility treatments along with IVF.
Will Advanced Fertility Treatment Help Me To Have A Successful IVF Treatment This Time?
Advanced fertility treatments definitely improve your chances of having a successful IVF treatment.
I Had ERA Test Done But The Clinic Was Still Not Able To Predict The Correct Date Of Uterus Fertility And My Implantation Failed?
It is essential to have your treatment at a reputed fertility clinic for accurate test results and proper treatment.
I Want To Have Pre-Implantation Genetic Screening For My Next IVF Cycle, But I Heard That It Could Damage The Future Development Of The Embryo
PGS is used to determine if your embryo has any chromosomal abnormalities which will prevent it from implanting or developing into a full-term baby. The test is safe and will not damage the embryo if conducted at a good laboratory.