Experts like Williams, however, stand by the utility of testing. While some embryos in the gray area between viable and nonviable may result in a healthy baby, he says preimplantation testing can identify those that are very unlikely to succeed, which can come with significant benefits for patients.
In 2022, Williams’ team at Columbia developed new technology to deliver genetic test results in hours rather than days or weeks, potentially allowing viable embryos to be transferred on the same day they’re tested. While the test can’t fix any problems it detects, Williams says quickly identifying a patient’s best embryos can help them get pregnant faster, with fewer expensive failed cycles and emotionally difficult miscarriages. “The big difference will be how long does it take to get pregnant, and how many losses does she have to go through before she gets pregnant?” Williams says.
Other researchers are also trying to tweak PGT-A to make it more effective. Currently, clinicians take biopsies from what becomes the placenta, so “you really don’t know what goes on inside the cells that go on to form the baby,” says Kylie Dunning, a reproductive biologist at the University of Adelaide in Australia. Dunning recently co-authored a paper describing a new approach: taking a molecular photograph of the embryo to assess fetal cells, rather than those that form the placenta. She believes that will clarify which embryos are truly nonviable. “Hopefully, that will result in more patients taking home a baby,” she says.
Another research team, this one led by scientists from Australia’s RMIT University and Monash IVF, published a pair of studies in 2021 describing another possible target for pre-IVF testing. They described a “golden window” for treatment: the several-day period in a woman’s natural reproductive cycle when levels of a molecule called PCX are lowest. PCX makes the surface of the womb slippery, potentially preventing embryos from attaching. Theoretically, if clinicians can determine when PCX levels are lowest and transfer embryos then, it could improve the chances of pregnancy.
Study co-author Guiying Nie, a reproductive biologist, says her team is still working to validate its findings, so no such test is currently available to patients. The challenge is finding a fast, non-invasive way to test PCX levels. Some kind of imaging test could work, she says, but it’s too soon to say.
A similar screening technique, called endometrial receptivity analysis, analyzes tissue from a uterine biopsy to try to determine the best time for an IVF cycle, but some research suggests it’s not as accurate as promised.
Looking beyond tests
There is a limit to what any test can do, Williams says, so his lab is trying to find other ways of boosting success rates. For example, his clinic uses a robotic arm to prepare the tiny trays where embryos grow to eliminate human error.
Other companies are also turning some tasks over to robots. Startup TMRW created automated tanks for storing frozen eggs and embryos, ideally eliminating mishaps like freezer failures. Sensors in the tanks detect changes in storage conditions, then alert staff so they can fix problems before they become critical.
Artificial intelligence also holds promise for fertility. Research teams are trying to teach AI systems to select the best embryos for transplantation by analyzing images of them, and various consumer apps use AI to help women pinpoint when they’re most likely to conceive based on fluctuations in hormone levels and other factors.
Making fertility care more convenient
Improving the logistics of fertility care is also important. New York-based New Hope Fertility offers a program called “At Home IVF,” which makes the process as remote-friendly as possible. A patient starts with an online consultation, then, when appropriate, gets fertility medication delivered to their door. Patients only need to come into the clinic for major appointments like egg harvesting and embryo transfers.
Some clinics, including New Hope, also offer what’s known as “mini” IVF, a process that is similar to traditional IVF but uses fewer or lower-dose fertility drugs to keep costs down. Because patients receive fewer stimulating drugs, they may produce fewer eggs that can be fertilized—but mini IVF can be the right choice for patients with budgetary constraints or certain health conditions, according to the Cleveland Clinic.
Williams’ lab has also been working to make IVF more convenient for couples. They developed a new transport technique, using a substance that keeps sperm samples warm and viable for several hours, to allow men to produce samples at home and then drop them off at the clinic, rather than going through the process in a medical office. It may seem like a small shift, but Williams says sperm samples tend to be higher quality when they’re collected at home, potentially because men feel more at ease.
Every refinement counts when it comes to fertility care. “We really fight for every percent improvement in success rates,” Williams says, because each one can be life-changing for families.
Credit : https://time.com/6211312/ivf-more-effective/