What If The IVF Treatment Fails? What Are Your Options? (part 2)

What If The IVF Treatment Fails? What Are Your Options? (part 2)

In our last blog post, we discussed treatments options for non-receptive endometrium (the uterus lining) leading to implantation failure. However, more often the IVF treatment would fail even though endometrium is receptive.

Seed germination requires high quality soil and seeds

 

Embryo implantation is analogous to germination of a seed in the soil. If the quality of the soil (the endometrium) is not the problem, another major factor that may impact implantation is the quality of the seed we use, or in order words, the embryo quality.

 

How does embryo quality impact successful implantation?

There is a direct correlation between the quality of women’s egg and embryo quality. A high-quality egg will usually produce a high-quality embryo, which has higher chances to implant and result in pregnancy. The quality of women’s egg is age-related. As a woman ages, her eggs become more prone to genetic defects, such as aneuploidies (presence of the wrong number of chromosomes). When such eggs are fertilized they form into embryos which are genetically unstable.  Such embryos will often not implant. However, if they do implant, the pregnancy may end in early miscarriage or birth of a child with a genetic disorder.  

Implanted human embryo

What can be done to improve the quality of embryos?

Embryo selection:

Recent developments in Assisted Reproductive Technologies allow the embryologist to select the embryos with better chances to result in a birth of a healthy child.

1. Genetic analysis of the developing embryos – There are two different genetic tests that can be performed with little risk of damage to the embryo. Five to six days after fertilization occurs,  the embryologist will remove a few cells from the developing embryos for genetic analysis: 

  • Preimplantation genetic screening (PGS) – is used to verify the presence of all 23 pairs of chromosomes. The results will allow identifying the embryo with a normal number of chromosomes. These embryos are more likely to result in an ongoing pregnancy with a lower risk of miscarriages. If the couple carries a sex-linked genetic disease, this test will allow to sex-select an embryo with the lowest risk. The current method of analysis, “Next Generation Sequencing” provides a high resolution of chromosome analysis with great accuracy and fast turnout time.
  • Preimplantation Genetic Diagnosis (PGD) – is used to test for a specific genetic mutation that is associated with specific disease, e.g., cystic fibrosis, Tay Sachs, etc. PGD allows couples that carry a genetic disease to ensure their offspring will not be affected by this disease.

2. Morphokinetic Analysis – Time-Lapse Embryoscope

This special incubator system offers a noninvasive alternative for embryo evaluation. This incubator system incorporates a time-lapse microscope camera that monitors embryo development measuring the time intervals for critical milestones in embryo development without the need of removing the embryos from the incubator’s carefully adjusted microenvironment. The information is analyzed by a computer equips the embryologist with an additional, more accurate decision-making tool for embryo selection.

Time-lapse microscopy showing the early phases of implantation, demonstrating how active the cells of the endometrium are in sensing the presence and quality of the embryo and physically engulfing it to create its new microenvironment. Video Credit: Charlotte H. E. Weimar et al. PLoS ONE July 2012.

Improving the embryo development potential:

Mitochondrial Nutrients – Scientists identified that coenzyme Q10 is the most beneficial to the function of mitochondria. Administration of Coenzyme Q10 was shown to reverse the age-related mitochondrial dysfunction and improve embryo development.

Improving embryo implantation:

1. Use of EmbryoGlue – This method is utilizing the natural substance, Hyaluronan, which is naturally secreted in the uterus, to enhance the attachment of the embryo to the uterus during implantation. The Embryo glue mimics those uterine secretions, and on the transfer day, the embryos are dipped in this special substance which may increase the implantation rate. 

2. Laser-assisted embryo hatching – the embryo is surrounded by a thick gelatinous shell, that prevents implantation. The embryo needs to hatch out of this shell in order to implant. It was shown that embryos surrounded by a thick shell might not be able to fully hatch out and therefore fail to implant. In those cases, the embryologist will use a laser beam to create a small dent in the zona pellucida of the embryo (“the shell”) with the aim of helping the embryo to hatch out of the shell successfully.  

3. Co-culture system – The embryologist will co-culture embryos with supporting cells to that either mimic the endometrial embryonic interaction (endometrial cells) or maintain the support that is given to the egg by the follicle (Cumulus cells), which is vital for implantation to take place. Co-culture systems were shown to improve embryo development and increase the pregnancy rate.

All these clinical options are available for Juno’s patient. However, the decision to use one option over the other is unique to each patient. As part of your personalized fertility treatment journey, Dr. Bentov will review your medical history and test results and will tailor a treatment option that would benefit you the most.  You are an integral part of the decision process, and we always encourage our patients to learn more about their treatment options, success rates and risks involved. Your input counts and that what makes Juno different!

In the next blog, we will discuss how mother’s overall health contributes to the implantation process and what can be done to improve the chances of implantation and pregnancy, stay tuned.

 

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