Fertility technology you may to consider with IVF
Fertility technology you may to consider want with IVF:
Often more than two or three embryos are produced in an IVF cycle. Good quality 'spare' embryos can be frozen, and later thawed to give another chance of pregnancy. Freezing and thawing have to be done under special conditions: >90% of embryos can survive the procedure. When embryos are to be thawed the woman's menstrual cycle is monitored with blood tests to make sure the embryos are replaced at the right time of the menstrual cycle.
Thaw cycle of IVF
When there have been embryos frozen following in vitro fertilisation, they can be thawed and transferred into the uterus at a later stage. This usually entails several bloods tests to time ovulation during a natural cycle. In some cases it is necessary to control a cycle using drugs to prepare the uterus for implantation. Embryos are transferred into the uterus at the appropriate time, as they are in an IVF cycle.
ICSI is a variation of IVF. Instead of the sperm and eggs being mixed together, a single sperm is injected into each mature egg. ICSI may be used, for example, when sperm quality is too poor for conventional IVF to work. ICSI allows almost any man with sperm, either in his semen or in his testes, to try IVF.
Photographs embryos every 10 minutes to capture developmental milestones in the embryo’s life that are missed when embryos are only inspected once a day.
Benefits of TiMI:
- Picks up unusual and detrimental events that escape a daily snap-shot inspection.
- Identifies 10-15% of embryos with very low potential.
- Several studies show that TiMI increases the chance of pregnancy using the first embryo transferred by up to 10%.
- Embryos are not removed from their incubator, therefore they develop in an uninterrupted environment.
Who can benefit from TiMI?
- People who expect to have several good quality embryos to choose from.
- People who have had low quality embryos previously and want more information about their embryo development.
Embryo selection with TiMI does not increase the overall chance of a baby from all the embryos available, but it can reduce the time to pregnancy by giving a better choice of which embryo to use first.
PGT Pre-implantation Genetic Testing (PGT)
Pre-implantation genetic testing can identify genetic abnormalities in embryos at the blastocyst stage (a blastocyst is an embryo that has been developed in the laboratory for five or six days after fertilisation). This allows us to select the 'best' embryos which are most likely to be free of genetic conditions and chromosomal abnormalities for transfer to the uterus.
Because many blastocysts have the wrong number of chromosomes (a condition known as aneuploidy), PGT is a powerful tool for selecting a good embryo for transfer. Aneuploidy can lead to miscarriages, birth defects and other complications.
Types of PGT:
PGT-M: Pre-implantation genetic testing for monogenic/single gene disorders
This is for those who may have a known genetic condition that they do not want to pass on to their children. PGT means that couples can have a child that is fully theirs genetically, without the child inheriting the particular genetic disorder.
Examples of conditions that may be excluded by this test are: neurofibromatosis type 1; Marfan syndrome; cystic fibrosis; Huntington's; muscular dystrophy.
How can TiMI & PGT work together?
Preimplantation genetic testing (PGT) is the strongest embryo selection tool we have since we know that many normal appearing embryos have the wrong number of chromosomes (aneuploidy).
The challenge with PGT is that it requires blastocysts on day 5 or 6 for testing – probably 3 or more. TiMI complements PGT because it provides the best undisturbed environment we have available in order to get as many blastocysts as possible. While the extra information we gain from watching the embryos with TiMI is helpful when not using PGS, it does not add to the selection process when PGS is used.
The challenge most patients face is knowing how many embryos they’ll have to work with. If the number is few, then TiMI is a safe way to increase your chances. If there are 3 or more blastocysts, then PGS alone or in combination with TiMI may be the better option.
PGT can be used by people who have a chance of passing serious genetic disorders on to their children, such as:
- Cystic Fibrosis, Huntington’s, Beta-thalessemia, Fragile X and Spinal Muscular Atrophy. These are caused by a change in single gene.
- People who have a high chance of pregnancy loss or a lower chance of pregnancy because of translocations between chromosomes.
Useful to know:
Ethics Committee approval is required to carry out PGD for any other reason, (such as ‘saviour siblings’). PGD cannot be used for gender selection in New Zealand.
Genetic Carrier Screening
Genetic carrier screening gives individuals and couple’s information about their risk of having a child with a genetic condition.
We now offer the option to do genetic testing through Invitae, either for your own information or to check compatibility with your partner or potential donor.
Genetic screening identifies whether you are a carrier of a range of inherited conditions. Most people are carriers of one or more genetic conditions, even though no one in their family has the condition. Being a carrier is important if the person using the sperm is also a carrier of the same condition.
Invitae’s carrier screening includes:
- Severe and prevalent disorders seen across all ethnicities
- Enhanced SMA testing to help identify silent carriers
- Comprehensive Fragile X analysis, including AGG interruptions
- Full gene sequencing with deletion and duplication analysis leading to a 99% detection rate for most genes
- Actionable results; no reporting of variants of unknown significance
Endometrial Receptivity Assay (ERA)
This is a method whereby the endometrium may be checked to determine whether the date of embryo transfer may need to be adjusted to match the woman’s own window for implantation.
For most women the time of endometrial receptivity for an embryo to implant is accurately predicted by the number of days after ovulation, but for some women the ‘window for implantation’ occurs later or earlier. The ERA is a method whereby the endometrium may be checked to determine whether the date of embryo transfer may need to be adjusted to match the woman’s own window for implantation.
How it works:
- The woman goes through a mock frozen embryo transfer cycle and on the day of embryo transfer instead of replacing an embryo, a Pipelle biopsy is done. This is where a small sample of the lining or endometrium is taken and then couriered to the ERA lab. (For NZ the nearest lab is Japan.)
- The ERA lab then checks the expression of 238 genes in the biopsy sample and sends a report indicating a receptive endometrium or a pre-receptive or post-receptive endometrium.
- The timing of the embryo transfer is then adjusted accordingly.
Who should do this test?
The current recommendations are that the ERA may be useful in women with recurrent implantation failure. There is debate about what the definition of implantation failure is - we consider ERA if a pregnancy has not resulted after the transfer of 2 to 3 good quality embryos into a normal uterus, in which the expectation of greater than 80% would have become pregnant.
This is an option in IVF or ICSI. A small hole is made in the soft shell of the embryo before it is replaced in the uterus.
Pre Natal Testing
It is possible to detect/screen for fetal abnormalities using non-invasive prenatal testing 'NIPT', Chorionic Villus Sampling 'CVS' or Amniocentesis.
- NIPT (non-invasive prenatal testing) - available in our Auckland clinic only - is a blood test performed any time from 10 weeks of pregnancy. The results are available within 5-10 days. NIPT uses cell-free fetal DNA (cfDNA) found in maternal blood to identify the most common chromosome conditions seen in newborns, Trisomy 21 (Down Syndrome), Trisomy 18, Trisomy 13 and sex chromosome abnormalities including Turner syndrome, Klinefelter syndrome , Triple X and XYY syndrome.
- CVS Chorionic Villus Sampling or Amniocentesis can also be used to confirm a diagnosis in those with a higher risk from the screening result. Screening is free for CVS or Amniocentesis for those at higher risk.
Please ask your Obstetrician, Genetic Counsellor or Lead Maternity Carer for more information.
hCG infusion before embryo transfer
Several studies have shown that a small amount of the hormone human Chorionic Gonadotrophin (hCG) infused into the uterus shortly before embryo transfer may increase the chance of an embryo implanting.
The chance of an embryo implanting depends on the quality of the embryo and the receptivity of the uterus. Little is known about how to influence the receptivity of the uterus, but there have been several studies looking at the infusion of a small amount of the hormone hCG before embryo transfer.
A recent meta-analysis looked at the results from 15 randomised control studies that included over 2500 patients. The conclusion was that on average infusion of hCG increased the chance of a live birth after embryo transfer. It also appeared to lower the chance of miscarriage. hCG infusion seemed to be more effective for the transfer of fresh embryos than frozen embryos. An infusion within 15 minutes of embryo transfer seemed to be more effective than an infusion done earlier, and a dose of around 500iu seemed to be better than higher doses.
Overall, the evidence for a potentially beneficial effect of hCG infusion is quite high, so this is one of the add-ons which we classify as of positive benefit.