Delays in pregnancy and going through fertility treatment are major challenges that a couple has to face. Undergoing fertility treatments causes physical, psychological, and mental stress for both men and women. The wheel of scientific advancement turns at a high speed, producing medical discoveries leading to more efficient treatments.
Before presenting the current scientific findings, and the latest fertility treatments, we need to go back to the past a little bit to learn about the beginnings of this journey of medical achievements. Before 1978, any fertility issue, especially in women meant being childless.
The firstborn baby through an IVF procedure was Louise Brown born on July 25th, 1978. This was a major event and a radical shift in this field. It is worth mentioning that IVF treatments back then are very different than those practiced nowadays.
Between 1978 and 1995 there have been many developments in egg harvesting, and in the types of tests and scans used infertility treatments. In 1995 a scientific revolution happened with the development of the Intracytoplasmic Sperm Injection ICSI method in Belgium. Which was the perfect solution for male fertility, which was considered a major hurdle in the way of IVF treatment. In this procedure, the sperm is directly injected into the egg in a fertility lab. This therapy option provided a solution to many male fertility problems that were considered hopeless before.
Between then and now we witnessed continuous scientific triumphs, such as the developments in infertility medications, the advancements in ultrasound scans, and the improvements in fertility labs.
Human embryos are usually weak, almost 50% of embryos are abnormal, and this is a normal and common fact. There are also hereditary diseases that are passed to the offspring, in addition to the possibility of the embryo having Downs Syndrome. The genetic testing of embryos allows the discovery of chromosomal abnormalities to detect Downs syndrome or any other genetic disorders.
Exactly as embryos can be tested, the technology to analyze and test chromosomes has also developed. At first, the tests were used to analyze one cell on the third day of embryo formation, and only five chromosomes were tested. Today we can test several chromosomes on the fifth day the embryos are frozen, we can test 24 chromosomes through NGS that include chromosomes X&Y to detect the embryo gender, in addition to 22 other chromosomes to check for any genetic anomalies. If an embryo is affected by a genetic abnormality or specific disease such as muscular dystrophy this embryo is discarded and not used. Chromosome analysis technology is constantly developing, the test has become easier and more efficient. we can perform genetic testing without having to take a biopsy from the embryo, and instead take a sample of the embryo culture media which contains DNA, this is called Noninvasive genetic testing. This most recent technique is available and is still developing, which makes its availability somewhat limited.
Sperms are the easiest gamete to freeze, sperm freezing was done for men who were undergoing chemotherapy and radiotherapy to treat cancers, and the frozen sperms were used later for ART procedures. The next development was embryo freezing. At that time, it was difficult to freeze the eggs, as the eggs have a high-water content which is easily damaged with crystal formation. Until Vitrification became available, which is a fast-freezing process. In this process, the freezing happens in seconds instead of 13 hours like before. Vitrification is used to freeze sperms, eggs, and embryos to reduce the damage that can be caused by conventional freezing methods and increase the success rate of the fertilization process.
The common belief was that women face fertility issues more than men and that men can reproduce until the end of their lives. But studies have shown that sperm quality declines with age, also, increased Sperm DNA fragmentation happens as years go by. These discoveries have been possible thanks to the DNA fragmentation test, which measures the degree of sperms DNA fragmentation. The amount of sperm DNA fragmentation can be measured and if high it can be treated with supplements and antioxidants. It is noteworthy that this fragmentation happens because of certain diseases, unhealthy lifestyles, some viruses, and smoking.
This is one of the most recent techniques used in infertility treatments. When semen was used in IVF or ICSI, it was prepped and filtered using conventional methods. But today we have more sensitive and accurate sperm sorting techniques thanks to nanotechnology, which allows sperm sorting and choosing the best sperm which improves fertilization.
Previously, embryos used to be put in an incubator, and exposed several times to study and observe the embryo's progress, this process entailed exposing the embryos to the external environment that could lead to harm. Today and thanks to the Timelapse technology the Embryoscope, we can observe the progress of the embryos inside the incubator without opening it. The Timelapse Embryoscope has a camera that takes shots every 30 seconds and merges them into a video that allows us to watch the continuous cell divisions and study the embryos inside the incubators. Observing the cell divisions provides information on the development of embryos from the first few seconds of their life until the fifth day when it is time to use or freeze the embryos. Thanks to this technology only the healthy embryos that had a normal cell division process are chosen for freezing to increase the success chances of conception.
Some women undergo hysterectomies due to illness or certain cancers, some women were even born without a uterus, despite having ovaries and the rest of their reproductive system. In the past, this meant that it was impossible to get pregnant. Today uterine transplants are possible, like any other organ transplant. The first uterine transplant procedure took place in Saudi Arabia in the year 2000, but unfortunately, the patient rejected the uterus three months post-surgery. Research on this has continued until the first baby was born from a transplanted uterus in 2014 in Sweden. In such procedures, the transplanted uterus is removed at the same time as the c-section surgery where the baby is delivered, because the patient cannot continue to take the strong autoimmune medications long-term. This means that every pregnancy attempt needs a new uterine transplant. This is a fairly recent discovery, and it is still developing, so it is not available in infertility treatment centers and is restricted to medical research centers.
Some men suffer from low sperm count or in some cases a complete lack of sperm azoospermia. These cases have been and still are considered impossible to treat cases of male infertility. Until recently the use of (Platelet-rich plasma PRP), where the plasma is injected into the testicles to increase the chance of sperm production and development. The other technique that is still under development and that has many hopes attached to it is the injection of stem cells into the testicles to help develop immature sperms.
There is also hope that these two techniques might help with the treatment of female infertility cases. Especially in the treatment of Premature ovarian insufficiency and diminished ovarian reserve from which many women suffer. Injecting the ovaries with plasma or stem cells could be a possible treatment for these issues in the future. The challenge facing researchers studying these possible treatments is the insufficient information on the long-term effects of these treatments on the recipients and offspring. scientists are working around the clock to find answers to these questions.
This is a useful solution for women who are single or those who are delaying pregnancy for any reason, and for divorced or widowed women. In this treatment a biopsy of the ovarian cortex is removed through a minimal access procedure called laparoscopy, this biopsy can later be reimplanted in the abdomen to develop eggs spontaneously or through IVF/ICSI. This is also beneficial in case a woman undergoes chemotherapy or radiation therapy to treat cancer, as these therapies affect the ovaries.
Thanks to this technique and after the end of the cancer treatment, the ovarian biopsy is reimplanted and stimulated, thus offering women an opportunity at getting pregnant either naturally or through ART. Fertility preservation has seen huge breakthroughs and is still ongoing. The implants are removed after the birth of the baby to guarantee that there won’t be any residual cancer cells in the mother’s body.
There is ongoing research to use the same technology that freezes the ovarian tissue, in reversing signs of aging women are subjected to after menopause. Theoretically, the ovarian implants taken at a young age can be reimplanted in the abdomen and when they start functioning, they start releasing hormones when a woman is menopausal usually in her fifties. Thus, reversing the effects of time and offering an autologous tissue transplant solution. allowing the clock to be turned back, and youth restored!
The ovaries start producing Estrogen and progesterone and reverse menopausal symptoms such as hot flushes, osteoporosis, heart disease, dementia, and other symptoms that can be improved. Hopefully, this developing breakthrough can offer a natural alternative to hormone replacement therapies.