Infertility remains a vexing medical problem for couples that want to have children. At present, more than 20 percent of married couples are categorized as infertile, defined as the inability to conceive through natural means after a year of recurring sexual relations with no contraception. In this issue of Better Health, we talk to a team of gynecologists that specialize in reproductive medicine. They discuss infertility and how people who want to conceive benefit from the latest technology that tackles not only this problem, but that also promotes healthy pregnancy and childbirth.
Causes and cures
Infertility does not discriminate against one gender over the other. The dysfunction lies with either the female or the male partner, explains Dr. Poonsak Waikwamdee from Fertility Center & IVF Clinic.
And the components of fertilization – sperm, ovum, and uterus – mean that infertility has numerous causes, such as sperm depletion, weak sperm, age-damaged ovum and sperm, and uterine fibroids.Between 20 to 30 percent of people over 35 years of age have these fertility obstacles. To keep a fertility-challenged pregnancy as natural as possible, at the early stage the doctor treats according to cause. For example, he or she will prescribe drugs that stimulate the testicles or that regulate abnormal ovary hormone function. The treatment for fibroids is surgery to remove them from the uterus.
Technology for fertilization
Couples for whom treatments for natural pregnancy don’t work turn to reproductive technologies. There are two current main methods:
- IUI: intrauterine insemination stimulates the ovary to release an ovum. Sperm is then inserted directly into the uterus to fertilize the ovum.
- IVF: in vitro fertilization requires surgery to remove a woman’s ovum, which is then fertilized with a sperm in a laboratory. The fertilized egg is cultured for 3 to 5 days until embryonic cells start dividing. The doctor selects the healthiest embryo to return to the mother’s womb, which develops into a fetus.
“IUI is indicated for couples who don’t have serious reproductive conditions,” says Dr. Poonsak. “IVF, on the other hand, helps those with difficult infertility problems, such as anovulation, obstructed fallopian tubes, endome- triosis and sperm anomalies. Doctors prescribe IVF treatment with increasing frequency while IUI is only used for 10 to 20 percent of patients.” IVF’s success rate hinges on a woman’s age, with younger patients having a better chance of getting pregnant.
Reproductive technology complications result from medication side effects. Over-stimulated or over-reacted ovaries release too many ova, which can lead to acute protein deficiency. This problem can also lead to twin pregnancy, which puts heavy burdens on the mother’s body and runs a high risk of preterm labor. But as medical technology advances these complications occur less and less. Also, chances of twin pregnancy decrease with advances in embryo selection. “In the past, we could not tell with complete accuracy which were the healthiest embryos, thus the need to insert multiple embryos into the womb,” Dr. Poonsak explains. “But the ability to choose one best embryo reduces the chance of twin pregnancy to zero.”
Two technologies for the perfect embryo
A study found that a perfect embryo raises the chance of pregnancy to 70 percent, but embryos fertilized in a laboratory have a normality rate of only around 30 percent. Clearly, embryo selection is the key to a successful pregnancy. At present, there are two embryo selection methods. One observes embryo growth rates with a device called an embryoscope. The other analyzes DNA to find embryos with flawed chromosomes. “The highest priorities when treating infertile patients are to ensure a singleton pregnancy, no or few complications, a healthy baby without genetic disorders, and a happy mother who has had the best care,” says Dr. Poonsak.
Tracking an embryo with the embryoscope
“A computer-operated system that collects embryo data,” is how gynecologist Dr. Nahathai Paktinun describes the embryoscope. In climate-controlled chambers cameras record pictures of embryos every 15 to 20 minutes from various angles, which allow the doctor to observe them 24 hours a day without disturbing them.
“Prior to the embryoscope, we had to remove embryos from their chamber once a day to check quality and cell division. This manual checking method risked damaging embryos with light, chemicals, and temperature and humidity fluctuations. Moreover, there are flaws in the dividing processes that we can’t detect from a once-a-day only observation. These include unbalanced dividing or the embryo re-absorbing bad parts of divided cells,” explains Dr. Nahathai.
Data collected from the embryo-scope helps the doctor evaluate embryo quality in regards to the embryo’s physical characteristics and the speed at which its cells divide. The embryo with the highest chance of success is transferred to the womb. This method not only eliminates the chance of twin pregnancy, but also increases the success rate of pregnancy by 15 to 20 percent compared to methods that necessitate removing embryos from climate-controlled chambers for observation.
“When treating infertile patients, the highest priorities are a singleton pregnancy, no or few complications, a baby with no genetic disorders, and a happy mother.”
Dr. Poonsak Waikwamdee
Raise your fertility odds with a chromosome check
DNA diagnosis highlights normal embryos, thus increasing the chance of pregnancy. This technology is key for older mothers who produce a higher amount of anomalous embryos. Research shows that aging mothers have a 50 to 80 percent chance of producing embryos with irregular chromosomes, which raises the chance of failed implants into the womb and miscarriages.
Gynecologist Dr. Chartchai Srisombut explains that the latest DNA diagnosis technology called comparative genomic hybridization (CGH) can now analyze all of an embryo’s chromosomes, up from the 5 to 12 pairs previously accessible. Moreover, previous diagnostic procedures required human judgment, which reduced selection accuracy.
CGH entails taking samples from an embryo, which has divided a sufficient number of cells and examines chromosome anomalies with a computer system. The computer compares ratios between suspect DNA and normal DNA, which precisely identifies genetic disorders such as Down syndrome.
“We found that embryos with normal characteristics may have a 40 percent chance of containing abnormal chromosomes,” Dr. Chartchai says. “Even an embryo that’s been cultured to the stage of blastocyst (the phase just before implantation) still has a nine percent risk of abnormal chromosomes which leads to failed impregnation.”
However, Dr. Chartchai notes that CGH is used only in cases where there’s difficulty implanting embryos or a family history of genetic disorders.
“Studies show that women using an IVF procedure who also undergo CGH analysis have a three times greater chance of a successful pregnancy than those who don’t receive the analysis,” says Dr. Chartchai. “CGH cuts the chance of abnormal chromosome-related miscarriage in half.”
For couples with fertility challenges, genetic diagnosis removes the worry of having an unhealthy baby. The procedure reassures soon-to-be parents that their unborn baby will arrive in perfect condition and will develop into a strong, healthy child.