With stories of 45 year celebrities having babies (and sometimes even twins and triplets) with high tech treatments, most people think that age is not a barrier to successful treatment. When using donor eggs from a young egg donor, that is definitely true. The chances for success with donor egg ivf is excellent, even for women in their late 40’s. However that is not the case in women using their own eggs. Pregnancies in women undergoing fertility treatment without the use of a donor over 45 are very unusual. A recent report from Florida describes a 46 year old woman who is reported to be oldest woman to conceive from IVF with her own eggs. Is this a major breakthrough? Not really. The main determinant over whether a fertilized egg will develop into a healthy baby is whether the embryo is genetically abnormal. Genetically normal embryos are common in 25 year olds but pregnancy rates are never 100%. Likewise, the vast majority of 45 year olds’ embryos are abnormal, and so the pregnancy rates would be expected to be quite low but not exactly 0%. When confronted with these odds, most couples would chose not to try.
Like most Reproductive Medicine practices, we perform what we refer to as “Third Party Reproduction” meaning we use donor sperm, donor eggs, gestational carriers for couples who need these procedures. One of the problems with the use of an egg and sperm donors or surrogates and gestational carriers, is that using them can be rather pricey. A lot of effort is required to make sure all parties involved are protected medically and legally, and so many patients may be tempted to do this at home without medical intervention. This story of a “Turkey Baster” do it yourself surrogacy from the UK illustrates why it is so important not to try this at home.
With government agencies in the US and UK, considering allowing the use “cloning” technologies to prevent the transmission of mitochondrial disease, nuclear transfer has become a hot topic in Reproductive Medicine. As discussed in our prior blog post, IVF is used to obtain eggs from both the intended mother and an egg donor, and the nucleus of the egg (which contain the mother’s genetic material) is transferred into the donor egg (which contains healthy unaffected mitochondria). British authorities have now issued a draft guidance document recommending letting research proceed on mitochondria donation. What will the USFDA recommend and will this type of research to help couples with mitochondrial diseases move forward? Only time will tell.
Many IVF and fertility practices such as ours use a procedure called PICSI to help certain couples where we are concerned that there may be a problem with sperm quality even when fertilization is succesful with ICSI. PICSI relies on placing the sperm on a field hyaluronic acid and having the embryologist determine whether sperm are able to bind to it. Sperm which are immature or otherwise abnormal are less likely to bind to the hyaluronic acid, and so sperm which do bind to it are used for the injection into the egg for ICSI. We and others have found that it may help certain couples who have failed ICSI cycles or had miscarriages from ICSI cycles. However, to date there are no large studies yet showing how effective it is, so researchers at the University of Leeds in the UK have initiated a large study to determine this.
Did you ever wonder what happens from conception until implantation? This video from the NIH website shows a time lapse video of the egg and embryo as it moves from the pronuclear stage, to the cleavage stage, to the morula stage and finally to a blastocyst, ready to implant in the uterus. Click here to view the video.