14a) How can I improve my chances of getting pregnant?

IVF-MicroscopeThere are a variety of tests and treatments that some parents undergo to significantly improve their chances of a successful pregnancy.

Before traveling to the clinic, fathers who donate their sperm can undergo a sperm fragmentation test, which identifies potential problems with sperm DNA prior to the IVF procedure. Mothers who want to donate their own eggs can take a variety of non-prescription supplements well in advance of egg donation, as well as the fertility medication required as part of the donation procedure. Knowing if either of the donors has fertility issues can help parents choose better treatment options (which may be as simple as taking nutritional supplements). Or the tests may point to the need for a 3rd party egg or sperm donor.

Additional treatments can be used at the time of the embryo transfer to improve your chance of a pregnancy. Depending on your situation our clinic may recommend a variety of options including blood thinners, intralipid transfusions or even “embryo glue”.

Embryo Glue

(for use on embryos during transfer)
Embryo Glue is a transfer medium with hyaluronic acid and recombinant albumin. The way it works is that the embryo glue helps the embryo attach, but once it does, it’s stuck there. So the embryo may not have implanted where it naturally would have. Initial studies looked promising but recent studies or not as definitive. Read more about the role of Embryo Glue in IVF success rates.

Atosiban/Tractocile

(to prevent uterine contractions during/following FET procedure )
TRACTOCILE is a brand name for the generic drug Atosiban, and is generally used to delay the premature birth of the baby. It works by supressing the contractions in the uterus, making them less strong and less frequent. It does this by blocking the effect of a natural hormone in your body called “oxytocin” which causes the uterus to contract. In some cases surrogates receiving an embryo transfer can react with muscle spams or contractions in the uterine walls. This can prevent the embryo from implanting. Atosiban injections can help prevent this. But the value of the treatment is really only for those women who suffer from uterine contractions, and not for all women. Read more about Atosiban as a treatment in IVF.

Intralipid infusion

(to improve receptivity)
Intralipid is a 20% fat emulsion that is administered routinely by the intravenous route, as a source of fat and energy. It has been known for some years that intralipid causes mild suppression of the immune system. Recently reproductive immunologists have started using the treatment in IVF to treat women who suffer from recurrent miscarriage or repeated failed implantation following embryo transfer.

An embryo contains only half the genetic material of the mother, therefore her uterus may see it as an invader, like a germ or foreign body. Normally the lining of the uterus contains immune cells that are specially adapted to tolerate an embryo. However, when these “friendly” cells are not there or do not work as they should, then the mother’s immune system may attack or reject the embryo with so-called “natural killer” or NK cells. This would make it difficult or impossible for the embryo to implant in the lining of the uterus. It is thought that intralipid is able to change the immune cells in the uterine lining, making the environment in the uterus more friendly towards the embryo. Read more about immunotherapy during IVF and also this recent research abstract.

Preimplantation Genetic Diagnosis


Finally, an important tool to help couples improve their pregnancy chances is to identify those embryos created during IVF that may be unhealthy or be unable to create a successful pregnancy. Many times an embryo may appear healthy under a microscope, but a missing or damaged chromosome may cause it to fail after a certain number of days or weeks. To find which embryos are healthy, IVF clinics use a process called Preimplantation Genetic Diagnosis, or PGD.

PGD-cGH is a genetic screening of the embryos that takes place at most clinics. This test identifies those embryos with chromosomal anomalies, which are responsible for up to 70% of failed IVF attempts. PGD/PGS can be done for an additional fee by most clinics.

There are various types of PGD tests, and they differ in what they test for, and also what they cost. Here are the most common…

PGD via Fluorescent In Situ Hybridization (FISH)


FISH is used for gender selection and some chromosomal abnormalities. The FISH technique tests embryos on day 3 of their development, and a single cell is removed from each embryo. The analysis involves testing fragments of DNA that are specific to each chromosome.

FISH, however, can only test about 10 chromosomes, out of a possible 23 pairs of chromosomes. This means that many abnormal embryos that would be unable to result in a pregnancy may remain undetected and may be transferred. Chromosomes that can be analyzed with FISH probes include X, Y, 1, 13, 16, 18, and 21.

Polymerase Chain Reaction (PCR)


PCR, sometimes called DNA amplification, is used for the diagnosis of single gene defects, including dominant and recessive disorders. It is a technique in which a particular DNA sequence is copied many times in order to facilitate its analysis. PCR rapidly multiplies a single DNA molecule into billions of molecules. PCR requires sufficient amounts of a pure, high-quality sample of DNA, which is sometimes difficult to obtain from a single cell.

Comparative Genomic Hybridization (CGH)


CGH allows genetic specialists to examine all 23 chromosomes, as compared to the FISH technique. It also gives a more detailed picture of the entire length of the chromosome, which gives a more accurate view of the health of the DNA of the embryo.

Unlike FISH, the CGH technique is performed at Day 5 of the embryos development, and usually takes about 72 hours. This means the embryos must be frozen while the diagnosis is performed. Newer processes for freezing embryos have improved the survival rate, so it is generally not considered a problem to have the day 5 embryos frozen (especially in comparison the benefit that CGH can offer).

 
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