We still have a lot to learn about how to combat infertility using IVF, but there could be a huge boost in success rates and scientific understanding thanks to new research.
Infertility affects around 15% of Australians, and it’s a health issue that remains stigmatised, and relatively poorly understood.
In-vitro fertilisation, or IVF, has been around for decades, but it’s a very expensive procedure with a surprisingly low success rate: around 1 in 5 IVF treatments will result in the birth of a healthy baby.
For couples and individuals wanting to start a family, this process can be heartbreaking, and sometimes financially crippling.
‘For every cycle initiated in Australia and New Zealand, only 18% of those cycles end up in a baby going home,’ says Dr Kylie Dunning, Chief Investigator at the Centre for Nanoscale BioPhotonics (CNBP), based at the University of Adelaide.
‘Most of the public doesn’t realise that it’s really a lottery.’
But that’s all about to change, thanks to the work of Dr Dunning and her team at the CNBP. They’ve uncovered new technologies that could revolutionise IVF — and significantly improve success rates.
What is IVF?
The basics of IVF involve combining an egg with a sample of sperm in a clinical setting to form an embryo, which is grown in the lab and then placed back into the patient’s body in the hope it will develop into a fetus.
The current IVF standard procedure includes a screening process to determine which embryo should be implanted. This involves the study of cells removed from the 5-day-old embryo, to assess its relative ‘health’.
According to recent research, however, this procedure is both risky and inaccurate.
‘They take a biopsy from the cells that go on to form the placenta, not the cells that form the baby,’ says Dr Dunning. ‘There’s enough evidence to show now that it’s not a reliable indicator of whether that embryo will go on to form a pregnancy, and result in the birth of a healthy baby.’
The procedure also increases the patient’s risk of developing pre-eclampsia, a serious high blood-pressure condition that can impact patients for life.
Using light-based technology to improve IVF
Dr Dunning’s research at the CNBP centres around a technique called auto-fluorescence, which uses light reflections, instead of biopsy, to determine the status of the embryo.
‘Instead of taking a biopsy, we shine light on the embryo and then capture what’s reflected,’ Dr Dunning says.
All cellular organs emit a ‘glow’ or light reflection, which can be measured using a high-powered camera. When a cell glows differently, the team know it needs to be examined.
‘So instead of taking a chunk of cells, we can instead look at the whole embryo, including the cells that will form the baby and the placenta, as a means of determining how healthy it is.’
Dr Dunning’s team took their light-based technology, known as biophotonics, one step further by placing probes right up next to the embryo to take nanoscale measurements of the embryonic fluid.
‘We use light down an optical fibre with a chemical sensor at the other end, that changes colour when the pH changes in the liquid in which we grow the embryo, for example,’ Dr Dunning says.
Both these techniques have been successfully trialled on mice, and the results show no damage to the embryos.
‘What we’re trying to do is assess the embryo in a way that does not cause any damage, and gives accurate information.’
As well as having a raft of benefits for humans, these new techniques have applications in livestock IVF, which is a multi-million-dollar industry in Australia.
The next steps in chromosome detection
Assessing the number of chromosomes in cells before implantation leads to another conundrum: which irregular numbers of chromosomes — a condition known as aneuploidy — will interrupt the pregnancy, or prevent the birth of a healthy baby?
‘We know that many human embryos already have some cells that are aneuploid, but there seems to be some sort of tipping point,’ says Dr Dunning.
‘The next lot of work is really understanding the threshold — how many cells with irregular number of chromosomes can an embryo afford to have and still be viable?’
Dr Dunning is using animal trials to answer this question, by artificially creating different scenarios in mice in order to test which combinations of aneuploidy in which cellular locations will still go on to form a healthy baby.
The automation of IVF
Another revolution in IVF sits in the hands of Dr Dunning’s colleague, CNBP senior investigator Prof Jeremy Thompson.
Prof Thompson has been working on a concept known as the IVF Garage — a highly automated IVF technique which could improve success by reducing human error.
‘At the moment we grow embryos in a small volume of liquid that’s then covered with oil, and that requires manual handling,’ Dr Dunning explains. ‘Handing sperm samples, moving embryos to different dishes, all of this is manual. So that requires the embryos to be taken in and out of the incubator, which isn’t good.’
Prof Thompson has devised a nanoscale ‘pod’ in which to house embryos, meaning the samples would not need to be handled, and embryologists could make changes to the environment automatically to better mimic what happens inside the body during pregnancy.
‘Jeremy’s team have found that growing embryos in these devices is not toxic, and they’re now looking at what’s called perfusion culture: as the embryo develops, its needs for certain nutrients changes, and that could be done in real time.’
The excitement for developments in IVF is multi-layered for Dr Dunning. Once this research hits the clinics, the impacts will be felt across the world.
‘That’s where we’re driven to make a difference and improve the success rates: to decrease the emotional and financial burden for couples and individuals needing to have IVF.’