Since 1978 marked for birth of first “test tube baby”, to this time there have been explosive advances in embryology lab. The emergence of these advanced technologies are helping to improve pregnancy rates steadily. These are some of the advancements in ART laboratories that time has witnessed.
ICSI (Intra Cytoplasmic Sperm Injection)
Intra Cytoplasmic Sperm Injection (ICSI) involves the insertion of a single sperm into the egg, by bypassing all the egg coat penetration and gamete fusion. ICSI has also made possible a more consistent fertilization of cryopreserved oocytes. ICSI is the most preferred and reliable advanced technique for the male factor infertility (exceptAzoospermia), surgically retrieved sperms, less egg number, previous fertilisation failures.
IMSI (Intra Morphologically Selected Sperm Injection)
Method which allow ICSI,morphologically selected sperm under the magnification of 6000X. which allow the embryologist to choose only ones which are the healthiest and have the best morphology. This particular sperm selection technique gives a better outcome in the fertilization and development of embryos. In addition, IMSI is a useful technique for couples with male infertility. This is however indicated in selected cases only.
PICSI (Physiological ICSI)
Physiological ICSI, offers new assessment criteria for sperm selection, as it is based on the ability of the sperm to bind to hyaluronic acid. The sperms which binding to this acid are supposed to be mature and have less chromosomal abnormalities. This method is useful in case of failure, or in case with low success rates after previous ICSI attempt, in couple with low embryo quality. Also applicable for the man who diagnosed with higher rate of sperm DNA fragmentation (abnormal sperms). Vasundhara hospital is credited with successful implementation of this technique in a good number of patients.
Piezo – ICSI
This is the most advanced techniques similar to the procedure of ICSI. Use of different type of micro-tool and tool driving units are only make it differ from ICSI.
IVM (In-Vitro Maturation)
Usually for IVF, injections are given to the female to produce more number of mature eggs at the same time. These eggs are collected outside the body for fertilization in IVF lab. Some cases, the oocytes collected are not mature. Such immature oocytes cannot fertilize directly. The immature eggs are cultured in a special media, which help the eggs to mature. Each individual egg is injected with one sperm (ICSI). This is a boon for PCOS patients and also those with estrogen dependent tumours. Although this is again only for experimental use.
TIME LAPSE IMAGING ;Embryoscope
Selection of embryos for transfer is the most crucial step in the IVF procedure which is likely to give you the result of a healthy pregnancy. The normal way of selection is to take out the embryo from the incubator and check under microscope at fixed time over 3-5 days. The evaluation time allows for culturing the embryos is limited by the need to minimize the time embryo spend outside of the safe environment of the incubator. The time-lapse embryo monitoring system allows to monitor embryos through the full course of their development. They are specially designed incubators with built in camera. It takes the images of growing embryos in every 10 minutes. as a result, time-lapse videos are generated over the 3-5 days. These advanced techniques help the embryologist to select the better embryos. It is used to help select embryos with lower risk of defects and/or greater potential of implantation. Vasundhara hospital is the first one in the state of Rajasthan to be equipped with an embryoScope. It is in fact one of the best IVF centres in Jaipur and Jodhpur.
LASER ASSISTED HATCHING
The embryo hatches and begins the implantation process via interaction with endometrial cells. The inefficiency of Implantation Rates after Embryo Transfer may be attributed to various factors including the potential failure of a euploid blastocyst to hatch from the Zona Pellucida (outer layer of embryo). Assisted Hatching is a technique performed after in vitro fertilization and involves the artificial thinning or opening of the zona pellucida by the embryologist prior to Embryo Transfer as an attempt to improve the probability of embryo implantation. There are 3 techniques for assisted hatching. mechanical hatching, chemical hatching and laser assisted hatching. Laser assisted hatching is the most advanced technique and it involve the creation of a precise gap in the zona pellucida of selected embryos using infrared diode laser. These small hatch help the embryo to hatch easily.
CRYOPRESERVATION
Cryopreservation (freezing) of embryos produced during human IVF is a logical way to provide an opportunity for patients to have repeated attempts at conception following a single drug stimulation cycle, preventing wastage of valuable genetic material and improving cumulative pregnancy rates. This approach may have several advantages to the patient. it provides an opportunity to limit the number of embryos transfer per cycle by bypassing the repeated stimulation and ovum pick-up procedure.
PGT (Preimplantation Genetic Testing)
Embryos undergo Preimplantation genetic testing are biopsied on day 3 or day 5. A small hole is created in the zona pellucida using laser and with a micropipette one blastomere is removed in each embryo. On day5 biopsy, trophectoderm cells are removed.
After these cells are removed, the blastocyst is frozen and stored in the lab.
The biopsied cells are sent for laboratory testing. Results are typically returned in a week to 10 days following the biopsy. PGT consist of two methods.
- PGD: Preimplantation Genetic Diagnosis is recommended to couples that are ailing or are carriers of a genetic disease or they already have a child that suffers from a genetic disease such as Thalassaimia, Cystic Fibrosis, Spinal Muscular Atrophy or Duchenne Muscular Dystrophy. In some cases, the child to be born may be genetically compatible with an already-heavy-suffering brother and serve by donating some stem cells to save his life.
- PGS: Preimplantation Genetic Screening is recommended to couples that are in an IVF program with recurrent failures in IVF, advanced maternal age, repeated pregnancy loss or severe male factor infertility. During the procedure the embryos that are produced in vitro after IVF are biopsied and checked for aneuploidies (kind of chromosomal abnormality).
Polar Body Biopsy
Polar body diagnosis (PBD) is a diagnostic method for the indirect genetic analysis of a mature oocytes.
polar body which is very small, non-functional and as a satellite isolated on the periphery of the oocyte. Removing the first polar body does not affect fertilisation or fetal development. Knowing the genome of the polar body we know the oocyte genome. The polar body biopsy is more acceptable ethically since material from the embryo itself is not used. The major application of PB biopsy is the detection of maternally derived chromosomal aneuploidies and translocations in oocytes. However, it is a very new technique, technically difficult, costly and still in progress, so it requires patience and thorough research until it is effective.
Although these technologies are advanced and beneficial but these are costly. Also, these are a boon if used in carefully selected patient population, these can also end up being an additional burden on patient’s pockets if advised universally. Hence, with the advanced technologies, we also need a good understanding of individualising each and every case and use these techniques judiciously as to get the maximum benefit in terms of successful IVF program.
Vasundhara hospital and fertility research centre Jaipur is a pioneer institute equipped with all the latest techniques and personalising the treatment plan according to individual need as to maximise the chances of a positive result.
