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Is Coculture “Miracle Grow” for Your Embryos?

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by Rachel Lehmann-Haupt, Dec. 22, 2009

After Amy Kramer, a 38-year old, single, real estate broker from Manhattan, went through 13 IUIs and one failed IVF cycle, her doctor suggested she turn to what she now refers to as “miracle grow" for her embryos.

“The last time I did IVF, my embryos grew too slowly,” she explains. “By day five they had only grown to five or six cells and my doctor wanted seven [cells] before the implantation.”

So her doctor, Dr. Steven Spandorfer, an Associate Professor at the Center for Reproductive Medicine and Fertility at Weill Cornell Medical College, decided to turn to Coculture, a procedure that helps embryos grow outside of the womb in a woman’s own endometrial cells. Doctors at Weill Cornell pioneered this procedure in humans in the mid-1990s, and still believe it's helpful for certain patients. A handful a clinics across the country offer the procedure now, including UCSF Center for Reproductive Health in San Francisco.

“Some women don’t have good embryo development,” says Dr. Spandorfer. "The premise [of Coculture] is that taking some of the patient’s own endometrial cells and adding them to the lab environment helps to grow the embryos."

According to Spandorfer, doctors believe these endometrial cells secrete a growth factor that helps embryos develop. UCSF Center for Reproductive Health began using coculture in 1999, and since then the clinic reports they have completed 35 IVF cycles using Coculture and in all the cycles, they saw "an improvement in embryo quality and relative growth 72 hours after egg retrieval."

The procedure involves a biopsy of the cells twelve days after ovulation. The cells are then frozen until they are needed during fertilization in a Petri dish after the IVF retrieval. “The procedure was painful and I had some cramping," says Kramer, "but it was less than two minutes so that’s good news.”

A 2004 study showed "a significant improvement in embryo quality with [endometrial coculture]" and demonstrated "that patients with a poor prognosis secondary to prior IVF failures can have a good outcome when utilizing [coculture]."

Not all doctors, however, think the procedure is a magic bullet for infertility or worth the expense since insurance doesn't usually cover it. Other doctors think the procedure is no longer necessary. The Advanced Fertility Center of Chicago posts information about Coculture on its clinic’s website, but no longer performs it because its doctors believe that their IVF pregnancy rates are just as good without it.

"It was a lot of extra work and added expense and hassle for the patient," says Dr. Richard Sherbahn, the clinic’s Medical Director. "Now that the culture media is more sophisticated, I'm just not sure it's worth it."

As for Amy, she says she'll decide if it was worth it if she sees a positive pregnancy test after her next transfer.


Rachel Lehmann-Haupt ( is a journalist and the author of In Her Own Sweet Time: Unexpected Adventures in Finding Love, Commitment and Motherhood (Basic Books, 2009).