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Fertility Doctor of the Month: Zsolt Peter Nagy, Ph.D.
Zsolt Peter Nagy, Ph.D., Reproductive Biology Associates, Atlanta, GA
As an embryologist, Zsolt Peter Nagy, Ph.D., has contributed to significant developments in the field of reproductive endocrinology and infertility. At the onset of his career, he was part of the team that improved the efficiency of ICSI. Intracytoplasmic sperm insemination is a procedure whereby one sperm is injected directly into an egg during an in vitro fertilization (IVF) cycle. It is a common treatment when male factor infertility is diagnosed. Most recently, his contributions to improvements in egg freezing have led to the development of the first frozen donor egg bank in the United States.
For his commitment to the advancement of laboratory techniques for fertility treatments, FertilityAuthority is pleased to honor Dr. Nagy as Fertility Doctor of the Month.
Patients put a lot of emphasis on the fertility doctor they choose. However the clinician is just one part of the equation. For example, fertilization — where the sperm and egg are introduced and the embryo is cultured and grown — takes place in the IVF lab and is overseen by the embryologist. And embryo and egg freezing are primarily IVF laboratory procedures. As such, Dr. Nagy provides supervision and management of the lab, and works to improve fertility treatment success rates. “It is also my responsibility to try to see if there is any new technology on the horizon and bring it in house or develop it in house,” Dr. Nagy says.
In 1983, the first reports of successful pregnancy following embryo freezing were published. Just three years later, 1986 saw the first pregnancy after egg freezing. According to Dr. Nagy, embryo freezing with the slow freezing procedure was working quite well. However egg freezing never really took off because it was not efficient. “For about 20 years, from about 1986 to 2006, you needed approximately 100 to 150 eggs to get one pregnancy.” With vitrification — a fast freeze and thaw process — and, “In our hands approximately five eggs are needed today to get one pregnancy. It’s a huge improvement. And because of that, today we are able to use this technology for many different indications,” Dr. Nagy says.
However, the American Society for Reproductive Medicine (ASRM) considers egg freezing experimental. “Because egg freezing has been so inefficient for 20 years, that is the reason that ASRM, according to their guidelines, regards egg freezing as experimental. I think [that designation] is probably going to change in the very near future,” Dr. Nagy says.
“One of the indications [for egg freezing] is for egg donation, which makes egg donation much more efficient, and it’s also much more convenient for the recipient and for the donor,” he adds. It can be used for other indications too, fertility preservation for cancer patients, and for social reasons — women who want to freeze their younger eggs for later use.
Dr. Nagy believes that while egg freezing can be used for many indications, “This is something that each individual IVF clinic has to set up certain guidelines for … when they accept a patient or person for freezing eggs for social reasons. This is something that is needs to be discussed — the ethical and moral aspects of it.” And, he adds, “It is definitely understandable that women who are not yet married, and who are engaging in their career … are worried that their chances to have children would be much lower in a few years.”
Frozen donor egg cycles at RBA started with a pilot study of 20 patients, or donor egg recipients; 17 of the 20 recipients got pregnant. “That was very unexpected,” Dr. Nagy says. “We were hoping to have some pregnancies, but couldn’t ever dream that we would have 17 out of 20 pregnant. That was really an excellent outcome.” That gave them the encouragement to think about using this model for more egg donor patients, and in 2007 to 2008 with 30 to 40 donors, they opened a donor egg bank. The recipients were free to choose egg donation from a fresh egg donor or from the frozen egg bank.
“Because of the convenience of the frozen donor eggs, 90 percent of the recipients chose the frozen donor eggs. And in 2011, I think we did probably 300 egg donor cycles and probably there were 20 fresh egg donations and the other 280 were from frozen eggs. By now we have more than 400 children born from frozen eggs,” Dr. Nagy says.
We asked Dr. Nagy what he thinks is in the future for reproductive medicine. His predictions?
- Within a few years, most egg donation cycles will use frozen eggs.
- He speculates that larger frozen donor egg banks will be developed, operating the way sperm banks do today.
- He’s also excited about potential new developments to evaluate the viability of the embryos, including the use of an embryoscope. To simplify, it’s a microscope inside the incubator that allows the embryologist to monitor the progress of embryo development without removing the embryo from the incubator. “Instead of looking once every day, you can look at the embryo around 6,000 times during the first four to five days of development, so you get a much larger amount of information that can give additional information on which embryo is most viable," according to Dr. Nagy.
Exciting developments are on the horizon. FertilityAuthority is pleased to recognize Dr. Nagy’s contributions, and will continue to follow his research.