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What You Can Learn From Your Embryos
a blog by Mylene Yao, M.D., Univfy, Inc., February 7, 2013
I’ve spent a good many years thinking about the embryo to figure out how to best peer into the black box that controls the first few days of embryo development. We are just scratching the surface of understanding molecular switches which, when malfunctioning, can lead to heartbreaking experiences. The results can include some types of miscarriages, biochemical pregnancies (pregnancies that fail shortly after pregnancy tests turn positive and before any signs of pregnancy can be detected by ultrasound), failed IVF attempts, and a catch-all called aneuploidy (or an abnormal number of chromosomes). We are endeavoring to unveil the mysteries of the black box, layer by layer, to be able to provide personalized medicine to our patients, tailoring treatment to each one’s individual disease at the molecular level in the way that doctors are now able to treat some types of breast cancer.
In the meantime, what can you do today to understand your fertility destiny? Hear your embryos out. They can tell you a lot.
Our research team has analyzed medical data from failed IVF cycles of thousands of patients and whether their subsequent IVF cycles brought them a baby. We learned that in addition to your age, reproductive history, body mass index, certain clinical diagnoses, and your IVF history (how many IVF cycles you have done and their outcomes), information learned from your most recent IVF cycle can be turned into predictors. For example, your response to the hormonal stimulation of your ovaries during IVF and the quantity and quality of your embryos can be used together to predict the chances of having baby with your next IVF cycle. Your response to the injected hormones includes your peak serum estradiol (highest estrogen level from blood tests), endometrial thickness on ultrasound on the day of HCG (human chorionic gonadotropin) injection, the number of eggs retrieved, and even the amount of gonadotropin itself. Embryo quality includes information such as the number of embryos and their developmental stages, usually described in terms of the number of cells on the third day of in vitro culture (Day 3), or if they develop to blastocyst stage on the fifth day of culture (Day 5).
Although each of these factors on its own has limited predictive power, collectively, they can serve as very strong predictors to tell you about your chances of success. Some patients may wish to learn about their personalized success rates to decide whether to pursue their first IVF cycle or to repeat IVF after an unsuccessful treatment. Some patients have been recommended IVF with donor eggs and wish to confirm that their prognosis is indeed poor before taking that big step. Still, a small group of patients would prefer not to know their prognosis at all. What is most important is that each woman can choose whether she would like to have more accurate and meaningful information from her reproductive and past IVF profile to support decisions going forward. The ability today to shed more light on your fertility prospects can give you more confidence as you pursue treatment choices. All the while, scientists will continue working to unlock the black box, so that we can take better control over our own reproductive futures.