ESHRE appeals to national societies to spread awareness about oocyte donation

The European Society of Human Reproduction and Embryology (ESHRE) has created an oocyte donation brochure DONATION OF OOCYTES in collaboration with the Council of Europe European Committee on Organ Transplantation (CD-P-TO).

ESHRE is encouraging national societies across Europe to translate the publication into their national languages. Composed by internationally recognized experts, the patient brochure on oocyte donation is a guide for women to support informed decisions about donating oocytes.

Many women are unsure whether it is safe or not to donate oocytes and are interested in knowing the future implications of such donations. This guide will provide clear, accurate and balances information about the cause.

To translate the guide into regional language first seek permission with the Council of Europe who holds the copyright of the publication. This can be done by sending an e-mail to publications.info@edqm.eu where you will have to specify your intention and the language of translation.

DONATION OF OOCYTES Brochure

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Novel microfluidic device quickly corrals vigorous motile sperms for IVF

Courtesy: Pixabay

Cornell University scientist has created an innovative microfluidic device that effectively separates the motile, highly energetic sperms; thereby increasing the chances of fertilization for couples undergoing IVF.

The current method of separating sperms for IVF is highly tedious, manual and can take hours for completion. Doctors and technicians spend hours to separate the motile, good quality sperms making the process expensive and time-consuming.

“With the new method, it’s 5 minutes instead of hours,” said Alireza Abbaspourrad, a researcher involved in the latest study.

The new device takes advantage of sperm’s ability of positive rheotaxis—natural tendency of the sperms to face against fluid flow after reaching a specific velocity. The researchers devised a microfluidic channel through which the semen sample flows to which the researchers added a “C” shaped corral and a retaining wall.

The structure creates interference to flow of sperms, and the highly motile, stronger sperm enter the corral only to be trapped by the retaining wall. “We could separate the good sperm from the not-so-strong in a reasonably elegant way. We are able to fine-tune our selection process,” said Soon Hon Cheong, another researcher involved in the study.

Meisam Zaferani, a doctoral student at the Cornell, said the device might find broader application beyond its uses in Assisted Reproductive Techniques, especially in dairy and livestock industries. “The unprecedented efficiency of our device in comparison to previous studies and its benign, passive nature makes it favorable for sperm separation,” he said.

The study, “Rheotaxis-Based Separation of Sperm with Progressive Motility Using a Microfluidic Corral System,” published in the Proceedings of the National Academy of Sciences July 30.

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Here is the short video of how the technique works

The fertility doctor who secretly fathered many children is barred from medical practice

Dr. Donald Cline, MD, from Marion County, Indiana who secretly used his sperm during the IVF treatment for many of his patients has surrendered his license and is barred from ever practicing again.

Dr. Cline practiced as infertility specialist in Indianapolis area during the 1970s and 1980s and may have fathered dozens of children under the guise of using "fresh sperm" from a medical student or resident. In the United States, the Centers for Disease Control and Prevention report that from 2011 to 2015, as many as 12 percent of women reported having used infertility services such as artificial insemination.

It is currently not known that how many couples did Cline deceived, exactly how many children were fathered and what was his motive behind this action. The matter came to light when Jacoba Ballard's discovered that she shares her DNA with 8 unknown siblings when she took a DNA test from 23andMe.com—a direct-to-consumer DNA testing service.

Out of 8, only one was identifiable by name, and she and Ballard got together to construct a family tree only to realize that their mothers have gone to Cline clinic for fertility treatments.  Ballard and her half-siblings arranged a meeting with Cline himself who finally confessed that he had used his sperm in as much as 50 cases to help unknowing patients who desperately wanted children. For now, it is not precisely known that how many women have Cline exactly fertilized using his sperms.

Many families and children have since come forward for DNA testing, and reports from ancestry.com and 23andMe have found another three dozen of Kelly half-sibling. They have formed a group on social media, and many of them are in contact with each other. With the rising popularity of DNA testing and social media presence of more and more people, the Ballard is sure of adding more siblings to her group.

Ballard filed a complaint against Cline with the Indiana attorney general's office. Cline was charged with obstruction of criminal justice after lying to investigators about two confirmed cases of paternity. US laws differ state wise when it comes to fertility doctors using their sperms, and Indiana law does not explicitly prohibit fertility doctors from using their sperms.

In December 2017, Cline pleaded guilty to two counts of obstruction of justice, admitting that he intentionally lied about using his sperm to impregnate his patients. Cline was given a 365-day suspended sentence for the felony conviction.

“Not only did Dr. Cline abuse his position of complete trust with his patients, his decisions will have a lasting impact through generations of the impacted families,” Prosecutor Terry Curry stated after the sentence was announced. “There were significant limitations to how a criminal case could proceed against Dr. Cline, but ultimately he admitted to his actions and to intentionally misleading investigators.”

The FDA clearance of direct-to-consumer DNA testing and a lot of TV advertisement has made DNA testing look like fun. Many of the ads promote it as a holiday or Christmas gift. However, consumers should be aware of the potential downside of casual genetic testing—they may find something that has the potential to change the life for good or bad and physician should always explain patients about the pros and cons of genetic testing.

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News from ESHRE 2018: Endometrial scratch does not result in more pregnancies

Endometrial scratch is often offered as an adjuvant therapy to improve the IVF success rates, but the results of a large randomized control trial have shown that the “add-on” procedure does not improve the pregnancy or live birth rates. The study results were presented at the European Society of Human Reproduction and Embryology (ESHRE) 34^th annual conference in Barcelona, Spain by Dr. Sarah Lensen, a researcher from the University of Auckland, New Zealand.

The study involved 1300 women who underwent IVF across 13 fertility centers in 5 countries (New Zealand, UK, Belgium, Sweden and Australia).

It is proposed that causing injury to the endometrial lining invokes an inflammatory response that helps create a favorable environment for the implantation of the embryo. A survey conducted in Australia, New Zealand, and the UK by Lensen and colleagues in 2016 revealed that about 83% of physician offer endometrial scratch to patients before IVF cycles, especially those who have recurrent implantation failure.

Lensen said in a statement at the conference, "Results from earlier studies have suggested a benefit from endometrial scratching in IVF, especially in women with previous implantation failure. However, many of these studies had a high risk of bias in their design or conduct and did not provide strong evidence. There was still uncertainty about the validity of a beneficial effect."

The women in the study group (690) received an endometrial scratch performed by Pipelle cannula between day 3 of the preceding cycle and day 3 of the IVF/embryo transfer cycle, while the control group (674) didn’t receive any such treatment.

In this intent to treat analysis, the clinical pregnancy rate in the endometrial scratch group was 31.4% and in the control group 31.2%; live birth rates were 26.1% in the former and 26.1% in the latter. No difference was seen in rates of biochemical pregnancy, ectopic pregnancy, or multiple pregnancies among both the groups.

The researchers also looked at other side effects of endometrial scratch and found that the median pain score for the procedure was 3.5. Women also suffered from vasovagal attack, excessive pain, and excessive bleeding. 

“Our results contradict those of many studies published previously,” said Lensen, “and, although our trial was the largest and most robust study undertaken so far, it can be difficult for one trial to change practice. However, there are other trials underway at the moment, including two large studies from the Netherlands and UK. Nevertheless, even based just on our results, I think clinics should now reconsider offering endometrial scratch as an adjuvant treatment.”

ESHRE Press Release

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Human eggs grown to maturity in the lab first time could unlock future fertility options

image credit: Prof David Albertini

In an extraordinary scientific feat, researchers were successful in growing human oocytes from the earliest follicular stage in the laboratory in just 20 days instead of 5 months in the body. The eggs fertility potential is unknown yet, and it remains to be seen whether they can produce healthy babies. 

The study was carried out in collaboration with the Royal Infirmary Edinburgh, The Center for Human Reproduction in New York and the Royal Hospital for Sick Children in Edinburgh, and published January 2018 in Journal of molecular human reproduction.

This process of oocytes maturation in lab could find potential applications in fertility preservation of cancer patients during the chemotherapy treatments. Immature eggs recovered from patients’ ovarian tissue could be matured in the lab and stored for later fertilization without the fear of reintroducing cancer.

Professor Evelyn Telfer from School of Biological Sciences said, “Being able to fully develop human eggs in the lab could widen the scope of available fertility treatments. We are now working on optimizing the conditions that support egg development in this way and studying how healthy they are. We also hope to find out, subject to regulatory approval, whether they can be fertilized.”

Till now researchers have successfully produced live offspring in mouse from in vitro grown (IVG) oocytes from primordial follicles. They have also grown human oocytes from secondary/multi-laminar stage to obtain fully grown oocytes capable of meiotic maturation.

However, this is the first report of in vitro complete human oocyte growth from immature primordial/unilaminar follicles using two-step culture system.

A series of magnified images show human eggs in development stages. Prof. Evelyn Telfer and Dr. Marie McLaughlin/University of Edinburgh/Handout via REUTERS

The scientist obtained fresh ovarian cortical pieces of approximate size 5 mm × 4 mm from women undergoing elective cesarean section. Fragments were cultured for 8 days according to the institute predetermined protocols.

Follicles ranging in diameter from 100–150 μm were dissected for further isolated culture. After about 8 days cumulus-oocyte complexes (COCs) were retrieved by gentle pressure on the cultured follicles. These COCs were further cultured for 4 more days when complexes containing oocytes >100 μm diameter were selected for in vitro maturation (IVM) in SAGE medium and subsequently fixed for analysis.

Confocal immuno-histochemical analysis of oocytes more than 100 μm diameter showed the presence of a Metaphase II spindle confirming that these IVG oocytes had resumed meiosis but their developmental potential is unknown.

Other scientists are looking at this process with great concern because of the shortened maturation process and lack of genetic analysis of the matured egg.

Telfer agrees that much work needed to be done and said, “We had no great expectations. To see at least one [egg reaching maturity], we thought, ‘Wow, that’s actually quite incredible.’”

The eggs fertility potential is unknown yet because of lack of regulatory approval, and even if they have can be fertilized much research is needed to see whether they can produce healthy babies.

But, the study has given new insights on human egg development that could be very useful in fertility treatment and regenerative therapies.

Her team is working on improving the process and getting an approval from the United Kingdom’s Human Fertilization and Embryology Authority—to try fertilizing the lab-matured eggs to create human embryos.

Full Text

University of Edinburgh press release

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Fresh or frozen-embryo transfer results in similar pregnancy rates in women without PCOS

Episona.com

Healthy infertile women with no polycystic ovarian syndrome have the same ongoing pregnancy and live birth rates from IVF irrespective of whether the embryo was fresh or frozen reports the results of two recent clinical trials published in JAMA. 

Recent clinical trials have documented higher pregnancy and live birth rates with the transfer of frozen embryos as compared to fresh ones. A clinical review published in the Journal of Human Reproduction Update also favored “elective frozen embryo transfer (eFET) not only in terms of achieving higher pregnancy rates but, more importantly, also in terms of lower maternal and infant morbidity and mortality.”

The two current studies were conducted to see whether fresh frozen embryo transfer resulted in higher birthrates in women who do not have PCOS.

The first multicenter, randomized trial recruited 2157 women who were scheduled to undergo their first IVF cycles. They were randomly assigned to undergo either fresh-embryo transfer or embryo cryopreservation followed by frozen-embryo transfer. The maximum embryo transferred in each participant was two with the live birth rate as the primary outcome after the first embryo transfer.

There was no significant difference in terms of live birth rates in the frozen-embryo group and the fresh-embryo group (48.7% and 50.2%; P=0.50) respectively. Both the groups were also similar in terms of risks of obstetrical and neonatal complications, rates of implantation, clinical pregnancy, overall pregnancy loss, and ongoing pregnancy.

But, frozen embryo transfer did result in a significantly lower risk of the ovarian hyperstimulation syndrome than fresh-embryo transfer (0.6% vs. 2.0%; P=0.005).

The second study randomly assigned 782 healthy infertile women with no PCOS to receive either a frozen embryo or a fresh embryo on day 3 during their first or second IVF. In this study also, the pregnancy rates were comparable in both the groups, 36.3% in the frozen-embryo group 34.5% in the fresh-embryo group (P = .65).

The authors concluded that in women who do not have PCOS, the pregnancy rates are similar with fresh or frozen embryos. In healthy infertile women, probably the uterine environment was favorable for fresh embryos transfer. 

Abstract-NEJM

Abstract-NEJM

Abstract-JAMA

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Consumption of pesticides treated fruits and vegetables linked with reduced fertility in women

Regular dietary consumption of fruits and vegetables treated with pesticides is linked to lower probability of live births and success rates of ARTs according to a study from Harvard T.H. Chan School of Public Health published October 30, 2017 in JAMA.

Animal exposure to pesticides at environmentally relevant concentrations is known to decrease the number of live births. Whether this holds good for humans is topic for research in recent years, the effects of high dose exposure causing reproductive injuries is already known.

More than 600 different pesticides chemicals, resulting into 1000s of combinations are available in US market with more than 450 kg applied every year.

Occupational exposure to high dose of some older pesticides are known to cause reproductive injury in exposed males causing infertility and azoospermia.

This prospective epidemiological study uses sophisticated biological markers to identify the effects of subclinical everyday exposure pesticide residues in fruits and vegetables on female fertility.

The study recruited 325 women undergoing infertility treatment as part of the Environment and Reproductive Health (EARTH) study. The women filled out study questionnaire about the daily consumption of fruits and vegetables. Women’s exposure to pesticides was calculated based on US government database of average pesticide residues on fresh fruits and vegetables.

The study found that women who ate more than two servings (2.3) of high-pesticide fruits or vegetables each day, compared with women who ate an average of one each day, were 18% less likely to become pregnant and 26% less likely to have a live birth than women with the lowest exposure.

If you can exchange one high-pesticide fruit or vegetable a day for a low-pesticide one, your odds of pregnancy are increased by 79% and live birth by 88% say the researchers.

Strawberries, spinach and peppers, tend to consistently make into the list of ‘dirty dozen’, a list of 12 most contaminated fruits and vegetables, while others, like peas and avocados, rank lower.

Jorge Chavarro, associate professor of nutrition and epidemiology at Harvard Chan School and senior author of the study, said that women trying to conceive may want to limit their intake of high-pesticide fruits and vegetables or eat organic versions, or choose low-pesticide produce such as avocados, onions, or oranges. “I am now more willing to buy organic apples than I was a few months ago,” he told TIME.

When the researchers modeled the effect of swapping one high-pesticide fruit or vegetable a day for a low-pesticide one, they found 79% higher odds of pregnancy and 88% higher odds of a live birth.

Dr. Yu-Han Chiu, a research fellow in the department of nutrition at the Harvard T.H. Chan School of Public Health and first author of the study told CNN "Although we did find that intake of high-pesticide-residue fruits and vegetables were associated to lower reproductive success, intake of low-pesticide-residue fruits and vegetables had the opposite association."

The researchers agree that the study just show an ‘association’ and more work is needed before a direct ‘causation’ can be established. Also, the results pertain to certain subset of women who already had reproductive issues and were seeking fertility treatment.

The study is accompanied by a commentary by Philip J. Landrigan titled

Pesticides and Human Reproduction

Which fruits you should buy organic

It's not always possible or affordable to buy completely organic produce. Nutritionist Lisa Drayer shows us which fruits to look for in the organic section.

Source: CNN

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News from ASRM 2017: Yoga helps to improve the outcome in infertility patients

Two papers presented here today at the at the American Society for Reproductive Medicine’s Scientific Congress in San Antonio (ASRM 2017) highlighted the importance of yoga in patients undergoing infertility treatments.

It is known that stress negatively affects reproductive outcome in ARTs and Yoga help improve the pregnancy rate and reduce the anxiety levels as an adjuvant treatment during the period.

Both the papers were also published in Fertility and Sterility September supplement.

A team of researchers from a private clinic in New Delhi examined the impact of Yoga on pregnancy rates for women who had already undergone one unsuccessful IVF treatment with fresh embryos.

Women with more than 5 years of subfertility, less than 38 years of age with no anatomical uterine anomalies were randomized to receive (n=105) either 30 sessions of Yoga over a period of 3 months, including asana (exercises) and pranayama (regulated breathing) followed by frozen embryo transfer or to have the embryo transfer in subsequent month(n=53) without any yoga sessions.

All women in the Yoga group completed Hamilton Depression Rating Scale (HAM- D), Hamilton Anxiety Rating Scale (HAM-A) and FertiQol questionnaire at baseline (S1) and after 3 months of YOGA sessions (S2) to assess the anxiety scores.

Following embryo transfer, 63% of the women in the yoga group achieved pregnancy as compared with 43% in the group with no Yoga training (P = 0.039). There was also remarkable improvement in the psychological wellbeing in women who had the yoga training.

The team from Chicago investigated the efficacy of attending an on-line or in person yoga class in bringing down the stress and anxiety levels in women with previous failed IVF.

In this small prospective cohort study of 26 patients, women were allowed to enroll into in person or an online yoga class for about 6 sessions. Spielberger State-Trait Anxiety Inventory (STAI) were completed before and after the intervention.

A significant decrease in anxiety and stress was observed in both the groups, which furthers the idea that an online yoga teaching is also equally effective as in person.

The study is still ongoing and recruiting participants, and the additional data will help strengthen the previous results.

We know infertility patients suffer from very high stress levels. These studies show that yoga represents a promising therapy for reducing patient stress during infertility treatment and even potentially improve outcome of such treatment,” said Richard J. Paulson, MD, President of the ASRM in a news release.

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Low serum AMH levels doubles the risk of miscarriage after in vitro fertilization–embryo transfer

geneticliteracyproject.org

Patients with low serum antimüllerian hormone (AMH) levels face a  33% higher risk of miscarriage as compared to women with high AMH says results of a university affiliated single center cohort study published in September issue of Journal Fertility and Sterility.

The researchers looked at AMH levels of more than 2,000 patients undergoing 2,688 IVF cycles with fresh oocytes, who attained a clinical pregnancy after IVF-ET. These patients had their centralized serum AMH levels measured within 1 year before they underwent embryo transfer.

It was seen that patients with reduced AMH levels suffered significantly more pregnancy losses as compared to women with normal AMH levels which remained the same after controlling for age and ovarian response to stimulation, which indicates that AMH is also a marker of reproductive potential and not just the number of oocytes.

AMH levels lower than 1.61 ng per mL were considered low but a definite cut-off could as the values vary by the test type.

A subgroup analysis of women according to age showed that in women older than 33 (34-36 and 37 and above) low serum AMH was associated with 33% miscarriage rate as compared to women with AMH > than 5.6 ng per mL, which was nearly twice as compared to women less than 33 years.

On the other hand, in women aged 33 and below, low serum AMH resulted in 22% rate of miscarriage, compared with about 13% among women with higher AMH levels, which was not statistically significant. But, when age was taken as single variable, the results were statistically significant.

The paper was also presented at October 2016 Annual meeting of the American Society for Reproductive Medicine in Salt Lake City, Utah.

No genetic testing of the embryos transferred or expelled products of conception was carried out to link the miscarriages to abnormalities such as aneuploidy.

Tubal re-anastomosis or IVF? A difficult choice to make when seeking reversal

Courtesy: Mayo Clinic 

Surgical re-anastomosis is an effective option, especially for younger women, whereas IVF is more cost effective for older women when seeking reversal of tubal ligation says the results of a systematic review published in current issue of Human Reproduction Update.

Female sterilization is one of the most common method of contraception used worldwide, with nearly 19% of women opting for it. The percentage is higher in Asia and Latin American countries (~ 25%) and lowest in European countries (3.8%).

In the United States, it is second most common method of contraception.  

But, circumstances and relationship change or a personal loss may aspire the women to desire future pregnancies. According to a statistic, up to 14.3% of women request reversal of sterilization. The categorical options are either tubal re-anastomosis or IVF.

Choosing between the two options is difficult decision to make and profoundly affected by many factors like age of women, time elapsed since sterilization, cost and desire for multiple children.

This systematic review looked at factors affecting the success of reversal, compared different methods of tubal re-anastomosis and how these methods fared compared to IVF.

The researchers searched the literature for randomized and non- randomized trials comparing fertility outcomes of various surgical methods and also looked at trails comparing re-anastomosis with IVF.

Women who have earlier suffered from tubal factor infertility were excluded from the analysis.

A total of 37 studies, with 10 689 women was included in the final analysis.  The pooled pregnancy rate after reversal was 42–69%, with variation in rate seen across different methods. About 4-8% of women had ectopic pregnancy after the surgery.

Age of the women at reversal of surgery was the only factor affecting the success rate of the procedure. The way the surgery was done i.e. laparoscopically, robotic and laparotomy using microscope did not play any part in achieving pregnancy.

Rates were lower in macroscopic laparotomic technique, which is currently not in much use.

IVF was better choice for women who were older, but no direct comparison data was available nor any cut-off age limit could be established.

The authors stressed the need of larger, randomized trials in future to compare re-anastomosis vs IVF in terms of  pregnancy rates and cost of procedures.  

ASRM's guidelines for the limits on the number of embryos transferred in In Vitro Fertilization (IVF) cycles.

courtesy: https://sickbayby.wordpress.com/tag/multiple-gestation/

In order to promote singleton pregnancies and bring down the number of multiple pregnancies in patients undergoing IVF, American Society for Reproductive Medicine (ASRM) and Society for Assisted Reproductive Technology (SART) updated the guidelines regarding the upper limit number of embryos transferred in IVF cycle. These guidelines replace the previous guidance issued in 2013.

The guidelines were  published online in the forthcoming issue of Journal of Fertility and Sterility.

The incidence of triplets and higher order multiple births have essentially declined in US for the last 15 years after steadily rising fourfold during the 1980s and 1990s. But, still multiple births are not desirable outcome of ART therapy.

The rise was due to older maternal age and increased use of ARTs, with no guidelines on the number of embryos transferred.

                                                     

Triplets

Triplets and Higher order births continue to have poor prognosis with 7% succumbing in first year of life as compared to .5% of singleton pregnancies. The ideal outcome after an ART procedure is to have a singleton pregnancy.

National data from CDC in 2013 demonstrate that clinics that perform higher rates of elective single-embryo transfer (eSET) in women aged <38 years have decreased rates of multiple gestation, with no significant impact on cumulative live-birth rates.

In women who are 42 years or younger transferring a single euploid blastocyst resulted in pregnancy rates similar to transferring two untested blastocysts while dramatically reducing the risk of twins.

Patient has the choice to choose the number of embryos transferred but it should be a fully informed decision taking into consideration medical, ethical and financial aspects of the procedure.

For drafting the recommendations, the patients have been categorized into favorable prognosis group and all others.

Conditions associated with favorable outcome are young age: euploid embryos, one or more good quality embryo available for cryopreservation and previous history of livebirth after an ART cycle.

For frozen embryo transfer the favorable conditions are when high quality, vitrified, day 5 or 6 blastocysts available.

The number of embryo transferred should be agreed upon by the treating physician and patients, depending upon the patient characteristics, data for the individual procedure and data from the ART services provided by the clinic. The following guidelines recommend the upper limits of the number of embryo transferred.

Patient with favorable prognosis:

A single euploid embryo transferred in patient of any age has the most favorable prognosis.

Patients under the age of 35 are always encouraged to receive one single embryo, irrespective of the embryo stage.  

Similarly, for patients between 35-37 years of age, a single embryo transfer is encouraged.

Patient between 38-40years of age, a single euploid embryo should be transferred, if availability is restricted than three cleavage-stage embryos or two blastocysts should be transferred.

Similarly, for patients between 41-42 years of age, the choice is to transfer single euploid embryo, if not than four cleavage-stage embryos or three blastocysts is the second choice.

Other scenarios:

In each of the above age group, if the patients do not belong to favorable prognosis category they can receive an additional embryo based on individual circumstances.

If patients who are in favorable prognosis category but fail to conceive after repeated cycles than an additional embryo may be transferred. If these patients have some coexisting medical condition that put them at high risk because of multiple gestation, a single embryo transfer is recommended.

In cases where the number of blastocysts transfer exceed the recommended limit, patient should receive counselling and everything should be well documented on the medical record.

Patients who are more than 43 years of age, insufficient data exist for number of embryos to be transferred using her own oocytes. The risk of multiple pregnancy increases dramatically as age increases, so caution must be exercised.

In donor-oocyte cycles decision should be made according to donor's age.

In frozen embryo transfer cycles, the patient should be categorized into favorable/other scenarios  group according to age of women when the embryo was frozen. And the number of frozen embryo transferred should not exceed the number of fresh embryo transfer recommended for each age group.

The full article in the Journal of Fertility and Sterility can be accessed here.

Highest Resolution Images Ever of Eggs, Sperm, and Embryos captured using 5K ultra-HD video.

High resolution image of 5day old human blastocyst 

Morphology is the gold standard by which we can assess the quality of embryos and gametes for success of various fertility treatments.

Imaging science in Reproductive Medicine has not made much significant advances since the last decade. Current options consist of either direct visualization through microscope objectives (limited magnification) or image capture via CCD/CMOS chip and inspection on a monitor (limited resolution).

Doctors attending the recent American Society for Reproductive Medicine’s annual meeting in Salt Lake City, Utah, got the opportunity to visualize first-ever 5K ultra-HD video footage of eggs, sperm, and embryos. It amounts to 14 million pixels per frame, 7 times more than the 1080p Full HD living room television.

The man behind this amazing achievement is Steven F. Palter, MD, a fertility specialist and scientific director at Gold Coast IVF in Woodbury, NY. CDC recently recognized Gold Coast IVF for having highest success rate in USA.

Dr. Palter designed a coupling system to make the RED Camera compatible with an embryo microscope. RED is ultra-high-resolution digital camera company that has revolutionized the movie industry in Hollywood.

860 recordings of eggs, sperm and embryos were made during IVF and ICSI procedures at 400x-960x magnification. The final images then were magnified digitally many times more on 55 inch 4k observation screens, producing the highest magnification and resolution video of these human cells which yielded observations of new cellular details. Movement of individual sperm was observed using high frame that simplified selection.

Dr. Palter said “The images are the sharpest, most revealing images of eggs, sperm, and embryos ever created anywhere. At this level, we are exploring a new frontier of knowledge about human reproduction. It’s an unexplored, uncharted world and we saw new details of the cells never seen before.”

Cellular details and image quality was far superior than what can be viewed with standard microscope. Although, no new structure was identified, the new 5K ultra-HD images could better delineate the morphology of sperms, eggs and embryos for selecting and improving the results of ARTs.

Further validation studies are being carried out currently.

Full text of article in Fertility and Sterility Journal can be accessed here.  

Making babies from skin cells: the future fertility treatment of IVG will open Pandora’s Box for better or worse!

Researchers have successfully demonstrated a new advancement in Reproductive Technology called In vitro gametogenesis (IVG), in which they could make gametes, produce an off spring from pluripotent stem cells derived from parent’s skin cells in mice.

Field of Reproductive medicine has come a long way since the discovery of IVF and birth of Louise Brown in 1978, and applying this technique in humans may be possible in near future.

The paper by Japanese scientist was published in the SCIENCE TRANSLATIONAL MEDICINE[1]

The techniques allows for creation of eggs and sperms from induced pluripotent stem cells (iPSCs) derived from adult body tissue such as skin in culture dish.  Though currently successful in mice, this opens doors to immense possibilities in reproductive and regenerative medicines.

Dr. Joyce Harper, professor of human genetic and embryology and Deputy Chair on the board of  the British Fertility Society said "It is hard to predict when innovative fertility technologies will be ready for use in humans. Ten years ago, we didn't think that egg freezing would arrive so quickly but it did. We just don't know when in-vitro gametogenesis will be used in humans, but the fact that it has been done successfully in mice makes is very interesting - if fertility treatments work in mice they usually end up working in humans at a later stage.

Three experts Dr I. Glenn Cohen^,, George Q. Daley^, and Eli Y. Adashi wrote  a  perspective essay ‘Disruptive reproductive technologies’ in Science Translational Medicine   discussing  the helpful aspects and the ethical, societal and  policy dilemmas if IVG is applied to humans.

It could be of great benefit in cancer survivors who have undergone chemotherapy and have lost reproductive function as a result.

It could help egg donors who have lost the capacity to produce eggs, especially elderly women who decide to start families in their 40s and 50. This would pave the way for same-sex couples to have babies of their own using both parents' genetic material. It could refine the current IVF procedure and save women from undergoing ovarian stimulation.

It could lead us to better understanding of embryonic development. Three parent baby is the recent example of it, thereby eliminating mitochondrial diseases.

Dr Cohen  further added “Combined with rapidly advancing gene-editing techniques like CRISPR, in vitro gametogenesis could also conceivably allow scientists to edit out some inherited diseases or install new traits. These technologies could allow you to get “closer to your vision of perfection” in children.”

Dr Sonia M. Suter, professor of law at George Washington University, calls this procedure ‘Solo IVG’ since theoretically eggs and sperms can be derived from the same women, she can conceive ‘on her own’. But, this will increase the risk of many genetic diseases

Her paper published in journal of law and bioscience could be accessed here. In the paper, she raises questions about ‘designer babies’, question of lineage of the offspring, legal aspects of IVG and the ‘unnaturalness’ of the whole procedure.

The ability to create embryos on large scale will open the doors for ‘embryo farming’ and devaluing human life.

Whatever the future of IVG might be it is going to be debated hotly in the world of science and translational medicine because of many ethical implications of the procedure.

In the future, our grandchildren could be coming from unexpected places, as the two cells that started us all might be coming from culture dish ,instead of being gonadal in origin. 


Could we make babies from skin cells?

CNN's Kristi Lu Stout spoke with George Daley, Dean of Harvard Medical School, about a new advancement in reproductive technology called IVG. 

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[1] http://science.sciencemag.org/content/338/6109/971.full





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