Recent Advances in IVF Treatment

Assisted reproductive technologies have come a long way since the birth of Louise Brown in 1978, the very first IVF baby. Over the past four decades, we have seen a dramatic increase in IVF success rates thanks to improved incubation techniques, new micromanipulation technologies and an increased knowledge in assisted reproduction in general.

Advances in technology and assisted reproductive medicine enable us to develop and offer you latest treatment methods aiming to improve both clinical success rates as well as live birth rates. Below are the main categories of technological breakthrough in assisted reproductive technologies that our clinic is equipped with. Please make sure to ask us about how you can benefit from these latest IVF developments.

IVF Treatment with Cytoplasmic Transfer

IVF treatment using Cytoplasmic transfer is a breakthrough innovation in IVF treatments. This treatment option is mostly suited for women in older age brackets who might be suffering from older and damaged cytoplasm and mitochondria in the egg cells as well as women with known mitochondrial DNA defects.

Mitochondria is an important organelle found in cell’s cytoplasm which provides the cell with energy and the ability to multiply and grow. It is referred to as the cell’s “power source”. During reproduction, the offspring (child) only receives maternal mitochondrial DNA, meaning, the only source of mitochondrial DNA that the child receives comes from the mother. If the mother’s mitochondrial DNA is defected, then the child gets a defected mitochondrial DNA and has developmental problems. Maternal mitochondrial DNA might be defected due to a genetic problem, or it can simply get older with age. Cytoplasmic transfer, refers to using the cytoplasm (the fluid inside the cell which contains important organelles, including the mitochondria) of a young and healthy egg donor along with the genetic material from the egg of the recipient. In other words, the healthy mitochondria is injected into the egg cell of the older patient, allowing it to have a renewed source of energy. With this method, we are able to overcome the problem of cytoplasm and organelle related problems in the aging eggs. However, while cytoplasmic transfer provides a better host for the patient’s own genetic material to grow and develop, it cannot correct genetic problems associated with aging.

For instance, it is known that as a woman ages, the incidence of congenital birth defects such as down’s syndrome or other genetic problems tend to increase. While cytoplasmic transfer allows the embryo to develop in a healthier environment, it cannot undo the genetic problems that occur with aging of the genetic material inside the eggs.

We recommend cytoplasmic IVF treatment for patients over 40 years of age, who still have an acceptable level of ovarian function, but cannot achieve pregnancy using standard IVF/ICSI treatments. Giving the patients’ own eggs a healthier power source increases the chances of success using own eggs. Nevertheless, given that patients over 40 years of age are more prone to have genetically defected children, we strongly recommend that embryos created after cytoplasmic transfer are screened for chromosomal aneuploidies using pre-implantation genetic screening prior to embryo transfer in order to make sure that only chromosomally euploid embryos are transferred into the uterus. For more information, please see our “Cytoplasmic IVF Transfer” page.

MicroFluidic Chip for Sperm Selection​

Discovery of Intra-Cytoplasmic Sperm Injection (ICSI) was one of the major milestones in the history of assisted reproductive treatments. ICSI allowed embryologists to directly fertilize the eggs with a hand selected sperm cell, dramatically improving fertilization rates compared to conventional IVF methods where eggs and sperm would be placed in a dish where the sperm would be expected to fertilize the eggs without much assistance. ICSI has helped hundreds of thousands of men become fathers while their previous IVF cycles failed due to poor sperm parameters that were not sufficient to provide fertilization using conventional IVF methods.

The MicroFluidic Chip is the second biggest breakthrough in assisted reproduction after ICSI. The MicroFluidic chip mimics the cervical pathways in the female reproductive system and eliminates majority of genetically defected sperm from moving from one side of the chip to the other. The sperm sample is loaded on one side of the chip. At this point, the sperm cells begin their journey, which is similar to their journey in the cervical pathway, leading up to the fallopian tubes. Those sperm cells that have DNA damage are unable to cross the finish line and get eliminated along the pathways of the chip, making sure that only sperm cells which reach the finish line are the genetically healthy ones with fertilization potential. In other words, while ICSI allows the embryologist to select the “best” sperm cells based on their appearance, the MicroFluidic chip allows the embryologist to select the “best” sperm cells not only based on their morphological features, but also on their genetic integrity.

The MicroFluidic chip is suitable for couples with male factor infertility where previous IVF cycles resulted in poor fertilization rates or early miscarriages, which may have been due to sperm DNA defects.

Stem Cell Therapy for Non-Obstructive Azoospermia

Recently, stem cell therapies have entered our lives in cosmetics and orthopedics. The idea of using stem cells for rejuvenation of the existing cell lines gives hope in IVF treatments as well in terms of endometrial rejuvenation and sperm cell production (spermatogenesis).

By programming the cells into precursors for germ lines, the stem cells can then grow to be a sperm cell. Research has provided evidence that Mesenchymal stem cells not only contribute to growth of cell line population, but also contribute to favorable immune response, increasing the likelihood of success with treatment.

One of the major challenges in male infertility is non-obstructive azoospermia. In obstructive azoospermia, surgical sperm extraction/aspiration methods such as PESA or TESA can prove useful in obtaining live sperm cells and in most cases, these sperm cells turn out to be viable and are used in IVF treatments to fertilize the oocytes of the female partner. However, in non-obstructive azoospermia, there is no blockage or obstruction. There is simply no sperm cell development. This can be a congenital defect, it can be caused by an accident or surgery, or it can be due to chemo or radiation therapy for cancer treatment. Regardless of the cause, non-obstructive azoospermia has never had a cure up till now and sperm donation have been recommended as the only viable treatment option.

Recent studies with mesenchymal stem cells have shown that adipose tissue derived mesenchymal stem cells can give rise to sperm-like cells, leading to recovery of fertility in many animal studies. Mesenchymal stem cells obtained from the patient himself are the least likely stem cells for carcinogenic transformation, therefore, they hold a very large promise for restoring male fertility in the very near future. Please see our “Stem cell therapy for non-obstructive azoospermia” page for more information.

Human Growth Hormone During IVF Cycles

The use of human growth hormone during IVF cycles was introduced a few years ago with the purpose of improving oocyte quality in an IVF cycle. While the earlier studies were not able to observe any significant results, one recent study has shown that correct timing of the human growth hormone supplementation can generate desired results in terms of oocyte quality and improved pregnancy rates.

Starting human growth hormone not on the cycle of ovulation induction, but earlier, has proved to positively effect the outcome of an ovulation induction cycle by stimulating small pre-antral follicles which would not have been stimulated using standard ovulation induction protocols that are used in IVF/ICSI treatments.

The outcome of this study has allowed human growth hormone trials to gain FDA approval in the United States. While the clinical trial is only available to a small group and the results will not be available until 2018, at North Cyprus IVF Center, the same clinical trial has been made commercially available since the beginning of 2016. We have treated 11 patients so far with HGH with some successful outcomes and will be ready to publish our own data in mid 2017. We provide this treatment option at no additional cost beyond the cost of human growth hormone injections!

Intralipid Infusion Therapy and Neupogen Wash in IVF Cycles

Intralipid Infusion Therapy is a relatively new advance in in IVF treatments where women suffering from a high level of natural killer cells are supplemented with an infusion of intralipids prior to and post embryo transfer to protect the embryo against NK cells. This is a method of lowering immune system response prior to and post embryo transfer in order to prevent the immune system from destroying the embryo by perceiving it as a “foreign object”.

Intralipid infusion therapy is recommended for patients who have undergone several failed IVF cycles as well as women who have suffered recurrent miscarriages that may point to an overactive immune system.

More recently, neupogen wash has replaced intralipid infusion therapy to a certain extent. Neupogen is a recombinant form of G-CSF (granulocyte colony stimulating factor). G-CSF acts as a chemical messenger in the body and has an important role in communication in the reproductive system. Clinical research has shown that healthier embryos and healthier placenta express higher levels of this chemical in the female body and this higher level has been associated with improved embryo viability and higher IVF success.

Research and clinical evidence shows that use of neupogen as an endometrial cavity wash and a sub-cutaneous injection improves endometrial lining thickness during IVF cycles. In similar studies on patients with repeated IVF failures, it has been shown that the use of neupogen on spericif time intervals during an IVF cycle improves success rates in this group of patients. However, the specific use and the time interval during the cycle are very critical.

Our own experience with neupogen has also been similar over the past few months that we have started using it, therefore, we do recommend and use it with patients in older age brackets or patients with unexplained IVF failures.

Asst. Prof. Dr Ahmet Ozyigit, MD
Asst. Prof. Dr Ahmet Ozyigit, MD
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