In a poignant New York Times interview in 2010 with the highly revered Dr. Howard Jones, he asserted, “Fertility investigators today should figure out which one embryo is likely to make a baby rather than transfer several. That will reduce costs, the number of multiple births and significantly increase success rates of in vitro fertilization.”
Approaches to PGS have become much more sophisticated and reliable over the past 10 years by utilizing streamlined DNA analysis, ensuring evaluation of all 46 chromosomes within a few cells carefully removed from each embryo.
Dr. Jones established the first U.S. IVF clinic over 30 years ago in Norfolk, VA with his wife, Dr. Georgeanna Jones, and their team achieved the first IVF pregnancy in the U.S. Since that time IVF treatments have become more complex, and thousands of women and men face a myriad of “alphabet soup” IVF jargon to learn. How intimidating does it sound when an IVF blogger writes, “I went to the XYZ Center for IVF, ICSI, TE biopsy, and PGS so I could have a euploid blastocyst SET with my FET”? Can some of this IVF “alphabet jargon” be more clearly explained?
From Our Expert, Dr. Ronald Feinberg
“The key value of PGS and CCS is our ability to predict which embryo or embryos have a normal complement of 46 chromosomes prior to uterine transfer. When a normal mature egg containing 23 chromosomes is fertilized with a normal sperm (containing another set of 23 chromosomes), an embryo with 46 chromosomes can develop.”
IVF has actually become more efficient over recent years, with the development of newer and better lab culture conditions. Exciting research developments exploring genes and DNA have yielded a perfect collaboration between IVF centers and genetics experts. With these advances, Dr. Jones’ long-standing goal of “one embryo, one healthy baby” is now a reality. This advice can be embraced because we are able to learn more about the chromosome health of embryos through pre-implantation genetic screening, or PGS.
Approaches to PGS have become much more sophisticated and reliable over the past 10 years by utilizing streamlined DNA analysis, ensuring evaluation of all 46 chromosomes within a few cells carefully removed from each embryo. Some centers also refer to PGS as comprehensive chromosome screening, or CCS.
The key value of PGS and CCS is our ability to predict which embryo or embryos have a normal complement of 46 chromosomes prior to uterine transfer. When a normal mature egg containing 23 chromosomes is fertilized with a normal sperm (containing another set of 23 chromosomes), an embryo with 46 chromosomes can develop. However, many embryos start out with an incorrect number of chromosomes stemming from an abnormal egg, sperm, or improper chromosome movement within the fertilized egg.
As certain embryos develop in the lab to become blastocysts, usually four to five days after fertilization, it is not possible to accurately distinguish normal (euploid) versus abnormal (aneuploid) embryos under the microscope, making accurate embryo selection a major challenge. This dilemma has led to several exciting discoveries demonstrating the importance of incorporating PGS into current IVF treatments:
The chance of successful pregnancy after single embryo transfer (SET) and PGS is 55% to 65%.
When Dr. Jones and others performed IVF treatments in the 1980s, the success rates were only about 10% to 20%, even when multiple embryos were transferred. For many years, IVF doctors didn’t think success rates would ever surpass 20%, the average monthly chance of natural conception for a fertile couple in their 20s. Transferring multiple embryos at one time became the norm to enhance IVF success rates, but with that strategy came the unintended consequences of multiple gestation, profound prematurity, cost, and significant emotional turmoil.
Age matters, but not as much with PGS.
If a 40-year-old woman has a euploid blastocyst transferred to her uterus, her chance of normal pregnancy is about the same as a 25-year-old IVF patient. While this is an astounding finding, it is very clear that older women are much less likely to create multiple embryos that are normal when compared to younger women. It is also more likely that older women might not produce any normal embryos in a given IVF cycle. A very high percentage of abnormal PGS results are caused by an abnormal number of chromosomes within the mature egg—a significant age-dependent event.
A single normal embryo can be transferred in a fresh or frozen embryo transfer (FET) cycle following PGS, yielding similar success rates.
This provides great flexibility in how and when treatments are carried out and empowers women and men to design their own specific family building pathways. Our colleagues in the maternal-fetal medicine and neonatal fields have published compelling data to suggest that FET actually yields fewer maternal and fetal pregnancy complications. They have also strongly urged that SETs be carried out to minimize risks. Most IVF clinics offering PGS utilize FET cycles.
Miscarriage rates are much lower after PGS.
Since the majority of early miscarriages—including “chemical” pregnancies—are caused by chromosome errors in the embryo, it makes sense that many miscarriages can be prevented with PGS testing. Transfer of a single euploid (46 chromosome) embryo results in miscarriage in less than 10% of pregnancies. Miscarriage creates a significant emotional burden for our patients in addition to other costs and delays in care.
PGS as performed in 2014 is just the beginning.
As DNA testing becomes more sophisticated and less costly, PGS will be fine-tuned to further enhance IVF success. IVF researchers are already discussing the use of DNA sequencing and other molecular modalities to better predict the health status of an embryo. The tiny trophectoderm (TE) cells biopsied from the blastocyst for PGS contain a powerhouse of molecular information about the embryo, which can be analyzed for many different diagnostic markers.
In the future, it is possible that maternal age alone will not be the “done deal” many have come to accept. Univfy researchers and collaborators have clearly found that many factors other than age alone can greatly impact and predict IVF success. Individualized patient and clinic-customized prediction testing holds great promise when our patients seek guidance for their IVF decision-making.
One major goal of IVF physicians is to identify proven health interventions that will optimize the vitality of eggs, sperm, and embryos, leading to enhanced fertility and family building options for our patients. PGS has given us a significant glimpse into the mysteries and wonders of human reproduction. With PGS, the vision of Dr. Howard Jones and the future of IVF are looking much brighter.
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"I feel so lucky to have found RADfertility. I tried two other clinics before I expanded my search and found RADfertility. I drive an hour each way to go to them but I don’t regret a thing. They are so caring and so professional. Every time I message them they respond quickly. Every time I see them they have a friendly smile and warm welcome. They explain everything so well and I never feel lost in the process as I did elsewhere. They also took the time to figure out what was wrong. Other clinics threw up their hands, said 'I don’t know' and pushed me to try IVF."
"Dr. Feinberg and the entire staff at RADfertility are absolutely amazing. The receptionists, coordinators, nurses, and lab staff are compassionate, caring, and straight forward. I’ve had a 12-year infertility journey and I’ve tried other clinics but RADfertility was the only one I felt at ease with. They answered any questions that I had and were there any time I needed them. My coordinator, Amy, was the absolute best and always had my back. Dr. Feinberg’s dedication to his patients is incredible. You are not just a number there, you are a person with individualized needs and care."
"My journey with RADfertility and Dr. McGuirk started when my husband and I were trying to conceive and were having difficulty. We went to RADfertility, where we met Dr. McGuirk. I always say she changed my life and 'fixed' me. Dr. McGuirk is always learning more about endometriosis and how to help her patients. She’s brilliant and truly cares for you! I’m eternally grateful to her and everyone at RADfertility for their unwavering support, love, and care."
"Every step of our journey was tailored to us. We were treated so respectfully. Every detail was clearly explained and we felt so comfortable. Rhonda Wright was a Godsend and inspiring. I highly recommend this place! I cried when my weekly appointments were done and I 'graduated.'"
"The staff and doctors are amazing. It will feel like home every time you walk in the door. They gifted us with our miracle baby and we couldn’t be happier. I will always recommend RADfertility above all others!"
"RADfertility's staff has heart and provided me with exceptional health care. I knew I was in good hands and felt like we were in this together. The doctors and nursing staff always answered all of my questions and provided thorough information about all of my options. I am so fortunate and appreciative of the care that I received at RADfertility. They go above and beyond."
"I cannot begin to explain how wonderful RADfertility is. We were frustrated with trying to start a family and it not working for us. The entire team of doctors and nurses made us feel comfortable and hopeful that we would be parents. We experienced so many ups and downs but we never felt like we were on our IVF journey alone, we had our RADfertility team every step of the way. If you're looking for a supportive team on the IVF journey, look no further. RADfertility is the absolute best."
"Dr. Schillings always kept us informed and never gave up on us. She always explained our options and risks with each procedure. She called us personally when there were any issues or sensitive subjects to cover. Dr. Schillings was the first doctor that had answers for us and wanted to help us have our miracle baby!"
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