Here's How Doctors are Moving Beyond Traditional IVF

By Nancy Wurtzel

The first successful in-vitro fertilization (IVF) baby was born almost four decades ago. Since then, IVF has become the gold standard for women trying to conceive and deliver a healthy child.

GROWING PRESSURE FOR LESS INVASIVE PROCEDURES

However, there is growing pressure for less invasive procedures, lower treatment costs, and better outcomes. Some frustrated patients are turning to older procedures instead of traditional IVF. At home and abroad, researchers are looking for ways to take IVF to a more sophisticated level, while many others are searching for entirely new, innovative fertility treatments.

EVATAR

Fresh technology, such as devices and apps, are giving insight into the future. One such example is EVATAR, a palm-size device developed by scientists in Chicago.

EVATAR is a miniaturized 3-D replication of the female reproductive tract. Created from donated human tissues, EVATAR simulates a female’s 28-day menstrual cycle, which researchers say will help develop treatments for specific medical problems that affect women, such as fibroids, endometriosis, miscarriage, and infertility.

Researchers are currently using the device to learn more about the basic biology of how the highly complicated female reproductive tract functions. However, future implications are wide-ranging, since EVATAR can be tailor-made using the stem cells of individual women. The ultimate goal is to use EVATAR to test the safety and efficacy of future infertility drugs and other treatments, thereby determining the best fertility treatment options for individual women.

“EVATAR allows us to think about all the organs kind of connected in a way,” said Theresa Woodruff, one of EVANTAR’s creators and a biomedical engineer, department of obstetrics and gynecology at Northwestern University. “…eventually, we hope [it] will be the future of personalized medicine,” she added.

INVOCELL

Intriguing IVF adaptions are also in the works. INVOcell, developed by French embryologist Claude Ranoux who has spent nearly 30 years fine-tuning his invention, saves patients money and provides a “tech-lite” approach to traditional IVF. Additionally, INVOcell, which has been available in Europe since 2008 and was approved by the FDA in 2015, costs are about half of a traditional IVF cycle.

Here’s how it works: A woman’s eggs are surgically extracted and combined with sperm inside a tiny cylinder. Then, instead of using a petri dish, the cylinder is inserted deep into the patient’ vaginal canal where it will rest for five days. At that point, the doctor retrieves the cylinder and transfers one or more of the resulting embryos into the woman’s uterus

“I see so many patients who can’t have kids because they can’t afford IVF,” said Dr. Kevin Doody, a Dallas, Texas-based reproductive endocrinologist who has conducted studies on the INVOcell. “We’ve got to do better. It’s a matter of medical ethics.”

Early numbers are promising. One randomized clinical trial of 40 women under age 38, found no significant difference in success rates between traditional IVF and INVOcell.

Although IVF produced more quality embryos overall, the birth rates were very similar. Of the 20 women undergoing IVF treatments, a dozen were impregnated and later successfully delivered 15 babies, including three sets of twins. In the INVOcell group, 11 of the 20 women gave birth to 16 babies, including five sets of twins.

Doody believes products like INVOcell will provide greater access to reproductive care, and open up the market to other breakthroughs.

Infertility breakthroughs have also taken place in other parts of the world.

IN-VITRO MATURATION (IVM)

In Australia, researchers are fine-tuning an existing process called in-vitro maturation (IVM) to achieve some impressive results. Originally developed as a fertility treatment for women with high egg counts, but who were not able to ovulate, IVM requires 90 percent fewer hormones to stimulate egg development in the ovary. This minimal amount of hormones is ideal for women who are at risk of estrogen-sensitive diseases, like a blood-clotting disorder or even breast cancer.

During the IVM process, the egg is removed from the mother’s ovary before maturity and then grown in a cell culture, a process which is less invasive and less expensive. This IVF alternative has thus far shown encouraging results. Researchers report IVM has an improved quality of eggs and a 50 percent increase in embryos, as compared to traditional IVF.

”We have demonstrated that it is possible to improve egg quality and embryo yield with next to no drugs, using potent growth factors produced by the egg,” said Associate Professor Robert Gilchrist from UNSW’s School of Women’s and Children’s Health.

IVM is expected to be available outside of the trial stages within two to four years. Gilchrist believes researchers can improve IVM outcomes, and it will eventually become the first-choice treatment of choice for all women undergoing infertility treatment.

Other international healthcare professionals have been experimenting with new fertility treatments for older women.

PLATELET RICH PLASMA THERAPY

Physicians in Greece, for instance, reported the results of their study of 180 women, some of them in menopause, while others who had damage to the lining of their uterus.

Employing a method that is usually used to help wounds heal faster, blood is drawn from a patient, and their platelet-rich plasma is then isolated. This platelet-rich plasma (PRP) is then transferred directly to the woman’s uterus and ovaries, as a way of repairing the reproductive system.

Widely used to hasten the repair of damaged bones and muscles, PRP may help stimulate tissue regeneration in the female reproductive system.

Journalist Jessica Hamzelou wrote in News Scientist magazine “If the results hold up to wider scrutiny, the technique may boost declining fertility in older women, allow women with early menopause to get pregnant, and help stave off the detrimental health effects of menopause.”

MINIMAL STIMULATIOIN IVF (MINI-IVF)

Back in the U.S., another fertility procedure, the “minimal stimulation IVF” or “mini-IVF” is causing patients to rethink the standard IVF tract. The mini-IVF, which has been in use for years, uses smaller doses of hormones delivered via tablets and nasal spray in place of injections.

The reduced hormones are not as taxing on the female body, and the process is more affordable. While a traditional IVF cycle can cost $12,000 or much more, “…a mini-IVF cycle might be as low as $4,500, on average,” wrote journalist Julie Revelant in her article “Mini-IVF: The Next Breakthrough in Fertility Treatments?”

A major drawback of the mini-IVF is that the process produces fewer eggs that result in fewer embryos. And, critics say if more cycles are necessary, then the cost savings evaporate.

However, some patients are turning to it with the hope of saving money while also undergoing a process that isn’t quite as rigorous.