How has In Vitro Fertilisation developed in the past 40 years?

The birth of the first “test-tube baby” was considered nearly a miracle. Four decades later, reproductive medicine has allowed a significant improvement in pregnancy rates. Institut Marquès has reached an 89% of success rate by cycle in IVF with donor eggs.

In Vitro Fertilisation (IVF) is one of the most used techniques in assisted reproduction. The technique consists in fertilising the oocyte with sperm in a laboratory and implanting it into the patient’s uterus.

So far, IVF has improved enormously. People who could not be helped by medicine some years ago can now become parents thanks to the progresses achieved. These improvements have entailed the biggest turning points in the fight against infertility.

–Laboratories: advances in laboratory quality control make a huge difference in the way of how work used to be 40 years ago and how it is now, since the success improvement in IVF largely depends on them.

These advances include:

• Air quality control by using special filters to preserve the air quality and avoid organic volatile impurities; temperature control in working areas that allows both embryos and oocytes to be maintained at 37 degrees (as in the uterus) when we take them out of the incubator.
• A better and more controlled manufacturing of the culture mediums with more information about the necessary compounds for a good development of the embryo.
• Technical improvements in incubators that keep the conditions the embryos need to develop, as well as the quality of materials used for embryo manipulation and culture, which go through many quality checks avoiding compounds that could be toxic for them.

-Sperm microinjection: It started developing in 1992. A micro needle is used to inject sperm into the oocyte. Unlike conventional IVF (where sperm cells are incubated together with the egg in order to achieve fecundation), ICSI achieves fecundation thanks to sperm injection.

–Blastocyst culture: is a technique that consists in maintaining the embryos in the laboratory inside the culture until day 5 after the egg retrieval. Transferring embryos in blastocyst stage allows a better embryo selection, increasing the implantation rate. In many cases, it allows transferring an only embryo, avoiding the risk of multiple pregnancy.

–Preimplantation Genetic Diagnosis: technique that allows analysing the genetic or chromosomal content of the embryos obtained after IVF. Only those free of anomaly and that have more implantation possibilities are transferred in the mother’s womb. It also allows couples with hereditary diseases to transfer only healthy embryos.

–Egg and embryo freezing by vitrification: embryos and oocytes are frozen through sudden cellular solidification at low temperatures. This way, ice formation can be avoided. To succeed, a big amount of cellular cryoprotectors are used; they avoid the cell membrane to break, allowing a high survival rate of cells once unfrozen.

-Time-lapse: technologic advance that allows a real-time monitoring of the embryo development. Embryoscope is an incubator with time-lapse technology that keeps in vitro those physiological conditions that the in vivo embryo requires. It also captures images of the embryo development for a better follow- up of the biologist working at the laboratory. Thanks to Embryomobile, a system developed by Institut Marquès, patients can monitor this “movie of life” from home.

Scientific research is one of the priority areas at Institut Marquès. We have developed our own and pioneer techniques in order to improve IVF. Amongst them, we would like to highlight our studies related to music. Music is used at the laboratory as a source of vibration, improving the exchange of fluids between the embryo and the culture medium. These vibrations allow a more balanced distribution of the nutrients that the embryo needs. Furthermore, they reproduce the movements that embryos have through the uterus and the fallopian tubes.

What does the future hold for reproductive medicine? There is a lot to be done. There is still some ongoing research in order to improve the oocytes and embryos’ imaging. Regarding genetic diagnosis, research aims to improve biopsy processes in order to make them less invasive for embryos. Also, some work is being carried out in the automatisation of some laboratory processes in order to achieve an exact control in embryos and oocytes manipulation. In the genetic area, research is being carried out in order to obtain as much information as possible and in the most viable way from the analysed embryo.