Dr. Cardone wrote the following in response to a journalist's question about the latest trends in infertility medicine. Please note that Cardone Reproductive Medicine and Infertility does not offer most of these diagnostic or treatment services at this time.
Egg freezing, also known as oocyte preservation, is one of the hottest trends – no pun intended—in fertility medicine today. It has come a long way from its debut over a decade ago when it was mainly recommended for young women undergoing cancer treatments. Now it is ready for prime time because of better freezing technologies like vitrification, which has improved the egg survival rate tremendously through rapid freezing and thawing. It is a viable option for women in their 20’s who want to delay childbearing. But here are the caveats: It is costly, does not improve the quality of eggs, but rather preserves them at a point in time in a woman’s life, and may require several egg retrievals to store the ideal number of 20 to 30 eggs.
Because of egg freezing, some clinics and egg donor agencies are developing egg banks that are similar in concept to sperm banks. Intended parents can then choose previously screened donated eggs, making the IVF donor cycle proceed more rapidly. Also with the donor’s consent, several couples can take advantage of using the few dozen eggs that may have been produced, reducing the need to recruit hard-to-find donors.
Embryo Evaluation Techniques: Finding the Ideal Embryo
Knowing the best embryos to transfer always has been one of the trickiest parts of in vitro fertilization. Innovative techniques for chromosomal, genetic and metabolic evaluation are making this both more reliable as well as creating some new ethical issues.
Comparative genomic hybridization (CGH) is one of the latest chromosomal screening procedures that allows the embryologist to evaluate the full set of chromosomes to see if there are extra or missing ones or if chromosomal parts are missing. It is rapidly replacing FISH (fluorescent in situ hybridization), an older groundbreaking technique that required the removal of one cell and can only reliably analyze a maximum of 12 out of 23 chromosomes. .Additionally, other more accurate and comprehensive tests have been developed that are speeding up the process.
Genetic testing can provide a wealth of information about the approximately 30,000 genes in the human body. But it also presents the field with the bigger question of what to do with this information. Of course, we always recommend genetic testing for patients who are concerned about transmitting inheritable diseases like cystic fibrosis or muscular dystrophy.
Embryo Metabolism Analysis
One of the most promising developments is looking at how the embryo interacts with the culture in which it is growing. The embryo is studied in the laboratory to determine what it takes in and secretes from the culture system – how it breathes, eats, secretes. Once we figure out the best markers in five to ten years, this non-invasive analysis has the potential to become one of the most reliable tests to determine embryo implantation success.
Single Embryo Transfer
In the ideal world where time and money are not considerations, single embryo transfer would be the best way to manage IVF cycles and prevent multiple births, a too common result of infertility treatments. Hopefully societal and economic considerations will move forward so couples, especially those under 35, will feel confident with only transferring one embryo during an IVF cycle.
ICSI, intracytoplasmic sperm injection, developed several decades ago is still the gold standard for treating male infertility. However, the PICSI Sperm Selection Device is showing some promise as a modification of ICSI to select the best sperm for this technique.
Ovarian Reserve Diagnostic Testing
Knowing whether women in their 40’s should try in vitro fertilization with their own eggs or move forward with donated eggs has been perplexing for both doctors and patients. A relatively new blood test for assessing the Anti-Mullerian hormone has become an effective guide to pointing them in the right direction. It can be performed at any time in a woman’s cycle and should be part of an overall assessment, but is considered the most accurate indicator.