Carol Lynn Curchoe, PhD,TS (ABB)
Founder of ART Compass, Senior Clinical Embryologist, ART Compass
Category:
Embryo Implantation, Failed IVF Cycles
In this session, Carol Lynn Curchoe, PhD, TS (ABB), a Founder of ART Compass, a Fertility Guidance Technology & Senior Embryologist, has been talking about success after a failed IVF attempt. Dr Curchoe explained what is crucial to look for in the IVF lab, discussed some of the experimental technologies that can help you achieve a positive outcome, all that based on her own experience as a senior embryologist.
Dr Curchoe began her presentation by listing things that are most important to have a successful IVF cycle. These are healthy oocytes, sperm, uterus, IVF lab factors and then operator skills.
I want to encourage you to think about what you should be eating at every meal instead of what you shouldn’t be eating. If we start to think about it that way like: ‘I should eat an avocado every day, I should try to eat some tomato every day, I should try to eat one apple a day then all of a sudden we lose the craving for the bad foods.Another thing Dr Curchoe discussed was BMI. Women of all BMIs can conceive, but when you’re having trouble conceiving, losing just 5% of your body weight and decreasing your BMI by just a little into the healthy area is so impactful for fertility and IVF outcomes. Dr Curchoe followed that if we start to make some of those healthy changes, we will see that 5% is much easier to achieve than we were previously thinking. We should also focus on are substances such as alcohol, tobacco, in a lot of areas of the United States, it’s THC, prescription drugs and also supplements. Supplements can fall into the good category, the neutral category like there’s nothing in there, or the bad category where they’re containing things that we don’t know are in there. They can contain hormones or molecules similar to hormones, but they’re disrupting what our bodies should be doing and what we need our doctors to do during our stimulation protocols. Therefore, you need to start making such changes at least 120 days before your retrieval, you want to cut down or cut out as much of your nicotine, tobacco, alcohol, caffeine just cut down on anything in your environment. Take recommended supplements, such as vitamin D, folic acid and coenzyme q10, which is helpful. Most people think cholesterol is something bad. However, you have to remember that sex hormones are made from the cholesterol molecule itself. You have to have good healthy levels of these fats for your body to make your sex hormones, it’s all-important. Dr Curchoe clarified that a lot of time, health, and wellness practitioners mention something called estrogen dominance. They start prescribing progesterone based supplements, and it’s crucial to keep in mind that those can interfere badly with fertility.
I have seen mosaic embryos go on to produce successful pregnancies, and I think that there’s ample evidence of that in the literature. I’m also a big fan of culturing embryos to the seventh day. For a variety of reasons, embryos can be slow-growing, and in general, we have seen that embryos that come back genetically normal have up to a 30% success rate. A lot of labs are not yet culturing to day-7, but I think that will become a widespread best practice.When it comes to IVF add-ons, such as ICSI (Intracytoplasmic sperm injection), Embryo glue, Assisted hatching, which is performed at two different time points. The first is usually around day-3 or around the time of biopsy. Then the other is when we thaw the embryo, and we’re preparing it for transfer. Sometimes, we like to help the embryo to escape the membrane called the zona pellucida around it. The embryo needs to escape that membrane to implant in your uterus. Some other experimental technologies are not widespread yet but probably will be in the next couple of years. The Zymot chip is a way to prepare sperm where it swims through channels similar to how it would swim through your cervix. It is thought that separating the sperm that way gives better quality sperm at the end with less DNA fragmentation. It has been selected more naturally as it would be in your body. It eliminates the step that we do in the lab, which is where we centrifuge the sperm, and fling it to the bottom and the side of the test tube that we’re centrifuging. It is potentially causing some stress to the sperm or some damage. Another technology is called PICSI, which stands for Physiological Intracytoplasmic Sperm Injection, and it allows the sperm to bind to the dish with the same protein that it would use to bind the egg. We’ll be picking the sperm that looks the most normal, which has also bound to this certain spot on the dish.
I’m not the biggest fan of PICSI, but I know some people have used it, and again it’s hard to tell what made a cycle successful on a second or third go-round when it finally succeeds. The use of the PICSI dish could be something that people consider.There are also a couple of different oocyte treatments. One of them helps collected immature oocytes to become mature in the lab. Those oocytes have a bit less of a success rate because they were not mature at the time of the retrieval, but it may be giving patients a chance, it probably still needs a little bit of development as well as using the Calcium ionophore (CA+) to activate oocytes. The last experimental technology that Dr Curchoe mentioned was Artificial Intelligence. The basic concept is that the computer can look at images of embryos or videos of embryos and help pick the embryo that’s going to be successful the fastest. Ultimately, we’d like this to go in the field as a replacement for biopsy. During the embryo biopsy, we pluck about 4 to 6 cells off the embryo, and it slightly damages it. Right now, it’s the best technology we have to say whether those embryos are normal or not. Finally, artificial intelligence now is all about these images and videos of embryos. However, the gold standard would be to analyze all of your data as a patient. Your demographics, your infertility diagnosis, everything about you in conjunction with the embryo images gives us tools for the prognosis and diagnosis of your infertility or your cycle. We’re not quite at that point yet where everything is connected in the realm of AI, though.
As an embryologist, I check my statistics to the Vienna consensus. I want to know how is my fertilization rate, how is my blastocystery, and so on. The skill does matter, and I think a lot of times with picking a clinic, you as the patient are weighing a clinic that may charge more for a cycle but gets their patients pregnant faster versus a clinic that charges less for cycles, but you might need more than one cycle. Then, by the time it all adds up, that could become very costly for you.
Disclaimer:
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