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|24 February, 2018

Advanced IVF to help produce 'super babies' of your choice

People can start choosing genes that increase mental intelligence, physical build, eye colour and so on.

Image used for illustrative proposes. A nurse works on a micromanipulator machine (used for fertilization) at Fortis Bloom Fertility and IVF Centre inside the Fortis hospital at Mohali in the northern Indian state of Punjab June 13, 2013. REUTERS/Ajay Verma

Image used for illustrative proposes. A nurse works on a micromanipulator machine (used for fertilization) at Fortis Bloom Fertility and IVF Centre inside the Fortis hospital at Mohali in the northern Indian state of Punjab June 13, 2013. REUTERS/Ajay Verma

REUTERS/Ajay Verma

People can start modifying embryos, for example, activating certain genes and replacing others.

With the advent of technologies, the future of In vitro fertilisation (IVF) is also changing. Genetic engineering of the embryo could mean that people will soon be able to produce 'super babies.'

"People can start modifying embryos, for example, activating certain genes and replacing others or like removing all defective genes that could cause cancer or other illnesses such as diabetes and dyslipidemia and replacing them with other genes," said Clancey Po, New Medical Centre's (NMC) director of corporate operations strategy.

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He also said that people can start choosing genes that increase mental intelligence, physical build, eye colour, hair color and so on.

"We believe that in the near future we could witness artificial surrogates where embryos would be carried to term in incubators rather than mothers," he added.

Some innovative techniques used in IVF are: Embryoscope (time-lapse system): It is a groundbreaking technology in the field of reproductive medicine. This technology has improved IVF treatment and success rates. This revolutionary incubator has a built-in camera that takes periodical pictures of embryos as they grow to ensure the best of embryos is selected for transfer.

Micro-dissection TESE (MicroTESE) is an invasive procedure utilised to locate sperm in men with non-obstructive azoospermia or severe testicular failure. MicroTESE is especially helpful in these men as there may be certain localised areas of sperm production that may be missed during blind biopsies or needle aspiration procedures. During a MicroTESE, the testes are surgically opened, tissue is inspected under a microscope and an intense search of every part of the testicle is performed to locate healthy areas that are more likely to contain sperm. After MicroTESE, the sperm may be used in a current IVF-ICSI cycle or frozen for later use.

Meanwhile, ROSI is a unique technique of injecting a female's eggs with immature sperm cells - spermatids - which can be found in the testes of men who would normally be pronounced sterile.

Undergoing genetic testing during an IVF cycle provides a wealth of information about each embryo before transferring to the uterus.

During an IVF cycle, following egg retrieval (OPU), when the egg and the sperm have fertilised to form an embryo, a single cell or cells are taken from each embryo to be tested.

The embryo transfer takes place after the results of the genetic testing are released, allowing patients to help prevent trisomies, such as Down Syndrome or the passing on of an inherited genetic disease. These genetic tests are possible during an IVF cycle: PGS 24-chromosome aneuploidy screening (includes gender identification), PGS 5-chromosome aneuploidy screening (includes gender identification), PGD for single gene disorders to avoid passing on hereditary disease (may be completed with 24-chromosome aneuploidy screening and/or HLA Matching), PGD for balanced translocations or inversions, includes 24-chromosome aneuploidy screening.

"The goal of both PGS and PGD testing is to help in selecting the embryos that are most likely to result in a healthy pregnancy," he added.

The success rate of IVF clinics varies from 35 to 72 per cent depending on a number of factors including reproductive history, maternal age, the cause of infertility and lifestyle factors.

To a large extent, it also depends on the centre's advance technologies in use, the set up and the design of the embryology lab, the air system, the embryologist experience and the doctor's professional medical expertise.

However, the chance of IVF success reduces over the age of 38 due to the quality and quantity of eggs, which decreases with age. The maximum age for IVF would be between 42 to 45 years old, however as long as there is an acceptable ovarian reserve there is a chance of having a successful IVF.

"In the UAE, IVF treatment is fully covered for Emiratis by Thiqa Insurance in Abu Dhabi region and at 90 percent in Dubai and the Northern Emirates," said Clancey.

Risk of multiple births

Reducing the risks of multiple births can be controlled by limiting the number of embryos transferred to maximum two, depending on the case and age.

"Currently, two methods are used to freeze embryos - slow cooling and vitrification.

For many years, all embryos were frozen using what is known as a slow-cooling protocol. The embryos were placed into a specific solution containing cryoprotectants and the temperature was slowly dropped (-0.33 Celsius/minutes) in a very precise manner. Slow-cooling worked best for cleavage stage embryos or embryos frozen on the day after egg collection (two per stage). Slow-cooling was not as effective when freezing unfertilised eggs or embryos at the blastocyst stage of development," he said.

Vitrification literally means turning to glass and is an ultra rapid form of cryopreservation (-20,000 C/mt) that basically consists of plunging the egg/embryo into liquid nitrogen resulting in near instantaneous freezing of the egg/embryo. Recovery rates and pregnancy rates have been shown to be superior when vitrification is compared with slow-cooling of eggs and blastocyst stage embryos.

"Before undergoing IVF couples should know that infertility is not uncommon. Almost 1 in 6 couples experience infertility," he said.

"Also, IVF is not always the first option. If the woman is below the age of 35, and has been trying to conceive without a positive pregnancy, the doctor will try oral or injectable fertility medication before IVF."

Clancey added that age matters. "IVF treatment is most successful at a younger age, so if an infertility problem is diagnosed, it's best not to wait too long before undergoing treatment."

IVF treatment comes at a cost but it is definitely worth it, he said.

"Couples may need more than one IVF cycle. One of the biggest misconceptions is that IVF works right away, but that's not always the case. It is very common that some patients need to undergo two or three treatments but then again, many others get pregnant from the first trial."

He added that it is not 100 per cent successful and its very important for patients to realise that the process can take time, money and even an emotional toll on their life, and in the end, it might not work. Besides, there is a risk of having multiple-pregnancies with IVF.

Infertility in the UAE

>20 per cent of Emirati couples face issues. A 2017 study by the Bourn Hall Fertility Centre in Dubai found that 1 in 5 couples in the UAE face issues related to infertility.

>There are 150,000 cases of infertility in the UAE, and in 30 per cent of the cases the men are solely responsible

>Smoking is affecting fertility. Almost 20 per cent of Emirati men smoke, and heavy smokers produce up to 20 per cent fewer sperm. It may increase the number of abnormally shaped sperm, making it harder for sperm to fertilise the egg. In fact, both male and female smokers are more likely than non-smokers to be infertile.

>UAE is facing infertility due to diabetes: A report by Aster IVF concludes that with 25 per cent of adults in the UAE being diabetic and a similar percentage being pre-diabetic, combined with the rise in smoking habits, has led to the rampant rise of infertility in recent years.

>UAE residents do not know obesity affects fertility. Almost 50 per cent of UAE residents are defined as 'overweight', which is double the world average according to the WHO. Yet a survey done by Orchid Fertility Centre found that 51 per cent of Emirati residents did not know that being overweight can affect fertility in both men and women.

>UAE allows for gender selection. The UAE and the US are the only two countries in the world, which allow for couples to select the gender of their child

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