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Houston Fertility Journal

The Evolution of Infertility Treatment

[fa icon="calendar"] Oct 18, 2017 1:16:53 PM / by Center of Reproductive Medicine   

Center of Reproductive Medicine

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Looking back on where infertility treatment options first started out, doctors really only started making headway when they stopped considering it an issue that was put upon people by God. Up until the 1800’s, when couples had difficulty conceiving, the blame was automatically put on the woman and the sins she had committed in her past. Once doctors started looking at infertility from a scientific perspective, the bricks that would eventually become the path to in vitro fertilization started to be placed. To begin this process, they had to start with the basics.

Questions they started asking were:

  • What actually makes up the female reproductive system?
  • What makes it more probable than not that they are able to get pregnant?

It wasn’t until 1827 that the discovery of the ova and eggs in the female body were made. In 1843, scientists finally gained awareness of pregnancy being achieved by sperm entering the ovum. Now that this base research has been done, they could finally start investigating the existence of disruptions and dysfunctions, and start providing solutions.

I. Artificial Insemination

The first sound treatment for infertility was artificial insemination, which came to light by the late 1850’s. A doctor named Dr. J. Martin Simms attempted the procedure a total of 55 times on 6 different women. This procedure involves the insertion of the male’s sperm “directly into the a woman’s cervix, fallopian tubes, or uterus.” At the time, Simms did not have knowledge of a woman’s ovulation cycles and how essential that that time is when it comes to successfully achieving pregnancy.

Because he was not timing the treatments accordingly, only one of them resulted in pregnancy. Unfortunately, that one also resulted in a miscarriage. In addition, no one was taking into account any possible issues that may have existed within male sperm. Therefore, 50% of the possible issues to consider were not being addressed.  

II. Artificial Insemination By Donor

In 1884, the first case of the use of donor sperm was recorded. The procedure was done in secret by a doctor named Dr. William Pancoast. The couple he was treating had been experiencing issues achieving pregnancy with one another. When he performed the procedure on the wife, instead of using the woman’s own husband’s sperm, he used a medical student’s without telling her.

Pancoast did eventually inform the couple, many years later, about what he had done. Though he did receive discipline for these actions, he opened up a whole new door of awareness for infertility treatment.

III. Transitioning To In Vitro Fertilization

When the science of in vitro fertilization first started being examined, many were extremely opposed to it. Because academia, government, and religion all had major issues concerning its ethics -- it took a long time for the research to provide any real results.

Between the 1920s and 30s the discovery of the hormones progesterone, estrogen, and testosterone were made. Once these had been identified, their roles in reproduction and conception could be closely studied. This lead to the development of chemical hormone substitutes in the 1940’s which is a standard part of infertility treatments today.

In 1944, the first US fertilization of a woman’s eggs done in a lab dish was carried out by Dr. John Rock of Harvard. this procedure was greatly embraced by the scientific community but, as you can imagine, not so much by the religious community. Still, IVF experiments began to spread quickly by numbers all around the world.

IV. IVF Success

The first baby created as a result of IVF was born in 1978 in Greater Manchester. A huge percentage of the general skepticism automatically shifted as so many couples struggling to grow their own families finally had a reason to be hopeful. The first American IVF clinic could now open it’s doors and be emphatically embraced by the public. This is when fertility treatment was given the opportunity to set in some roots and grow into the greater knowledge we now have.

V. Treatments Advanced

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Infertility treatments, and its research, are always advancing and scientists are always looking for new ways to treat struggling couples.  Below are some of examples of how research has allowed advancements in infertility knowledge to branch out in many promising and productive ways.

Donor eggs

A new wave of development occurred in 1987 when people were given the option of using donor eggs. The first pregnancy successfully created by egg donation was in 1983. There have been 50,000 live births recorded due to donor eggs since. Using donor eggs with IVF is great option for women who have low ovarian reserve or low egg quality.

Freezing Eggs, Embryos & Sperm

A huge part of many successful IVF stories is the involvement of cryopreservation (the freezing of sperm, eggs and embryos). Experiments with freezing eggs started in 1953. The first pregnancy successfully achieved with freezing eggs was in 1984 and the first live birth in 1999. There were some initial complications when it comes to thawing the eggs and embryos.

Eventually though, technology developments made it safe. Some patients need the option of cryopreservation more than others. Many need to give their body a rest in between retrieval and implantation, and doing so eliminates the risk of ovarian hyperstimulation syndrome.

Also, many women choose to freeze their eggs who want to have children in the future but do not wish to start raising a family in their more fertile years. Freezing their eggs ensures the supply of eggs for when they feel absolutely sure that they are ready.

Transferring Single Embyros

In the beginning stages of IVF treatments, doctors were transferring multiple embryos to increase the chances of a successful pregnancy. However, this began resulting in multiple pregnancies which can be very harmful to the mother and the babies that are involved.

With advances in technology, doctors have found that they could transfer just one embryo and increase it’s chances of success by understanding the nutritional needs of the embryo during its developmental stages and knowing when it is best to culture them.  

If cultured during the blastocyst stage (5 or 6 days after fertilization), the embryo is much more likely to implant itself after the transfer.

Intracytoplasmic Sperm Injection

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This procedure consists of the doctor injecting the sperm directly into the egg. This was performed first in 1987 and has helped a considerable amount of cases involving male infertility and low sperm quality.

Preimplantation Genetic Screening

Genetic testing to determine the health of the embryo began in 1990. The screening is done to determine if an embryo has an odd amount of chromosomes, which often is the cause of miscarriages. Doing these screenings can reduce the chance of having a baby with a genetic disorder.

Aside from the screening, the diagnosis is the procedure used prior to implantation in order to help identify genetic defects within the embryos. This can actually prevent the genetic diseases or disorders from being passed onto the baby. The embryos used during preimplantation genetic diagnosis are usually created during the process of in vitro fertilization.

Assisted Hatching

Assisted hatching is exactly what it sounds like. The procedure assists with the hatching of the embryo so it can make it’s way through the uterine lining. This is also necessary for individuals with poor prognosis who lack the energy to hatch their own. The hatching procedure involves the embryologist making a tiny hole in the zona pellucida before the transfer takes place.

Newer Developments

Embryoscope

A tool in infertility treatment that has recently been developed is called the embryoscope. It is an incubator which captures photos of the embryos during the development stages. Doctors were having to take the embryo out multiple times to check on it’s status, risking the possibility of handling errors and contamination. Using the embryoscope eliminates these risks.

Eastern Technique

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More and more, infertility clinics are beginning to explore the techniques practiced in other parts of the world. If the fertility specialists are not finding any success with the techniques they are using with certain patients, they may venture into new territories in order to continue helping their patient on their journey toward fertility.

Examples of these techniques are acupuncture and Chinese herbal medicine. “In one study of more than 1400 cycles, three acupuncture sessions before and after embryo transfer improved the fertilization rate, especially in women over age 35 who used fresh (rather than frozen) embryo transfer and in women 35 to 39 who use frozen embryo transfer.”

Egg Stimulation

Doctors used clomid in order to stimulate a woman’s body so it could produce more eggs during treatment for years. After a study done in 2005, it was found that 5% of 150 babies born after using one of these drugs, called Famara, has birth defects in comparison with less than 2% of 36000 babies born without any involved of fertility treatment. This heightened awareness toward the safety of the drugs being used in such circumstances.

There are 3 commonly used stimulation protocols for in vitro fertilization:

  • Luteal Lupron protocol, which is also called “long Lupron”
  • Antagonist protocols which involve antagonist medications
  • Flare and micro-flare protocols or short Lupron protocols, used for patients who are expected have a low response to ovarian stimulation

The goal is to get about 8 to 15 eggs during the egg retrieval procedure. It is up to the infertility specialist to determine the proper medication protocol and dosing regimen that will be safest and the most successful for the patient. Because of this, you should always be sure that you are being treated by a specialist that you feel the utmost confidence in. Make sure that you have all the information when it comes to the decisions they are making for you, and that they are never hesitant to inform you of these details.

The Present

Research is only continuing to grow and expand vastly around the world. What was once deemed impossible has been discovered and stretched into various avenues and ideas that we are still continuing to build upon. However, this does mean there a still a number of unanswered questions and much more that we have left to discover. 

Every person’s situation is a unique one, but we have learned a lot over the years in order to properly accommodate each and every person’s individual need. With the knowledge that we have acquired these days and what we can look forward to in the days to come, there is no reason why everyone should not possess the ability to grow a family of their very own.

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Topics: History, Infertility Treatment

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