1 in 7 couples cannot conceive, and in the UK alone 3.5 million people are affected by infertility. For at least 25% of these couples, a cause of this infertility cannot be identified. There are now a few options to try and overcome this, but is the newest development the biggest success of all?
Over a certain age women’s fertility begins to drop naturally (usually after 36 years of age) but many women struggle before this natural decrease with conditions such as polycystic ovary syndrome (PCOS), endometriosis, and pelvic inflammatory disease (PID). PCOS is thought to effect 1 in 5 women in the UK, with half not presenting any symptoms at all. Considering such statistics, infertility is not mentioned much in school (and I went to an all girls school). So after a visit to the doctor who’s just told you that you may have trouble conceiving, what are the options available and where is research going?
Treatment is broken down into three categories: medical (when ovulation is irregular), surgical (for conditions such as endometriosis), or assisted conception (either IUI-intrauterine insemination or IVF–in vitro fertilisation). The treatment offered will depend on the cause of the infertility.
Last week the media went into a frenzy with a study conducted at the University of Edinburgh. A human egg must mature from a primordial follicle to an oocyte (see diagram) before it can be released and fertilised. The research had successfully matured a human egg in vitro (out of the body). This technique had previously been conducted with the eggs of mice. These were fertilised and produced live offspring, but this was a first for human eggs. This research has been underway for many years, in an attempt to better understand the inner workings of egg and sperm cells. Human egg cells are a lot more complicated than mice eggs cells for example, so this breakthrough is a huge achievement in the scientific community. However, what are the practical advantages to this research?
This research is of huge benefit to those affected by childhood cancers or other conditions, where affected children are advised to have their eggs frozen before puberty. During puberty, eggs develop into oocytes which can be fertilised. When the eggs are frozen before puberty, they have not had time to reach maturation and therefore, are difficult to use when the child becomes an adult and wants to have children themselves. Until now, it has not been possible to mature these immature eggs outside the body, meaning that this research is a huge step for those who have had difficult childhood illnesses and want to conceive in later life.
If you want to know more about how they matured the eggs, please follow THIS link.
IVF is probably the procedure best known to the general public and has been widely covered by the media. IVF works by injecting women with a cocktail of hormones, triggering the release of numerous eggs which can then be collected and fertilised in vitro. The younger you are, the greater the chance of a successful pregnancy from IVF treatment. In 2010, the chance of a woman under 35 having a successful IVF pregnancy was just 32.2%, whilst a woman over 44 had only a 1.9% chance. Despite IVF being so well documented for the public, the success rates are actually very low. So how does this research help?
A primary cause of low IVF success rates is due to immature eggs being released for the treatment, which cannot be fertilised. A large percentage of the eggs released are therefore discarded, reducing the chance of a successful pregnancy as fewer eggs can be fertilised and implanted. The ability to mature eggs outside the body provides the opportunity for immature eggs to be matured for IVF, and therefore increase the chance of a successful IVF pregnancy. This work also provides another option for those who suffer from conditions that require an operation, such as endometriosis. During surgery a piece of an ovary could be removed, thus avoiding the need for hormone treatment and egg extraction completely, as the eggs could be matured without need of the body!
There is still plenty of research and testing to do before this becomes something available to those suffering from infertility. Currently, the University of Edinburgh research group does not have the right to fertilise these eggs (you need a license to create life in a lab), but other facilities do, so it is not the end of the road. Prof. Telfer, who led the research, hopes having the matured cells will allow for a greater understanding of this unbelievably complicated process from which we all came. Infertility is a bigger issue than we may have thought, as it is an invisible condition, but there is hope for those who want treatment.