By – Dr Satish Kumar Adiga, Head, Centre of Excellence in Clinical Embryology at Kasturba Medical College, Manipal Academy of Higher Education, Manipal
Procreation is a vital event in the life of every individual, especially married couples. However, in one in six couples, procreation is not easily fulfilled due to some factors impairing fertility. Generally, infertility is when a sexually active couple does not achieve pregnancy despite having unprotected sex and desiring to become pregnant for at least twelve months.
A recent estimate by WHO shows similar prevalence of infertility between regions — including in India — indicating that this is a major health challenge globally. Lifetime prevalence was 17.8% in high-income countries and 16.5% in low and middle-income countries.
The birth of the world’s first IVF baby on 25 July 1978 earned its reputation as one of the major medical breakthroughs of the 20th century. Assisted Reproductive Technology (ART) or IVF technology has since become a beacon of hope for millions of couples struggling with infertility. Over the years, significant advancements in IVF technology have steadily increased its success rate by placing a strong emphasis on safety for both patients and children born through the technology. This has paved the way for countless success stories, dispelling misconceptions and offering new possibilities for hopeful parents worldwide.
Safety in IVF: A Top Priority
With IVF’s increasing popularity, more and more ethical concerns are being raised about the wellbeing of children conceived through the technology. Generally, ART procedures are considered safe and most children born through these techniques are healthy. With millions of successful births through IVF procedures conducted globally, the safety of the process has been continuously improved through the integration of cutting-edge technologies, stringent protocols, and extensive research. Clinics and fertility centres around the world adhere to rigorous standards set by respected medical organisations and governing bodies to ensure the well-being of their patients.
The most common technique used in IVF is intra cytoplasmic sperm injection (ICSI) where a single sperm cell is directly injected into an egg. Embryologists generally perform ICSIs when the male partner’s ejaculate has very few quality sperm or in situations where sperm needs to be taken directly from testicles. Though this sounds like bypassing all natural processes involved in procreation, the incidence of malformations in babies born through ICSI are similarly low to those conceived naturally. Interestingly, a recent European study showed that the psychosocial health and quality of life was slightly better in ICSI adolescents than in their naturally conceived counterparts.
Improvements in cryopreservation techniques have minimised the necessity for multiple fresh embryo transfers
Other than ICSI, cryopreservation is another routinely used method for short and long-term storage of eggs, sperm, and embryos. Improvements in cryopreservation techniques have minimised the necessity for multiple fresh embryo transfers and eventual complications such as multiple gestation, preterm birth and associated problems. Though social egg freezing in India is not as popular as it is in the West, by cryopreserving eggs or embryos for future transfers, patients can space out the procedures, allowing their bodies to recover and reduce the risks associated with multiple IVF cycles. The egg or embryo cryopreservation technique involves freezing them at very low temperatures for storage and is generally considered safe and has been a standard practice in IVF treatment for several decades. The eggs or embryos are placed in a solution to prevent ice crystal formation and then cooled rapidly to very low temperatures, around -196 degrees Celsius using liquid nitrogen. There is the concern that the eggs or embryos’ exposure to supraphysiological conditions and years-long storage at low temperature could impact offspring’s health. Medical research has so far, however, failed to show any conclusive evidence of negative impacts of egg or embryo storage on the health of IVF-born children. Instead, the use of high-quality equipment by experienced and skilled embryologists, and proper handling of embryos are crucial to ensure their overall health and safety.
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One of the major safety enhancements in IVF is the utilisation of Preimplantation Genetic Testing (PGT) techniques. PGT allows the screening of embryos for genetic abnormalities before they are transferred to the uterus, thereby significantly reducing the chances of implanting embryos with chromosomal issues. The recent introduction of non-invasive genetic testing helps avoid embryo biopsy altogether, thereby further reducing the risk of damage to embryos. This advancement has not only increased the success rate of IVF but has also led to a decrease in the occurrence of certain genetic disorders and malformations in children.
New innovations to be used with caution
Apart from the techniques discussed earlier, there are recent breakthroughs useful in preventing the inheritance of mitochondrial diseases in children. This story is the beginning of a new treatment with massive potential for good. Exemplifiably, the birth of a three-parental baby derived from the DNA of three parents raises questions about the long-term health risks involved. Rightfully, rigorous regulation and checks on the unknowns of this new and controversial technology are needed.
Patient education and informed consent
Ensuring the safety of IVF also involves comprehensive patient education and informed consent. Fertility specialists diligently inform patients about the potential risks and benefits associated with the procedure, helping them make well-informed decisions about their treatment options.
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As IVF technology continues to evolve, it is clear that safety remains a paramount concern for both patients and fertility experts. Through innovative techniques, personalized treatments, and comprehensive patient education, IVF is not only achieving remarkable success rates but also offering couples the reassurance they need while embarking on their journey to parenthood. As research continues and technology advances, the future of IVF looks even more promising, providing hope and happiness to countless individuals and families worldwide.
The author is a recipient of the ICMR Subhash Mukherjee National Award for his contributions to the IVF field.