Dr Gautam Allahbadia, head of IVF team at Millennium Medical Center (MMC IVF) , Dubai talks on the advancements in IVF (In-Vitro Fertilization).
Dr Gautam Allahbadia in conversation with Uma Ghosh on the Uma Show:
Uma: Previously we discussed IVF extensively, but today we want you to highlight on how IVF and genetic studies are coming together to create a difference in the world of having babies?
Dr Gautam Allahbadia: IVF will now be more invariably linked to genetics in the years to come. For listeners who haven’t caught up with the last episode, let me reinstate on what IVF is. In-vitro fertilization is outside the body fertilization of the female egg and the sperm, creating an Embryo. I will stress more on what happens once the embryo is formed, as it explains the basis of how genetics has helped improve the results of IVF.
I will hereby put forward the discussion into two parts:
First is the medical terminology of Pre-implantation Genetic Screening (PGS), which is the screening of embryos of Day 3 or Day 5 of the IVF cycle. Embryo biopsy, through which the embryologist creates a hole in the outer shell of the embryo, gently evacuates one cell or a couple of cells that are then sent for genetic analysis. This analysis screens the embryos entire chromosomal complement, and tell test it for normalcy. Thus, this process of complete chromosomal screening by next-generation sequencing (NGS) is nothing less than a revolution.
Through research in the field, it was found that nature does not let chromosomally abnormal babies stick to the uterus, passing it down in the form of abortions or miscarriages. With PGS IVF, we can comfortably keep the embryos outside, and continuously review them, preventing repeated miscarriages. We transfer the normal embryos into the uterus, which is expected to term into healthy pregnancies, in the form of chromosomally normal offsprings. This has proved to be a miracle for women who previously suffered the oddities of abnormal pregnancies.
The PGS at Aster IVF here helps women who have suffered IVF failures or have had multiple abortions and miscarriages, in increasing pregnancy success rates.
Dr Gautam continues, that now we will examine how the advance treatment removing cells from the trophectoderm has been an imperative step in reproductive sciences. Removing cells from the trophectoderm was done due to the findings of mosaicism, which means that Day 3 of embryo biopsy can show abnormal results but nature makes corrections on the day 5, making abnormal baby normal (flushing abnormal cells). This is now a preferred means of screening that we do in Aster IVF.
Uma: Doctor we talked about PGS previously but there is another terminology called PGD. Could you elaborate on what it is?
Dr Gautam Allahbadia: Pre-Implantation Genetic Diagnosis (PGD) was initially used to diagnose hereditary disorders like thalassemia or severe muscular dystrophies, and avoid their transfers. Through PGD the gene that carried the abnormality was discarded. So, its primary purpose was to eliminate genetic disorders from the next generation. But with the advent of NGS, we have over 200 diseases that can be screened and then normal embryos can be produced. We also have an option of gene compatibility test to determine the peculiarities of different diseases, with blood samples from the family taken to locate what gene causes the disorder. Once the gene is localized, it is discarded from the next round of IVF cycle. PGD has also been able to eliminate sex-related diseases.
There is family balancing coming into the picture recently, helping parents’ better plan their family. The technology is becoming simpler with success rates as high as 60-70%. It has changed our conformist ways of looking at different diseases.
Uma: So doctor as you said there are a lot of new developments happening on a daily basis. What is the latest breakthrough?
Dr Gautam Allahbadia: When we talk of PGS and PGD, what is now being studied and will hopefully be included in the mainstream practice is the need to conduct a biopsy on Day 3 or 5. You have a blastocoel cavity wherein the embryologist will put in a needle and aspirate the fluid from this cavity, which will give the free-floating DNA of the baby, through which we can get the entire chromosomal analysis. Thus, there wouldn’t be any need to conduct a biopsy. The whole technique will become non-invasive and less traumatic to the embryo.