Advancing fertility treatment today – 10 things to know

Baylor College of Medicine’s fertility program has spent the last 40 years firmly planted on the leading edge of infertility treatment.

In honor of National Infertility Awareness Week, Dr. Laura Detti, director of Baylor’s division of reproductive endocrinology and infertility, provides insight on the fertility advancements making headlines today and how Baylor is contributing to improving treatment and outcomes for our patients at the Family Fertility Center at Texas Children’s Pavilion for Women.

1. Technology-driven embryo selection

While much of the buzz today is around artificial intelligence to improve fertility treatments, Detti and her team have long relied on the EmbryoScope® to identify the best embryo for implantation.

“We were among the first institutions to adopt this technology back in 2013. We remain one of the few centers with this device in our lab and one of the most experienced in using it,” she said.

The specially designed incubator uses time-lapse imaging to continuously track and evaluate embryo development in a stable environment, optimizing embryo growth, quality and the selection process.

2. Egg rejuvenation

Egg rejuvenation aims to boost the quality of eggs from older women to improve IVF outcomes.

“Currently, it can only be used for research, not in clinical practice, and the results vary across institutions,” Detti noted.

“The term ‘egg rejuvenation’ is broad,” she added. “It could mean taking supplements that may enhance the egg quality. Or there are more invasive methods, such as injecting growth factors inside the ovaries or acting directly on the egg after it is retrieved from the ovary by taking out the cytoplasm, the center of the egg, and substituting it with the cytoplasm of a younger, donor egg – a process that isn’t FDA approved.”

3. In vitro maturation (IVM) with in vitro fertilization (IVF)

An emerging technique in IVF, in vitro maturation is a process in which the immature eggs that are removed from a woman’s ovaries during egg retrieval for IVF are matured outside the body before being fertilized. Once mature, typically within the following 24 hours, the eggs are fertilized with sperm or frozen. This process ensures that most, if not all, immature eggs can still be utilized.

“In vitro maturation protocols can range widely, from adding minimal supplements to the immature eggs to using a group of substances that increase the maturation rate,” Detti said. “Here in our lab, we perform a mild form of IVM. Essentially, we keep the eggs in culture for a little longer after egg retrieval so that some of the eggs mature overnight.

4. Embryo implantation

EmbryoGlue®, a solution that contains a high concentration of hyaluronan, or hyaluronic acid, is combined with the embryo before it is transferred to the patient to help it adhere better to the uterine wall.

“We support embryo implantation through the use of EmbryoGlue with every embryo transfer we do,” Detti shared.

5. Platelet-rich plasma

“We’ve recently started using platelet-rich plasma (PRP), derived from the patient’s own blood, to improve implantation and improve uterine conditions like scarring of the uterus or adenomyosis that can impact fertility,” she explained.

“The process involves centrifuging the patient’s blood, then injecting it inside the uterus with a microneedle under direct visualization with a hysteroscope.”

6. Personalized medicine for superovulation

During IVF, rather than using the same medications and doses across the board to stimulate patients’ ovaries (ovulation induction), Detti and her team are taking a personalized medicine approach, tailoring the treatment to each patient based on several specific factors for each patient.

7. Advanced preimplantation genetic testing (PGT)

“We partner with Baylor’s top-ranked Department of Molecular and Human Genetics to provide our patients the latest in genetic screening, testing and diagnostics,” Detti explained. “That includes preimplantation genetic testing to test embryos conceived through IVF for certain genetic conditions.”

8. Fertility preservation options for cancer patients

“Our Oncofertility program was among the first and remains one of the few centers in Texas offering ovarian tissue cryopreservation, a fertility preservation option for oncology patients who have not yet gone through puberty,” Detti said. “Oocyte cryopreservation is also available for patients who are postpubescent when they do not have time to undergo egg freezing.”

In partnership with the University of Texas MD Anderson Cancer Center, the Oncofertility program offers fertility preservation to patients before undergoing cancer treatment.

9. Uterine transplantation for absolute uterine factor infertility (AUFI)

“A clinical trial underway at Baylor College of Medicine and Texas Children’s Hospital enables women without a uterus or a functioning uterus an opportunity to carry and deliver a baby through a donated uterus. It’s truly the cutting edge of fertility medicine,” Detti said.

10. Expertise for the most challenging and complex cases

Recent headlines have brought new attention to women who endure years of infertility struggles.

“We treat many different, difficult and high-risk cases here, including those with genetic challenges, recurrent pregnancy loss, endometriosis, advanced maternal age, prior failed IVF cycles and high-risk patients. Cutting-edge, evidence-based medicine is key to the treatment of these cases – and to advancing our field in general,” Detti added.

By Sharon Dearman, a writer with the Department of Obstetrics and Gynecology