Could personalisation boost IVF success and prove to be the answer to the heartbreak of infertility and miscarriage? New research looks at how precious embryos settle into the womb, and snuggle down for a healthy pregnancy.
The hardest part of IVF is the dreaded two-week wait, wondering if implantation has happened and you’re pregnant. Sadly, about 70% of the time, the embryo does not ‘velcro on’ to the womb lining, with a crushing disappointment for hopeful couples. And still no-one is sure WHY this happens, or fails to. IVF success rates remain pretty static for the last ten years – couples spend thousands of euro in the hopes of becoming parents, with slim chances of success, in most individual treatment cycles.
“We still don’t understand the mechanism of implantation, that’s how in the dark we are,” explains Dr.David Greening, who is starting work on demystifying the problem. “We actually don’t understand why it fails. It’s as simple as that.” Pioneering research at La Trobe University and the Hudson Institute of Medical Research hopes to change the outlook for the one in six couples waiting for a baby. Aimed at understanding infertility, it hopes to improve pregnancy success, naturally or via IVF.
Could personalisation boost IVF success?
Crucially, this approach may lead to a ‘personalised IVF’, something I have been advocating for years. In collaboration with experts from Monash IVF and Monash University, and led by Dr David Greening at La Trobe Institute for Molecular Science, along with Professor Lois Salamonsen of Hudson Institute, the team is working on discovering just why embryo fail to implant in some women.
A grant of $750,000 project grant, awarded to the team, funds their work on understanding the ”communication mechanism” between an embryo and womb lining, to help more women achieve a healthy pregnancy.
Dr Greening says the aim of the research project over the next two years is to improve the rate of successful implantation for couples with infertility.
“One in 25 pregnancies now results from IVF, with a success rate of up to about 30 per cent. Embryos often fail to attach to the endometrium, or womb lining,” Dr Greening explains. They need to ”Velcro” together, and that’s crucial to the success of pregnancies. Vesicles are little bubble like structures released by cells in the womb to start the Velcro process. When implantation fails, it seems the vesicles aren’t be sending the right signals.
The researchers hope to develop treatments, or supplements, to boost signalling for successful implantation and continued pregnancy. Very little is known about mutual communication between the embryo and the mother.”
Recent research focused mostly on improving embryos, but what happens with the lining of the womb needs to be studied.
“Often, ART/IVF follows a ‘one-size fits all’ approach. It clearly does not work for everyone. What we are working on could be the start of personalised IVF, tailored to an individual women’s cycle,” reveals Professor Salamonsen, a world expert in human uterine biology
“The endometrium is the soil and the egg is the seed. If the soil is not properly prepared, the chance of the seed growing successfully is much lower.”
Identifying blood markers allows doctors screen women are at risk of failed implantation, by detecting the quality of communication between embryo and endometrium with a blood test.
An ultimate goal is to create personalised fertility medicine, or supplements, to improve IVF. If infertility is caused by failed implantation, it may help couples obviate expensive IVF completely.
Natural Goldilocks hormones
Every month cells in the womb prepare for possible pregnancy. Women with implantation issues, here in Ireland, are often prescribed DHEA (dehydroepiandrosterone) a steroid hormone. This helps get the womb ready to welcome an embryo aboard for a healthy pregnancy. A recent study in Edinburgh, published in the journal Fertility and Sterility, is looking at how it affects the lining receptivity to implantation, especially for older women undertaking the IVF path to pregnancy. DHEA treatment also boosts production of active androgens – (men naturally have high levels of these, which explains some of the side-effects of therapy).
Researchers found endometrial womb cells treated with DHEA doubled amounts of key proteins which are key to good implantation after IVF.
“An embryo only successfully implants if the conditions are just right. We’re excited to see DHEA and androgens may improve cell environment,” explains lead author, Douglas Gibson.