Recent developments in IVF treatment

Which ones were added to the classical methods?

While efforts to increase the success of IVF applications continue, it is also aimed to make it cheaper and safer. In this context, under the name of patient-friendly treatments, although fewer eggs are obtained by using less drugs, more clinical pregnancies are tried to be achieved. Thus, both the cost is reduced and the side effects are much less since less amount of hormone is given to the patient.

Long-acting injections, which were released to the market abroad during the current year, but which are still under licensing studies in our country, have started to be used. Thanks to these, injections are made weekly, not every day. Studies on oral medications for ovarian stimulation are also ongoing.

Today, where multiple pregnancies are accepted as a complication, not a success, an important step has been taken by implementing the single embryo transfer in the world in Scandinavian countries, Belgium and our country.

Since the indicator of success in IVF applications is accepted as the birth of a healthy baby, single embryo transfer is the most important development of recent years by obtaining fewer embryos after stimulating the ovaries with less medication. Due to the cheapness of IVF applications, tube surgery requiring surgery and vaccination treatments, which have a success rate of around 15% and applied in mild male infertility and unexplained infertility, have become less applicable.

 

New methods in the selection of embryos to be transferred

In order to find the best quality of the embryo to be transferred in IVF treatment, its external appearance is based on the criteria determined today. However, this evaluation does not always show us the best, and it is seen that embryos that are described as very high quality do not result in pregnancy. With the inadequacy of this method, it can be determined which embryos have a higher chance of attaching to the uterus, with studies on the metabolic activities of embryos (metabolomics) developed in recent years. By examining the changes in the endometrium or uterus, called proteomics, it is investigated whether the inside of the uterus is healthy, that is, how suitable the embryo is for settling and reaching pregnancy.

 

What do stem cell studies promise in solving the infertility problem?

In approximately 10-15% of reproductive medicine practices worldwide, the lack of progeny cells and problems with their production, and the deficiency/damage in the reproductive organs due to congenital or unknown reasons, the applications are insufficient or the treatment cannot be obtained. Stem cells emerge as an extremely important resource for infertility studies in the near future, thanks to their potential to transform into functional cells and tissues.

In its simplest definition, “stem cell” is a cell that has the ability to renew itself, maintains its current number thanks to its continuous division feature, forms the precursor cells that come after it in the development process, and has the ability to differentiate into the desired body cell type when the appropriate environment and conditions are provided. While the existence of stem cells was known only in sources such as bone marrow, blood and umbilical cord until recently, new studies show that many organs and tissues contain stem cells.

 

Stem cells in reproductive medicine applications

When considered as an application potential, reproductive medicine applications intersect with stem cell research in three main points: Tissue and organ production for the purpose of preserving fertility, producing functional progeny cells from stem cells and treating infertility, both in theoretical approaches and depending on the results and data obtained in animal experiments to date. The approaches to obtaining progeny cells from stem cells are basically based on 3 different stem cell sources: Embryonic stem cells, cells derived from bone marrow or cord blood.

The current findings obtained in studies with clinical and experimental animals for the preservation of fertility, especially before a surgical operation or cancer treatment, show that the approach of freezing progeny cells before treatment and returning them to the patient after treatment may be beneficial in restoring fertility in the newborn and pre-adolescent period, and that this approach can be beneficial in adult individuals. indicates that more work is needed on the subject. In the near future, new approaches to freezing/thawing of progeny stem cells, long-term culture and enrichment and transplantation, especially in adult tissues, will play an important role in the restoration of fertility and the routine clinical use of effective protocols. Although a positive result is still not obtained from these experimental studies, the magnitude of the results cannot be ignored, and it may be possible for couples who are called absolutely sterile and who have no eggs or sperm to have children in the future, thanks to stem cells.

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