Insights by an IVF expert who never says “impossible”
Imagine a future where human reproductive system can be restarted by stem cells and infertility treatment is aided by artificial intelligence to ensure successful pregnancy for couples failing to conceive naturally. These science-fiction plots are already on the way in some of the best reproductive centers worldwide, says Professor Ercan Bastu, M.D, an infertility specialist at Acibadem Healthcare Group in Istanbul, Turkey. In the modern world, where families tend to postpone parenthood until fulfilling their career or personal goals, medical solutions are being developed to meet their changing needs.
Half of IVF patients are aged 40+
Fertility issues affect an average of 10 to 15% of all couples. It is recommended to see a doctor when they have been regularly trying to conceive a baby for at least one year, in case that the woman is below 35 years of age. If the female partner is above 35, then 6-month attempts are enough before consulting a specialist for some tests and evaluation. Recently, patients over 40 years of age become the prevalent group of candidates for in vitro fertilization (IVF). Professor Ercan Baştu explains: “For example, last month half of my patients were over 40. Lots of women postpone their pregnancy and it’s definitely harder for them to succeed because finding the oocytes of good quality and number is not that easy compared to a younger age.”
IVF alone is not enough, new techniques come to light
In our changing environment, the best specialists in assisted reproduction are adjusting to the new reality, exploring new treatment options. Technology comes to help with modern devices, such as the embryoscope that allows tracking the development and quality of the embryos. Genetic tests (PGD) let to evaluate the embryos’ genetics and identify any abnormalities that would impede a successful pregnancy. A new treatment option is available even for men who have no mature sperm cells – a condition called azoospermia that was previously associated with little or no chance of success in IVF treatment. An advanced technique called ROSI helps to activate sperm cells with electrical stimulation, explains Professor Baştu who is among the first to apply the new method at Acibadem. “For women who don’t have enough ovarian reserve, we can use some new treatment modalities to get oocytes of good quality, like platelet-rich plasma (PRP) or stem cells. We are currently working on getting approval from the Health Ministry for stem cells” the fertility expert adds.
What about the future? Professor Baştu gives some precious insights: “Artificial intelligence is a very hot topic nowadays, and we have done some research on it, because AI will help us to decide which embryo has an implantation potential, which embryo is of good quality, and it will be very objective and very quick. We will also have some sort of new diagnostic testing for embryos’ chromosome status without touching or harming the embryo. We will take the embryo culture and analyze it. In the future we will learn the crosstalk between the endometrium and the embryo in detail, especially to understand their genetic situation on molecular interaction, and we can help them to establish a good relation between the embryo and endometrium. I think we’ll see it in the future.”
Comprehensive approach to infertility treatment
Successful assisted reproduction requires a good understanding of the health conditions impeding the pregnancy. That’s why a comprehensive approach is crucial, states Professor Ercan Baştu, whose career development includes a masterclass in clinical embryology at the University of Leeds, UK; advanced endoscopy masterclass at the University of Surrey in UK, as well as some scientific research at Harvard University in USA.
The reason for IVF failures cannot be named in all cases but additional tests and changing the type of treatment might help to improve the outcomes. Sometimes, surgery might be needed to allow conceiving, says the IVF expert who provides complex infertility treatment, including endoscopic surgeries, to patients from all over the world. Endometriosis, blocked fallopian tubes, myomas and abnormalities of the uterus that need to be corrected with hysteroscopy are some examples of conditions that need a good surgery. With proper treatment, these patients might even be able to conceive naturally, without assisted reproduction. Nowadays, laparoscopic techniques and robot-assisted surgeries make operations safer than ever.
What makes a good IVF clinic?
Quality of service and patients’ comfort are the key prerequisites to successful IVF, says Professor Ercan Baştu.
“We provide high-quality services, this is the main thing. We are an updated clinic and we have done a lot of research about infertility. We usually have the latest technology in our lab, and the latest developments in medicine; we can use it. Every new thing in Europe or the US, we’ve got it and we can use it. Our success rate is similar and maybe higher when compared to other countries. That’s why patients are usually satisfied with their treatment in Acibadem.”
The infertility specialist explains that success rates depend on many factors, especially the age. For example, when there is one blastocyst or day 5 embryo with good genetics, there is 60 to 70% chance for pregnancy. However, it would be difficult to have a quality blastocyst above the age 40 and in this case pregnancy rate drops to 30-40% for this age group.
And still, what makes the patients satisfied is to have their questions answered in details and feel comfortably even away from home during the treatment. At Acibadem, their journey starts with a detailed conversation – either in English or another native language for the couple, aided by an experienced translator. Then, an ultrasound is performed, test results are evaluated and a road map for treatment is presented and explained to the patients. During the treatment, couples may ask their questions directly to the doctor, who usually shares his phone number for patients’ comfort.
IVF as a happy ending story
Professor Ercan Baştu has hundreds of happy stories in his career but one of them he remembers most clearly – he says it changed his approach to patients once and forever.
“They came to me so sad, nearly crying, and told me that they wanted a baby. The woman was 46 years old, so I told them: I cannot do an IVF procedure for you, it’s nearly impossible, don’t waste your time and money. Then the woman told me that they had a boy, 19 years old, and they had lost him 2 months ago. He had always wanted a brother or sister and they wanted to try it, even if they didn’t have a chance. I said: okay, if you understand your chances, let’s try it. The woman had just one oocyte and we took it. The same day the man had to give sperm but he couldn’t because after his boy’s death he had started drinking. We needed to freeze the oocyte. The woman came again 2 months later and told me that she wanted to try again. We got 2 oocytes but this time their quality was not good. Two months later she came again, she was 47. She insisted to try again and we tried. This time we had 2 oocytes, and I took the one we had frozen the first time. The man managed to give sperm this time. We had one embryo with an average quality; I did the transfer and she got pregnant. Two months ago she gave birth to a boy. And look at the pictures above my desk – there are no patients’ pictures, just one and that’s him. This is incredible! Now I never say “impossible”: if they say they want to try, I just accompany them. One is one, it can still help.”