New Hope for Women with Repeated Miscarriage or IVF Failure Interview

New Hope for Women with Repeated Miscarriage or IVF Failure Interview

A Genetic screening test with the potential to dramatically improve the chance of an IVF cycle resulting in a healthy baby is being pioneered by Genea, with fantastic results for patients. The technique - microarray comparative genomic hybridisation (CGH) - was first used in Australia by scientists at Genea and allows a full chromosome count of embryos created using IVF.

Random chromosome abnormalities are one of the main causes of failed IVF cycles and of repeated miscarriages in both fertility patients and women who conceive naturally. But by using CGH scientists can ensure that only embryos that contain the correct number and sequence of chromosomes are considered for transfer - with dramatic results. Where there is a chromosomally normal embryo to transfer after CGH screening, almost nine out of ten patients achieve a pregnancy.

New data, to be presented at an international fertility conference, reveals a pregnancy rate of 88 per cent - based on patients aged less than 38, where a fetal heartbeat at seven weeks gestation was seen. For women aged more than 38, the pregnancy rate is 65 per cent. Genea's Scientific Director, Steven McArthur said: "These Pregnancy rates surpass all of the expectations we had when developing the CGH microarray service. It is an exciting development for patients, many of whom have experienced failed IVF cycles or miscarriages, to be able to access a service that provides such a high chance of achieving a healthy pregnancy."

During IVF, embryos are created by combining eggs and sperm in the lab. At Genea, they are closely monitored for five days and those that are developing normally will be considered for analysis and transfer.

But even if an IVF embryo appears to have developed normally when examined under a microscope, there can often be hidden errors in its genetic makeup that mean it will never result in a healthy baby. With CGH, a detailed analysis of all 46 chromosomes can be carried out before a pregnancy has even begun.

Associate Professor Mark Bowman, Medical Director at Genea, said that CGH would not be recommended for all IVF patients and was most appropriate in instances where maternal age was likely to increase the risk of chromosome abnormalities or where women had unexplained recurrent miscarriage.

"Repeated IVF failure and recurrent miscarriage are common problems as women get older, as a result of older eggs" Prof Bowman said. "If we can attain a good number of eggs in an IVF cycle, then CGH offers those couples the chance to achieve a healthy pregnancy faster than they would have by undertaking IVF without testing."

Australia's first CGH baby was born in November 2010 to a Genea patient with a history of recurrent miscarriage. To date another 14 women have had healthy babies after the use of the screening and there are 13 on-going pregnancies.

Genea's Scientific Director Steven McArthur added: "Microarray CGH offers us the equivalent of pre natal screening, but at day five of the development of an embryo. The main benefit for a couple is time, which can be crucial especially for women in their late thirties. Being able to identify which embryos are free of chromosome abnormalities has the potential to minimise the number of treatment cycles, reducing both the emotional and financial stress for patients."

An IVF cycle with CGH screening costs around $6,500 out of pocket, depending on a patient's health cover.

About microarray CGH: A small number of cells are removed from the growing embryo five days after fertilisation. They are taken from the trophectoderm, the part of the embryo that will form the placenta, and the inner cell mass that will become the baby is not touched. Embryos are frozen while the CGH analysis is carried out.

The DNA is analysed and displayed on a computer screen as 60,000 tiny dots - each corresponding to part of the human genome. Lasers scan the fluorescent dots and compare the DNA to that of known normal DNA. A detailed image of each chromosome is created, allowing scientists to report on specific parts of chromosomes where genetic material is missing or has been added.

Interview with Professor Mark Bowman and Steven McArthur

Question: Can you please explain what the screening test Genea has developed?

Steven McArthur: At Genea, we have developed systems for growing and screening embryos that enabled us to be the first clinic group in Australia to offer mirco-array screening of all 23 chromosome pairs in a five or six day old embryo. The test, known as CGH - microarray comparative genomic hybridisation - allows the screening of random chromosome abnormalities that are one of the main causes of failed IVF cycles and of repeated miscarriages in both fertility patients and women who conceive naturally.


Question: How does the microarray comparative genomic hybridisation (CGH) dramatically improve the chance of an IVF cycle resulting in a healthy baby?

Steven McArthur: Previously, genetic screening during IVF had been limited to looking at seven to nine chromosome pairs - leaving the possibility of an implantation failure or a pregnancy failing - usually in the early stages - due to problems in the unscreened chromosomes. CGH allows us to investigate all chromosomes and only consider transferring embryos that have the correct number and sequence of chromosomes.


Question: Can you talk about the main causes of failed IVF cycles?

Professor Mark Bowman: Although people often think that it is their body 'rejecting' embryos, most failed IVF cycles occur because the embryo lacks the ability to implant, even if it looks good. Often that is because of chromosome errors in the embryo. This is why CGH offers great potential for couples with recurrent IVF failure or miscarriage.


Question: What other circumstances need to be taken into consideration to successfully improve the chance of an IVF cycle resulting in a healthy baby?

Professor Mark Bowman: The chance of success can be significantly altered - higher or lower - through the type of IVF drugs used and the conditions in the laboratory. At Genea these are maximised and this leads to a higher chance of pregnancy, compared to the average of other IVF clinics across Australia and NZ.


Question: The data that has been presented includes patients aged less than 38; how will this test improve the likelihood of woman over 38 conceiving?

Steven McArthur: The likelihood of chromosome aneuploidy - most recognisable example being Down Syndrome - increases with maternal age. Many chromosome aneuploidies result in miscarriages and repeated IVF cycle failure. The pregnancy rate for women aged more than 38 who have a health embryo to transfer following a cycle of IVF and CGH screening at Genea is 65 per cent.


Question: Can you talk about why CGH would not be recommended for all IVF patients?

Professor Mark Bowman: At least 50 per cent of younger couples successfully conceive at their first IVF attempt at Genea, through simply selecting the best looking embryo to implant. Another large group will became pregnant at their second attempt. These couples don't need to consider the added interventions and cost of CGH.


Question: An IVF cycle with CGH screening costs around $6,500 out of pocket, depending on a patient's health cover; will this price reduce in time?

Professor Mark Bowman: That depends on whether the federal government considers it appropriate to reimburse the CGH component of the cycle, through Medicare.


Question: How does Genea differ from other IVF clinics?

Steven McArthur: Genea continues to lead the way in research and development at all levels of assisted reproductive technology. Advancements in stimulation protocols, embryo culture conditions and technologies for the analysis of the genetics of embryos ensure that Genea is best placed to provide the greatest chance of achieving a live healthy birth for couples requiring IVF.