ASRM 2013 Update: Hot Topics

November 17, 2013Carole No Comments »

Other news from the meeting. Time lapse photography and aneuploidy testing of embryos are hot topics again this year. We are still looking for the best methods to find those embryos that will implant and go the distance to a healthy baby. As I have mentioned in previous posts, morphology assessment (judging an embryo on it’s appearance under the microscope) is still the major method for making these choices. How the appearance of the embryo changes over time can be measured by taking continuous video images and determining when normal embryos reach certain stages. Deviations from this normal progression (either too fast or too slow)  have been found to decrease the chances that the embryo will implant.

Aside from a normal appearance, the chromosomal normality of an embryo is also a must-have for implantation and a healthy baby. Testing for abnormal numbers of chromosomes (either too many or too few of each of the 23 kinds of chromosomes) has been considered critical to help us get past the “beauty contest” assessment of the appearance of embryos. As the IVF community becomes more experienced with pre-implantation genetic screening, we are better able to determine which methods for sampling the embryo (day 3 or trophectoderm stage embryo biopsy) and testing the embryo for aneuploidy (via microarray, PCR or SNP array) , it is starting to look like using aneuploidy testing –perhaps in conjunction with time-lapse imaging–may become more routine in the future.

The company Auxogyn is one of at least three companies (Auxogyn’s Eeva, Fertilitech’s Embryoscope, Vitrolife’s Primovision) that are investing in time lapse imaging and producing systems for imaging and mathematical algorithms for analyzing embryo growth over time. On Auxogyn’s website, you can find more information about the science behind this technology. There is also a video on their page which explains the research that demonstrated that embryos that implant have a different pattern of gene expression during embryo development than those that don’t implant. More importantly for embryologists, this pattern correlated to the rates at which embryos hit certain time points in development–which is revealed by time-lapse imaging. Below is a chart of the relationship between embryo development over time and gene activation over time.  Image source from http://dev.biologists.org/content/139/5/829/F2.expansion.html.

http://dev.biologists.org/content/139/5/829/F2.large.jpg

It was interesting to attend the annual ASRM meeting and hear the debate among those embryologists and physicians who were more enthused about aneuploidy testing (an invasive method that requires removal of some embryonic cells for testing)  and time-lapse imaging which is appealingly non-invasive, but is still not completely vetted as to what it can and can’t do. There is some debate about whether time lapse is a good substitute for aneuploidy testing to determine embryo viability– because the correlation tells us about overall genetic activation for embryo cell cycle (division and genome replication) events. Time-lapse is limited though. It won’t be able to replace genetic testing for specific gene sequences that are associated with genetic illness. On the other hand, timelapse is  probably a good barometer of how well the embryos motor is running which is tied to how well the genes that run that motor are turned on, ramped up or down and turned off.

My guess is that there is a place for both technologies and they will more often be used together in the future, depending on the question being asked of the embryo. Will you implant? vs. Will you be a healthy child?

These time-lapse systems are ridiculously expensive and the ART programs using them currently are large clinics who are running clinical trials with the companies developing these systems to test them. At the trade show, I asked what  the costs were for these time-lapse imaging systems and didn’t really get any answers. Tens of thousands of dollars is a safe bet so small and medium centers probably won’t be getting these in any time soon.  Also, these systems are still working their way through FDA approval and similar regulatory approval in other countries. But they are coming.

So  for me–the bigger and currently unanswerable questions are: Will these new technologies be available to all clinics- large and small? and all patients? Self-pay vs insured? Or will they be “extras’ that only the most affluent patients will be able to buy? Developing exciting new technology is one step in the process. Ensuring that every patient that may benefit has access is another.

I always draw fire when I blog about the importance of pushing forward the political agenda of infertility insurance coverage for everyone  but if we don’t ensure access to patients of these newest technologies, what’s the point? Since infertility does not recognize economic boundaries, fertility solutions shouldn’t either.

© 2013, Carole. All rights reserved.

Join the discussion