The evidence surrounding these techniques is still limited and further research is required to confirm the significance of the application of this techniques. In addition, the HFEA provide information on these techniques on their website and use a ‘traffic light’ system to help explain the research evidence available for many of the more commonly used techniques, with ‘Red’ meaning that there is no evidence to support the technique being effective and ‘Amber’ meaning that more research is required. None of the techniques are currently ‘Green’. This is available here
Before an embryo can attach to the wall of the womb, it has to break out or ‘hatch’ from its outer layer called the zona pellucida. It has been suggested that making a hole in or thinning this outer layer may help embryos to ‘hatch’, increasing the chances of the woman becoming pregnant in some cases.
Assisted hatching is done between day 3 and 5 of development, and involves using a laser to accurately create a hole in the zona pellucida. There is a small risk of damage to the embryo during the process.
The results of studies are not yet conclusive. See the HFEA website for up to date information.
New techniques allow us to examine all of the chromosomes and to see if an embryo lacks or has additional chromosomes, a condition called aneuploidy. This technique may be helpful in those patients that have had multiple IVF failures or for older women who produce more genetically abnormal eggs. More recent research suggests that younger women may also produce large numbers of abnormal eggs during IVF treatment and may also benefit from this procedure by achieving higher than average success rates and limiting multiple pregnancies.
Please see our genetic screening page for more information.
Embryoglue® is a different type of culture media used in the laboratory at the time of the embryo transfer. This media has an increased viscosity compared to conventional embryo transfer media and contains a product called hyaluronan. Hyaluronan is a compound found throughout the body, with increasing concentrations found in the uterus at the time of implantation.
It is thought that the improvement in pregnancy rate is due to hyaluronan increasing cell-cell adhesion of the embryo and the cells of the endometrium. The embryo and the endometrial cells have receptors for hyaluronan and so the embryo may have an increased chance of binding to the endometrium if it has been soaked with hyaluronan prior to transfer. The increased viscosity of EmbryoGlue may also aid in the dispersion of the embryo in to the endometrium.
A time-lapse technology called the Embryoscope™ involves culturing embryos in an incubator equipped with a special microscope, camera and computer. Available since 2011 it has already led to the birth of thousands of healthy babies. Each individual embryo is imaged separately and monitored every 15 minutes allowing subtle changes in development to be detected. This allows selection of embryos with the highest pregnancy potential – so-called morphokinetics.
Up to 70% of embryos appear normal when observed on a daily basis using older incubation systems yet do not go on to give successful pregnancy after transfer. The ability to more accurately select an embryo capable of pregnancy on the basis of the time-lapse imaging is an exciting development. It is also thought that embryos identified in this way are less likely to lead to early pregnancy loss than other systems and preliminary results are excellent.
Boston Place Clinic was the first UK IVF lab designed specifically to use Embryoscope™ incubators and to maximise the potential of your embryos.
Studies have suggested that the endometrial scratch may improve implantation rates in patients who have had multiple failed IVF cycles despite good quality embryos. Embryo implantation into the womb may fail due to poor embryo quality or abnormal embryo genetics. It can also often fail due to poor ‘endometrial receptivity’. This is where the lining of the womb is not favourable for the embryo to implant.
The procedure involves “scratching” the endometrial lining of the womb with a very small catheter prior to an attempt to get pregnant.
Endometrial scratch is thought to increase the immune system cells and therefore the growth factors at the site of the endometrial scratch. This is believed to make the womb lining more receptive to embryo implantation.
The endometrial scratch is performed in the cycle before you start stimulation medication. As there is a small risk of infection a prophylactic dose of antibiotic is recommended.
IMSI & PICSI are tools used in addition to ICSI which allows our embryologists to select sperm with low levels of DNA fragmentation and which are potentially more likely to lead to normal embryo development.
IMSI uses a much higher magnification which allows the embryologist to see minor defects in sperm appearance and the presence of structures known as vacuoles within the sperm heads which indicate high levels of sperm DNA fragmentation. IMSI can be used to select sperm with an absence of large vacuoles which are therefore more likely to contain low levels of DNA fragmentation, potentially leading to improved embryo development.
PICSI is a method that enables us to select mature sperm for injection by their ability to bind to hyaluronic acid (HA) which is a marker for sperm maturity. Men with poorer sperm samples often have a greater degree of immature sperm. These can still show normal motility and morphology however they may have higher levels of damaged DNA.
Please note that IMSI & PICSI are used in addition to ICSI but are not suitable for all sperm samples. These techniques may not be suitable if there is a limited number of sperm available for selection, such as low sperm count or surgically retrieved sperm.