The research that could finally improve IVF's success rate
Every IVF attempt starts with an embryo – the beginning of a baby. But in something like 70 per cent of cases that little collection of cells will fail to successfully latch onto the wall of the uterus, and heartache follows. The extraordinary thing about this is that experts still do not understand why it happens.
They say IVF success rates have not improved much for a decade. And yet couples continue to fork out thousands of dollars for a procedure that, in the majority of individual cycles, does not result in a child.
“We still don’t understand the mechanism of implantation, that’s how in the dark we are,” said researcher David Greening. “We actually don’t understand why it fails. It’s as simple as that.”
But research being conducted by La Trobe University and the Hudson Institute of Medical Research is offering hope for the one in six couples who experience infertility.
Its ultimate goal is to create personalised medicine or supplements to improve successful implantation during IVF, or in cases where the cause of infertility is caused by failed implantation, to allow a women to bypass IVF completely.
Breakthroughs may be possible because of the discovery that the lining of the womb and the embryo communicate with each other through tiny bubble-like structures called extracellular vesicles.
“During reproduction, these vesicles carry a signal to the embryo, resulting in the outer layer of the embryo changing so that it can successfully implant into the wall of the uterus and form a placenta,” Dr Greening said.
He said in cases where the implantation was not successful, the vesicles may not be sending the right signals. It’s hoped researchers may be able to develop treatments or supplements that would change that signalling to allow a successful implantation.
While those involved in the project are trying to keep a lid on expectations, Dr Greening said even small improvements in IVF success rate could have a huge impact.
The latest research on IVF success rates in Australia says the chances of a woman falling pregnant and going on to have a baby in her first round of IVF is around 33 per cent.
Success rates were highest for women aged under 30 (44 per cent) and lowest for women aged 45 or over (1.4 per cent).
After the first round, the odds of women getting pregnant in following cycles falls with every attempt, so while almost a quarter of women who received second round IVF went on to have a baby (giving a combined success rate overall closer to 50 per cent), only 7 per cent of women had a baby after the eighth round.
Monique Sierakowski, 40, estimates that she and her husband spent $70,000 in their ultimately successful quest to have two babies. It took four rounds for her to become pregnant with her daughter, Frankie, now three, and five rounds to have her son, Patrick, aged eight months.
“You wouldn’t change a single dollar spent, But if you can stop someone else spending that much money, that’s an amazing thing,” said the retail operations manager.
“And it’s also the toll on you emotionally. If you can avoid that it would be so important for future generations.”
Ms Sierakowski said of the nine cycles, five resulted in pregnancy and three ended in miscarriage – with two of these babies growing to the point she was able to hear their heartbeat - before they were lost.
An IVF nurse would give her a call once a week with blood test results that would reveal if the baby was still alive. Sometimes they would say “sorry, it’s negative”.
“That would be over the phone. You could be at work. You could be in the car. You could be anywhere,” she said. “It’s like winning the lottery essentially.”
But she said she only had positive feelings about the IVF clinic that helped her.
As well as often costing couples a fortune, IVF is also a big drain on the public purse. In 2015, Medicare expenditure for assisted reproductive technologies was over $250 million.
The Melbourne project trying to improve embryo signalling has received more than $1 million from the government through the National Health and Medical Research Council.
However, the Hudson Institute of Medical Research’s Professor Lois Salamonsen said the companies behind IVF clinics, which have been reporting profits in the tens of millions, were not willing to put any significant funds into their research.
“They expect the government to do that,” she said. “[But] because there is such limited funding for medical research, this research is being put up against things such as cancer and not considered important.”
Professor Salamonsen said the recent research had focused on improving embryos, but what happens with the lining of the womb was now what needed to be studied most.
“The endometrium (uterus lining) is the soil and the egg. If the soil is not properly prepared, the chance of the seed growing successfully is much lower.”