IVF is expensive. Can recent cost-cutting technologies make a difference?
The year was 2004, the date was August 4, when our article, 'Inside the tube and closer to nature', was published as a letter to the editor, in the journal Reproductive Biomedicine, online. The founder-editor of the journal was the late Robert Edwards, Nobel prize winner in physiology and more famously known for being a pioneer in the field of IVF (in vitro fertilisation), credited for the birth of the world's first test tube baby. The article spoke of our experience with performing tubal procedures in IVF and their efficacy in successful pregnancy rates. The concept being: retrieval and transfer of the female oocytes into the ampullary portion of the fallopian tube, in its natural environment. Either these oocytes were loaded with sperms, or an intrauterine insemination was performed so that the sperms swam naturally towards their destination to fertilise with the oocyte. The concept of performing this was to reliably place gametes in their natural environment to enable fertilisation.
Mimicking nature is the intention of IVF, be it temperature control or the well-fortified culture media used and their growth periodically monitored in CO2 incubators. Now, tubal procedures have become obsolete. Advances in cell culture methods and the expense of anaesthesia and it being a laparoscopic procedure, sealed their fate.
Cutting costs in conventional IVF
But then again, we feel the urge to cut costs in conventional IVF. This compels us to research techniques that could possibly reduce the number of injections that are taken by women, known as controlled ovarian hyperstimulation, to yield more than just a few mature follicles in their ovaries. When these follicles, which are monitored by ultrasounds on alternate days, reach a mature size, we surgically aspirate them to retrieve oocytes.
The first method of cost cutting was to either perform a natural cycle IVF, or use minimal stimulation protocols with a combination of more tablets than injections. Depending on the individual's age, diagnosis and ovarian reserve, stimulation protocols are tailor-made for their needs. The other method, which is not new in the market is, invitro maturation of oocytes (IVM). In this method, we retrieve oocytes from follicles that are not fully mature (1.4 x 1.4 cm) and culture them in media, to which are added specific proportions of follicle-stimulating and luteinising hormones along with serum-derived protein and growth factors. This method cut short nearly half the cost of injections and also reduced risks of a potential complication called ovarian hyperstimulation syndrome. (OHSS). However, the American Society of Reproductive Medicine only recently, in 2021, declared it as non-experimental and its usage around the globe is much lower in comparison to conventional IVF. The reason being, lower success rates. Also, there is a learning curve in lab preparations for this process and it does remain challenging for regular use.
New learnings
The same year as IVM was gaining popularity as the new kid on the block, I was doing my Master's in clinical embryology (2004-2006) at the Jones Institute of Reproductive Medicine in Virginia, U.S.. For my final thesis, I decided to perform in vitro maturation on a select group of PCOS (polycystic ovarian syndrome) patients who were ideal, as they required more injections, and so were also at risk of OHSS. However, I soon realised the nuances of culturing immature oocytes outside of the body not only depended on stringent culture conditions but also the basic quality of oocytes. PCOS patients are a tricky group where quality is concerned. I had to abandon my research and convert it to a literature review instead.
Recently, a U.S.-based biotechnology company that works in reproductive health Gameto, grabbed headlines, with the introduction of 'Fertilo', which utilised ovarian support cells derived from stem cells, to literally recreate the ovarian environment, in vitro. These ovarian support cells are derived from human induced pluripotent stem cells (HIPSC) that overexpress a variety of transcription and growth factors. Not only that, they behave like the nourishing granulosa cells that respond to exogenous hormones and feed the oocyte in vivo. So instead of supplementing the hormones as discussed earlier, the ovarian stem cells formed the elixir in culture in which immature oocytes were incubated for 30 hours, following which a maturity check was performed and fertilisation was enabled by conventional methods such as IVF and ICSI. To test safety and efficacy, 20 patients were recruited. Once cleared, the remaining 20 patients were randomised to two groups, one using fertile and the other using conventional IVM. The success rates projected as maturation rate, ongoing pregnancies and live births is double in the Fertilo group in comparison to the IVM group.
The bias in the study however, is that the population was less than 37 years old and also had normal ovarian reserves. The success of this remains to be seen in a variety of diagnoses like older women, PCOS patients, those with low ovarian reserves etc. In this subset of patients, the current refined stimulation protocols have actually yielded much better results than a decade ago, including a reduction in OHSS.
Proceeding with caution
There are many factors that need to be considered before plucking a gamete out of its natural environment and subjecting it to in vitro conditions. The oocyte maturation process requires an intact meiotic spindle, proper nuclear maturation whereby there is resumption of meiosis (cell reduction division) and cytoplasmic maturation that enables accumulation of growth factors, leading to normal fertilisation and growth in vitro. Apart from these processes, disruption of epigenetic events from maternally expressed genes could result in poor integrity of embryos post fertilisation.
In conclusion, newer culture methods and research methodologies that cut costs and complications are most welcome; however, elaborate multicentre studies and a follow-up of the pregnancies and births are required to ensure that results are on par, or better than conventional and time-tested IVF methods.
The real test of IVF is not merely pregnancy rates, but how well the babies are doing 20 years into the future.
(Dr. Priya Selvaraj is Director, GG Hospital, Fertility Research and Women's Specialty Centre, Chennai. She can be reached at drpriya@gghospital.in)
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Time of India
2 days ago
- Time of India
Atrial Fibrillation
Lalit Kapoor is a 1971 graduate from IIT Kanpur and has done his MBA from UCLA. Lalit is a successful serial entrepreneur in Silicon Valley. With age, he developed lifestyle diseases and decided to reverse them by changing diet and lifestyle. This led him to study and research in the field of nutrition and plant-based whole food field. Eventually, he successfully got rid of all his chronic diseases and reinvented himself. Lalit became an inspiration for his IIT-K batch mates and started to guide them with his learnings. Many of them benefitted and successfully reversed their chronic diseases. He further incorporated the Nobel prize winning work by Nobel laureates Dr Yoshinori Ohsumi (2016) on autophagy, Dr Jeffery Hall (2017) on circadian rhythm and Dr Tasuko Honzo (2018) on immunotherapy into his recommendations. He has conducted over 450 course sessions which have been attended by over 150,000 people in over 50 countries with thousands of success stories. He runs over 100 active social groups and his NGO 'Plant Based Wellness Foundation' has over 40 centers worldwide. Lalit has also taught a course as a visiting faculty on Nutrition & Health at IIT Kanpur for one semester. LESS ... MORE There is a common misconception among many young people (under 50), particularly those who are not overweight and who exercise regularly, that they are fit and healthy. Many people in their 40s become health-conscious but are misled by the popularity of low-carb diets—a trend heavily supported by the meat and dairy industries. Let's consider someone in their 40s who follows a high-protein, high-fat, low-carb diet (such as keto), is very active, and goes to the gym regularly. This lifestyle gives them a false sense of wellness. High levels of physical activity can delay the negative effects of a diet rich in animal protein and saturated fat, temporarily masking underlying cardiovascular issues. If they also consume alcohol (which is common, though smoking is fortunately less prevalent today), they may believe, 'I'm fit and healthy because I work out and avoid carbs.' However, physical activity can only compensate for dietary deficiencies up to a point. Eventually, the body's compensatory mechanisms are overwhelmed. A common outcome is a cardiovascular event—sometimes subtle or unnoticed—that reveals the underlying damage. These events may include: 1. Silent Myocardial Infarction (SMI) which account for 45% of all heart attacks. 2. Coronary Artery Disease 3. Heart Valve Disease 4. Arrhythmia 5. Minor stroke These are all serious conditions, and often present with no noticeable symptoms. In this post, we focus on one such condition: Atrial Fibrillation (AFib). What is AFib? Atrial Fibrillation is an irregular and often rapid heart rate that increases the risk of stroke, heart failure, and other complications, including death. In AFib, the heart's two upper chambers (atria) beat chaotically and out of sync with the two lower chambers (ventricles). It is the most common form of arrhythmia, affecting more than 2.5 million people in the U.S. Symptoms of AFib: Often unnoticeable May include lightheadedness, dizziness, shortness of breath, fatigue, chest pain, or palpitations Can be episodic or persistent, sometimes requiring emergency treatment A major concern with AFib is the formation of blood clots in the atria. These clots can travel to other organs, especially the brain, causing a stroke. People with AFib are five times more likely to suffer a stroke, which is why blood thinners are often prescribed. How AFib Affects the Heart: In a healthy heart, the sinoatrial (SA) node sends electrical signals that synchronize the atria and ventricles, allowing for effective blood circulation. In AFib, these electrical signals originate from abnormal locations, causing the atria to quiver instead of contract. This leads to an irregular heart rhythm. An electrocardiogram (ECG or EKG) is the most effective way to diagnose AFib. AFib is progressive, with three stages: (1) Paroxysmal (intermittent) (2) Persistent (3) Permanent If left untreated, AFib leads to remodeling of the heart—where the heart enlarges, works harder, and its tissues sustain damage. Causes of AFib: When you search for causes of AFib, you get flooded with a list like the following: Age: With age atrial tissues become weak and diseased High BP Enlarged atria which can be due to high BP or lung disease or prior AFib history Hormonal abnormality Alcohol and Smoking Family History Obesity Sleep Apnea Heart valve Failure Diabetes Coronary Artery Disease What's often ignored is the dietary root of these conditions. As discussed in my blogs on the politics of food and healthcare—and highlighted in the documentary What the Health—diet is a primary driver of all these issues. The Cardiovascular System and Nitric Oxide: The inner lining of the cardiovascular system—the endothelium—is made of endothelial cells. These cells release nitric oxide (NO), a gas that serves three vital functions: Facilitates smooth blood flow Acts as the body's strongest natural vasodilator Prevents arteries from thickening and stiffening, helping to regulate blood pressure Inflammatory foods damage the endothelium. The body responds by forming plaque (fatty deposits) in the arteries—a condition known as atherosclerosis. These deposits include cholesterol, fatty substances, calcium, cellular waste, and fibrin (a clotting agent). Atherosclerosis reduces the endothelium's ability to produce nitric oxide, impairing blood flow and flexibility. This stiffens the arteries and heart muscle, compromising their function. Dietary nitrates—found abundantly in green leafy vegetables and beets—help restore nitric oxide levels and protect the endothelium. These foods can prevent and even reverse plaque buildup, yet are often lacking in the modern diet, especially among the younger generation. Other Dietary Concerns: Electrolytes, especially magnesium and potassium, are essential for healthy electrical signaling in the heart. Green leafy vegetables are rich in both. Calcium supplements should be avoided, as they can block magnesium absorption and contribute to arterial calcification. Vitamin D3 deficiency—common in people who work indoors—also impairs magnesium absorption. A plant-based, whole-food diet, combined with physical activity and intermittent fasting, can halt the progression of AFib and significantly reduce stroke risk. Treatment of AFib: Since AFib is progressive, early dietary intervention is key to slowing or reversing the disease. AFib treatment requires a three pronged approach: (1) Rate control (2) Rhythm maintenance and (3) Stroke Prevention. Treatments for AFib may include medications and other interventions to try to alter the heart's electrical system. If medication does not help, there are other invasive procedures like Cardioversion, Catheter or Surgical Ablation and Atrial Pacemaker. Watch the following videos linked below for more information. Dr. Esselstyn on How to Reverse Heart Disease Are Keto Diets Safe? Facebook Twitter Linkedin Email Disclaimer Views expressed above are the author's own.
News18
3 days ago
- News18
Google DeepMind CEO Predicts AI Will Help Humans Colonise The Galaxy Starting 2030
Last Updated: Google DeepMind CEO and Nobel laureate Demis Hassabis said that starting 2030 humans will be able to colonise the galaxy and artificial intelligence will power this revolution. 2024 Nobel Prize winner and Google DeepMind CEO Demis Hassabis told a news outlet recently that humans will be able to 'colonise the galaxy" starting 2030 and the revolution will be powered by artificial intelligence (AI). The Nobel chemistry laureate told WIRED that AI will lead humanity to far into the universe while turbocharging human productivity. Hassabis, who was jointly awarded the Nobel Prize with David Baker 'for computational protein design", said the 'golden era' was only five years away and that AI models set to bring about a renaissance in human existence. 'If everything goes well, then we should be in an era of radical abundance, a kind of golden era. AGI can solve what I call root-node problems in the world, curing terrible diseases, much healthier and longer lifespans, finding new energy sources," Hassabis was quoted as saying in an interview with WIRED. AGI, or Artificial General Intelligence, refers to an AI system with human-like cognitive abilities, capable of understanding, learning, and applying knowledge across a wide range of tasks. 'If that all happens, then it should be an era of maximum human flourishing, where we travel to the stars and colonise the galaxy. I think that will begin to happen in 2030," he said. When asked whether abundance through AI would still result in unequal distribution, Demis Hassabis said the technology could make the world feel 'like a non-zero-sum game." Although AGI has the potential to open vast new frontiers for humanity, Hassabis has previously expressed concern that society may not be prepared for its impact and admitted that the risks and consequences of such powerful technology often keep him up at night. 'It's a sort of like probability distribution. But it's coming, either way it's coming very soon and I'm not sure society's quite ready for that yet. And we need to think that through and also think about these issues that I talked about earlier, to do with the controllability of these systems and also the access to these systems and ensuring that all goes well," he said. He has also advocated for creating a UN-style global body to oversee the development and governance of AGI. 'I would advocate for a kind of CERN for AGI, and by that, I mean a kind of international research-focused high-end collaboration on the frontiers of AGI development to try and make that as safe as possible," he further added.
The Hindu
5 days ago
- The Hindu
Is global warming becoming a distraction?
The story so far: A global mean temperature rise of 2°C is enshrined in the Paris Agreement as a safe level of global warming by 2100 with respect to the pre-industrial baseline. This threshold was reduced further to 1.5°C due to the demand from the Alliance of Small Island and Developing States. The climate community has since been trying to quantify climate change and its consequences relative to these warming levels. Unfortunately, the models scientists use for climate projections aren't perfect, which affects the uncertainties in global mean temperature rise estimates. To make predictions for years far beyond 2050, the models need to know the greenhouse gas emissions at the time. Modellers create these figures by imagining energy sources of the future, population growth, and climate actions and policies by then. However, it is anything but easy to simulate societies of the distant future. Thus, projections of global warming in the distant future depend heavily on uncertainties inherent to these speculative scenarios. Is global mean warming important? After 2023 and 2024 turned out to be record warm years, the spectre of crossing the 1.5°C threshold looms large. However, the 2°C warming threshold emerged from a rather arbitrary assumption rooted in the work of economics Nobel laureate William Nordhaus in the 1970s. There has been much debate since as to what this figure represents in real terms, because the two warming levels — 1.5°C and 2°C — aren't particularly special in climate science. In fact, there are uncertainties about the magnitude and/or duration of warming overshoot required for it to be catastrophic. The onslaught of climate-related disasters also makes it clear that any additional warming should be avoided. The exact amount of warming, whether 1.5°C, 1.75°C or 2°C, hardly matters for disaster management and adaptations required today. Did the world really cross 1.5°C? Global temperature estimates are prepared by blending observations and models. Also, multiple groups produce multiple models, which produce multiple estimates — and they are not alike. Two such models of late have claimed the world exceeded 1.5°C of warming in late 2024 whereas one has estimated the world didn't. Be that as it may, the question remains as to whether 2025 will continue to warm or if the rate of warming will drop. Rapid warming events in the past suggest that the rate of warming after sudden jumps tends to decline after a few years. For example, 2024 started out warm following the record warmth of 2023 before the rate of warming dropped. The rate in 2025 has already fallen below that seen in 2024 for the same months. Considering the uncertainties in warming plus irreducible uncertainties in estimating today's temperatures, it is confusing why global mean warming levels remain relevant. Climate adaptation and resilience require large investments. We also need reliable local information to avoid maladapting. Thus, climate mitigation must continue, in fact even accelerate while global mean warming is a distraction we can do without. But with the back-pedalling on climate action in some countries, short-and medium-term predictions, from days to a decade or two, are most urgent now, especially at the hyperlocal scale. What about climate disasters? Climate disasters like heatwaves, floods, and droughts are becoming more protracted, frequent, and intense. Insurance losses, number of lives, and number of livelihoods lost worldwide are rising year on year. These disasters are a reminder that unless researchers can pinpoint which disaster is likely to occur where and with sufficient actionable lead time — for example, a few days to few weeks for most extreme events — focusing on global mean warming can be wasteful, if not misguided. Early-warning systems and disaster management are becoming better overall and global plans under the UN, such as Early Warnings for All, promise to ensure poorer countries are not left out. If we are to manage day-to-day crises better even as the risks of climate hazards increase, we also need predictions at the decadal timescale to allow countries to plan ahead for adaptation and resilience. This in turn demands that we focus on tracking disasters, preparedness, management and recovery. The earth's tropics are a hotspot of climate change's consequences since they are warmer to begin with. So catastrophic floods outside the tropics, such as those in Valencia in 2024, are a stark reminder that good early warnings are worthless unless they are actionable up to the last mile. It has become common in the wake of disasters for some research groups to claim it was caused by global warming. However, we need to focus on more important questions: whether a given forecast was accurate and whether all disaster management agencies on the ground received it in time. If a forecast fails, they need to be recorded and documented as such; if a forecast was accurate but the government failed to prepare for it in time, the points of failure must be quickly identified and corrected. This acknowledges that climate risk and uncertainties are never zero, that risks are not predestined, and that we have agency in mitigating them. Raghu Murtugudde is retired professor, IIT Bombay, and emeritus professor, University of Maryland.
