What infertility tests should you expect?
An infertility work-up involves carefully and systematically testing for all the things that have to go right to have a successful pregnancy, in order to see if there is a problem. For the couple, this will start with taking a thorough history. For the woman, she will also need blood work, an ultrasound of the ovaries, and possibly an X-ray to make sure there are no issues with her fallopian tubes and uterus. For the man, the evaluation will typically require a semen analysis.
What are the most common treatments?
There are a wide variety of treatments that can range anywhere from adjusting the timing of intercourse or using simple oral medications, all the way to IVF (in vitro fertilization), embryo testing, donor egg, donor sperm, and gestational carriers, commonly called surrogates. The key is to carefully evaluate the cause of the infertility so as to provide the optimal treatment. In many cases, a very simple solution is possible.
How have infertility treatments advanced over the years? What do you see in the near future?
Fertility treatment represents one of the great triumphs of modern medicine. Causes of infertility that were incurable just a generation ago are now readily corrected. Going forward, I think we will see fertility treatments become increasingly successful and increasingly used for helping couples who are carriers of very severe genetic diseases have healthy children.
Can you explain the technology your team developed to keep frozen eggs and embryos safe?
After two high-profile failures of storage tanks at fertility clinics in the Midwest and California led to the loss of thousands of eggs and embryos, we assembled a team at Columbia University Fertility Center to innovate a solution to this problem to prevent another tank failure from resulting in the loss of embryos. We developed a weight-based monitoring system that detects a problem with a storage tank before temperatures start to rise, in some cases over a month in advance, providing an earlier warning and greatly increased time to respond, fix the problem, and save the eggs and embryos. Our goal is to make a tank failure as impossible as possible. Cryogenic storage is safe and failures are very rare. But, when dealing with something as precious as an egg or embryo, even a single tank failure is one too many.
What’s new and exciting in this field?
We are working hard to constantly advance and improve fertility treatment to make it safer and more effective. Two exciting new advances include CORAL-IVF (Columbia Oral IVF), a new approach for stimulating the eggs to develop that uses a combination of oral medications in lieu of costly and uncomfortable injectable medications. In our preliminary results on patients who have not had success with traditional approaches, CORAL-IVF resulted in more embryos being produced but without the need for the 30 or so injections of conventional IVF and with much lower costs — about $40 versus $4,000.
Another very exciting area is the application of IVF to help ensure that couples who are carriers for genetic diseases can have a healthy child. In the past, those who were carriers of severe genetic diseases such as cystic fibrosis and Tay-Sachs had to take a chance that they would have an unaffected child. Now, we can test the embryos in the lab, before the woman is pregnant, and only put a healthy embryo back into her uterus, thereby ensuring that the child will not be affected by the disease.