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GENETICS & IVF INSTITUTE: A DECADE OF ACHIEVEMENT AND SERVICE
Joseph D. Schulman, M.D., Director
Written in 1994 on the occasion of our tenth anniversary.
10 Years of Commitment and Caring
The Genetics & IVF Institute has passed its 10 year anniversary. We enter our next decade of efforts to help patients with an extraordinary reputation for innovation and excellence, as the largest integrated provider of infertility and genetic services in the world. Genetics & IVF Institute's 200+ staff members are excited by the technological breakthroughs of the past, and anticipate playing a leadership role in future advances in the fields of human genetics and reproductive medicine. We performed our first prenatal genetic testing procedures near the end of 1984, and first introduced non-surgical ultrasound-guided transvaginal egg retrieval for IVF into the U.S. in early 1985. Consider how much health care in these areas has advanced through world-wide research, and our own specific contributions to it, in the short decade now ending!
Advances in Prenatal Genetic Testing (1): CVS and AFP+
In 1984-85, prenatal genetic testing was largely limited to amniocentesis to screen fetuses for genetic diseases of a few types (chromosome defects such as Down syndrome), and this testing was generally performed nearly half-way through pregnancy. Women over age 35 were almost the only patients seeking such testing. Now, prenatal testing by CVS (chorionic villus sampling) can be offered about 7 weeks after the first missed menstrual period. GIVF was one of the first in the world to do CVS, and we currently have the world's second largest CVS experience. The results-reporting time for prenatal genetic testing has been reduced in laboratories such as our own to 7-10 days. AFP+ serum screening can now identify women under the age of 35 who are at high risk for prenatal genetic abnormalities, and who may wish further testing.
Advances in Prenatal Genetic Testing (2): DNA, PGD, and XY Sperm Separation
New DNA tests can identify women who are genetic disease carriers and whose fetuses may be at risk for serious diseases such as cystic fibrosis, fragile X, Tay Sachs, Gaucher, Huntington, and others. Preimplantation genetic diagnosis (PGD) of IVF embryos can even identify some abnormalities before implantation. The technique of X/Y sperm separation, developed by Genetics & IVF Institute and its collaborators, improves the efficacy of this process in some situations. This MicroSort sperm separation technology has other implications as well. DNA analysis now permits extremely accurate prenatal and postnatal paternity testing, work regularly performed by our Fairfax Identity Laboratories division.
Advances in Infertility Treatment (1): IVF, GIFT, and Cryopreservation
In the past 10 years, advances in infertility treatment have been perhaps even more dramatic. IVF was new in 1984-85, and available at only a handful of locations in the world, of which we were among the first: Genetics & IVF Institute has now achieved over 1350 pregnancies through IVF and related assisted reproductive technologies. Numerous technical changes have made IVF simpler and more effective. Our work in 1985 made laparoscopy for IVF a thing of the past in the United States. (We also incidentally reported the world's first non-surgical GIFT pregnancy, but rarely use this technology today.) For couples with standard indications for IVF such as blocked or diseased fallopian tubes, the pregnancy rates per treatment cycle using fresh embryo transfers have nearly doubled in the past decade.
Embryo cryopreservation, which further enhances IVF cycle pregnancy attainment, was not available for human embryos in 1984. Methods for freezing embryos were developed about that time, and again Genetics & IVF Institute was in the forefront of this technology, achieving the first twin IVF birth in the U.S. from frozen embryos.
Huge advances have been made for couples with reduced sperm or egg quality as major factors in their infertility. ICSI (intracytoplasmic sperm injection) has completely transformed the therapy of male infertility. Genetics & IVF Institute physicians and scientists brought this method to the U.S. from its inventors in Brussels in 1993, and have achieved over 400 ICSI pregnancies to date (Fall, 1996) in severe cases of male infertility, most of which were previously considered untreatable. For men with no sperm in their ejaculate, GIVF also developed a method for removing sperm from the testis painlessly under sedation using non-surgical sperm aspiration (NSA), as recently described in a report in the New York Times. The combination of NSA and ICSI will enable large numbers of men to father children without the need for surgical procedures such as vasectomy reversal, epididymal operations, or open testicular biopsy.
For infertility due to poor egg quality, there has also been great progress. The use of donor oocytes became possible about the time Genetics & IVF Institute opened, with the first pregnancy reported from Australia. We rapidly began to offer donor cycles with known donors, and then with anonymous donors- which is much more complex. Genetics & IVF Institute has made a unique and major commitment to anonymous egg donation, and we now are the only program in the world with over 120 pre-screened and currently available donors for patient selection; patients come here from throughout the U.S. and many other countries. The average pregnancy rate in our donor cycles, from one retrieval followed by IVF or ICSI, is approximately 50%.
Genetics & IVF Institute is one of the most active centers in the U.S. for treatment of patients with recurrent pregnancy loss and implantation failure. Research has made possible therapies that can help some patients with these problems.
Genetics & IVF Institute has long worked with cancer patients from the National Cancer Institute and other medical facilities for their freezing (cryopreservation) of sperm before chemotherapy or radiation.
Genetics & IVF Institute is now the first center in the U.S. to offer the cryopreservation of ovarian tissue to women who must undergo chemotherapy or radiation which may destroy their ovaries. These women can, after surviving the disease, have the tissue replaced in the abdomen with the possibility of a return of ovarian and reproductive function.
Into the Next Decade
The next decade will see many powerful further improvements. We hope to develop some of them at Genetics & IVF Institute, and rapidly and thoughtfully implement useful advances developed by others, for the future benefit of the patients and referring physicians whom we serve.
Click here for a recent review covering these and other topics: Recent Advances in Reproductive Genetic Technologies.
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