The challenges of developing and effectively delivering fertility preservation as a part of mainstream cancer care are related to the challenges of expanding the reach of in vitro fertilization (IVF) and other assisted reproductive technologies beyond infertility and into other areas of medicine. In prior articles, I discussed the use of IVF and preimplantation genetic analysis of embryos for the prevention of monogenic diseases such as cystic fibrosis, and demonstrated that the procedure can be efficacious and cost effective versus the alternatives of the chromic symptomatic treatments currently in use or the gene therapy treatments in development. I also discussed how IVF could and should be an important part of modern hematology practice, giving families the option of proactively addressing their risks for diseases like sickle cell anemia, thalassemia and hemophilia.
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When Noah Shulman was born a few days after Christmas 2016, his parents Kristelle and Evan had no reason to worry about him. The pregnancy went smoothly, and so did the birth.
But within a few days of taking his first breath, Noah began to struggle. He wasn’t feeding, so he started losing weight. He was also lethargic. Several pediatricians reassured the Shulmans that they were probably just overly sensitive to Noah’s symptoms because Kristelle is a nurse and Evan is a physician assistant–a case of first-time-parent-white-coat syndrome. “They kind of dismissed us as neurotic parents,” says Evan.
I cried just once about my second miscarriage ― before it even happened, on the way home from a grocery store. A nurse called me to say that my pregnancy hormone levels had failed to increase properly for the third time in a row.
She didn’t warn me that I would lose the six-week pregnancy, and she didn’t have to. I knew, from previous experience, what that meant. Afterward, I was largely silent about the loss. I focused on my work and deflected any attempts my family made to reach out.
As soon as I knew I was miscarrying again, I settled on a plan, and having action steps calmed me. After trying to conceive naturally for a year, and then having three intrauterine inseminations (two of which resulted in our losses), my husband and I decided to “join the big leagues,” as we joked, and do in vitro fertilization, the most effective treatment that medical science can offer infertile people.
Danielle Lloyd, a former Miss Great Britain and celebrity mother of four boys, wants to guarantee that her next baby will be a girl. So, she revealed in a TV interview last year, she’s planning to get pregnant through in vitro fertilization.
The news sparked an uproar in Britain, where screening embryos for gender is prohibited at IVF clinics. Unruffled, Lloyd, 35, began checking out clinics in the few places on the planet where the service is readily available: Cyprus, the United Arab Emirates — and the United States.
“I can see why people are against it, and I don’t want to upset anyone,” Lloyd said. “But I can’t see myself living not having a daughter when I know it’s possible.”
The revolution in genomics is not only changing the way people who carry genetic diseases have children. It is starting to make its way into everyone else’s family planning, too. As the ability to analyze big data grows, doctors can now tell with much more accuracy and ease whether two people are carriers of a huge catalog of genetic diseases before the couple starts trying to have a child. For those who test positive, in vitro fertilization and improved techniques for screening embryos can minimize a couple’s chances of having a child with inherited diseases. If one person has a recessive gene for a disease, it doesn’t mean they will pass it on to their children. But if both parents have the same gene, the odds are greatly increased. A decade ago, for the small population of parents known to be at risk, genetic screening and screening of embryos would cost around $5,000 and could only look for a handful of inherited illnesses. Now, tests from a half-dozen companies can identify hundreds of illnesses for far less.
Imagine being able to skyrocket your chances of a successful pregnancy and make sure your future baby will be free of genetic disease—pretty enticing, right? To date, preimplantation genetic diagnosis (PGD) and screening (PGS) have been the most reliable ways to accomplish these ends, but they could only be done in tandem with IVF (not the most desirable method for otherwise fertile couples, thanks to its heavy emotional and physical tolls). Now a brand-new device called Previvo is making it possible to get all the same genetic intel without having to do IVF. Here’s how it works: The early part of the process mimics a medicated IUI cycle, with the female patient taking fertility drugs to induce superovulation (i.e., producing a bunch of eggs rather than just one). She then takes a “trigger shot” to release the multiple eggs from her ovaries and is inseminated with sperm 36 hours later (as is also typical of IUI).