A reproductive endocrinologist here says emerging technologies in the field of reproductive health have the potential to increase live birth rates significantly for women who receive in-vitro fertilization treatments.

Dr. Edwin Robins, owner and medical director of The Center for Reproductive Health, of Spokane, says a fairly new preservation technique for storing fertilized embryos and human egg cells greatly increases the cells' survival rates during and after preservation. This could, in turn, increase live birth rates.

In addition, a new and relatively uncommon method of testing in-vitro fertilized embryos early for genetic defects shows potential in increasing pregnancy and live birth rates for women who undergo such treatments, says Robins. He claims that his practice, located at 508 W. Sixth in Spokane's medical district, is the only one here that offers in-vitro fertilization.

In-vitro fertilization involves the fertilization of the female's extracted eggs in a petri dish through the injection of sperm cells. The resulting embryo eventually is transplanted into the woman's uterus. That transplant often occurs several days after fertilization, or it can be preserved through freezing and implanted at a later time.

A procedure called cryopreservation is the most widely practiced method to preserve embryos until they're ready to be implanted. That means the embryo is frozen a certain number of days—usually between three and six—after the initial fertilization, to stop the cells from dividing further, he says.

A new method of cryo preservation called vitrification, however, has the potential to greatly improve the rate of live births that result from frozen embryos, he says.

Robins says to vitrify literally means to go from a liquid state to a solid. A common example of a vitrified substance is glass, which is actually a highly compressed liquid.

"Vitrification is really a very firm liquid, and that word is now being incorporated in cryopreservation of cells," he says. "We used to do slow freezing, taking (the embryo) down a degree every couple of minutes until it was frozen, and then do a procedure to crystallize it and freeze the embryo."

He adds that the slow-freezing procedure is labor intensive and can take as long as 2 1/2 hours to bring the embryo from body temperature to a frozen, unchanging state.

Using vitrification to preserve an embryo allows the cells to be injected with a higher concentration of what's called cryoprotectant, a chemical substance that forces water out of the cells and protects them during the freezing process, Robins says. After injecting the cryoprotectant, the embryo is plunged into liquid nitrogen, which brings it instantly from 98 degrees Fahrenheit down to 160 degrees below zero, he says.

With vitrification, he says, "Everything stops, and it protects (the embryo) like cryopreservation should but the embryo is more likely to survive because there is no ice crystallization that affects the cells, and so they survive at a higher rate."

Robins says the survival rate of an embryo that's preserved through the slow-freezing method is 60 percent, versus more than a 90-percent survival rate with vitrification.

Another new application for vitrification is in preserving human egg cells, which are larger than most other types of human cells and contain a great amount of water, which prevents them from being effectively cryopreserved. Ice crystals that form when an egg is frozen can destroy the cell, but injecting a cryoprotectant to replace the water in the cell allows it to be frozen and preserved successfully.

"Prior to (vitrification), there was no way to preserve eggs," Robins says.

Not only does the preserving of embryos through vitrification increase the likelihood that an embryo will survive and grow into a fetus once inside the female, it's also shown to have a positive effect on implanting the embryo into the female's uterus.

"We discovered that if you can cryopreserve the embryo and put it back, at the same time you improve the implantation rate," he says. "If you cryopreserve them, you can put them back at the right time and get a better pregnancy rate."

He adds, "This is the most important thing to come along since I don't know when."

Abnormality test

Robins says that another major influencing factor in the success rate of an in-vitro fertilization pregnancy is chromosomal mistakes found in the embryos.

"Even if you put them back at the right time, you have higher miscarriage rates because they have more chromosomal mistakes," he says. "Most of the eggs don't multiply correctly."

Robins says that he and his colleagues discovered that embryos that were allowed to develop for five days after fertilization and then preserved have a much higher pregnancy success rate than embryos that were carried out to six days of development before being preserved.

The pregnancy-success rate of day-five embryos implanted in 2009, the latest year for which such data is available, was at about 78 percent, versus 42 percent for day-six embryos, Robins says.

"If they go out to day six, a higher percentage is abnormal," he says.

Yet, Robins says another new technology enables the clinic to biopsy its patients' embryos to determine which of them have chromosomal abnormalities before they are implanted.

A cell with a chromosomal abnormality is called aneuploidy, and means it either has extra chromosomes or is missing some. Most embryos with aneuploidy can't survive full term and result in a miscarriage, Robins says. The most common survivable aneuploidy is the presence of a third twenty-first chromosome, which causes Down syndrome.

A new test, called a qPCR test, which is done by taking a sample of the embryos' surrounding tissue that eventually becomes the placenta, can determine if such chromosomal abnormalities exist in a patient's embryos, Robins says. The test results are more than 98 percent accurate.

As an example, he says that for one of his patients the genetic test was used to identify which of her six embryos were aneuploidies. Based on those test results, Robins was able to implant the one normal embryo which led to a successful pregnancy. That patient has now been pregnant for more than seven weeks, he says.

Robins says he believes The Center for Reproductive Health is one of only about five clinics in the U.S. that currently offers its patients the qPCR test. He adds that he has access to it because a former colleague was the one who discovered it.

"That is what's amazing for a town the size of Spokane," he says. "I don't advertise that I offer it; I just use it for my patients. I get patients from all over because our (successful fertilization) rates are higher than everywhere else."

The Center's live birth rate for patients who became pregnant through in-vitro fertilization varies and depends on factors such as the patient's age and embryo quality. Robins says more than half of his patients are under the age of 35.

The cost for a patient or a couple to receive an in-vitro fertilization can vary greatly, depending on the type of treatments they need, Robins says.

In general, the cost of an in-vitro fertilization cycle, which is the time from when the egg is initially fertilized to when its implanted, ranges from about $10,000 to upwards of $30,000, depending on how many cycles it takes for a pregnancy to occur or if any additional tests or treatments are needed. A patient who receives an in-vitro fertilization and who also requires genetic testing to determine which embryo would have the best chance of successfully implanting could pay about $18,300, says Lora McDaniel, The Center's financial coordinator.

Robins' clinic, which he founded in 1998, offers a variety of reproductive health services, including artificial insemination, induced ovulation, and surgery to correct fertility-related abnormalities.

The Center is located at 508 W. Sixth. It employs 16 people.