egg

The man who showed the secrets of human life to the world

Photographer who revealed the origins of life: Princeton IVF blog
Swedish photographer Lennart Nilsson pioneering embryo images

This year, someone who revealed the secrets of human reproduction quietly passed away, and you probably never heard of him... 

The Swedish photographer Lennart Nilsson is not exactly a household name, but his photographs adorn the offices of many fertility clinics across the world and his images of human reproduction and early human life are known throughout the world.

Those pictures, such as the one above, were first published in a Life Magazine article in 1965 called “The Drama of Life Before Birth.” and later on in a book entitled “A Child Is Born.” His photos were even shown in the PBS series NOVA, in an episode entitled, "The Odyssey of Life."

Nilsson developed techniques for microphotography that enabled him to produce stunning images of something was at one time invisible, the origins of human life. Today we live in a world where IVF is widely available, images of human embryos, eggs and sperm can downloaded to your phone in seconds and every OBGYN has an ultrasound in his or her office.  These are just things we take for granted.

In 1965, what Nilsson did was truly amazing. He revealed to us a hidden world, and what he shared with the world was even more amazing than fiction, a glimpse of the world that fertility specialists and embryologists see every day.

Eggs and fertility after menopause?

Making Eggs after Menopause: Princeton IVF blog

Researchers in Greece report being able to generate eggs from women who have already gone through menopause.

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Doctors in Greece may have found a way to make postmenopausal women grow eggs.

As reported in the New Scientist, fertility researchers have been looking into a new way of potential of helping women in menopause continue to produce eggs. As a women ages, the number and quality of her eggs inevitably declines. By the average age of menopause at age 51-52, there are relatively few eggs left in the ovary, and those that do remain, generally are of such poor quality that ovulation just simply ceases. When this happens, fertility disappears, menstrual periods stop and the symptoms of the lack of estrogen such as hot flashes and vaginal dryness get worse. These symptoms of menopause actually start years before the periods stop but the potential for pregnancy, even if it small, remains.

What if there was a way to reverse this? With this in mind, a team in Greece tried using something called platelet-rich plasma to see if it was possible to regenerate eggs. Platelet rich plasma (PRP) has been used with some success to try and regenerate injured bone and muscle. Among other things, it contains a mixture of growth factors, chemicals found throughout the body that are involved in the natural processes of inflammation and tissue repair. The idea was to try to use the PRP to regenerate ovarian tissue and somehow activate the dormant eggs to grow.

Regenerative medicine for reproductive medicine

The researchers did find some success, and a number of these women did begin to ovulate again. In one patient, they were even able to harvest and fertilize some of these eggs through IVF. The embryos were frozen for later use, so it is unknown whether this procedure can actually result in a pregnancy.

There are still lots of unanswered questions before we can consider this an option for infertile couples in menopause, early or otherwise. We know that the eggs are generally of poor quality in women in their late 40's and when there is fertilization that embryos are generally unhealthy. These embryos rarely implant, and when they do the risk of miscarriage and genetic disorders such as Down Syndrome is quite high. It is not uncommon for women in above 45 to produce enough eggs to do IVF, but it is uncommon that any are good enough to result in a healthy pregnancy. Would the eggs from PRP be any different?

While it is possible that the PRP may improve the quality of these eggs to the point where they can result in a healthy baby, it is just as likely (if not more so) that they they will not. We don't know if the center that reported this data will be able continue to get patients to respond as time goes on or if other fertility clinics will be able to replicate these results. We also do not know if the benefits are short acting or long term, and if they are long acting what the implications are for these patients. Does it mean that a 60 year old can now conceive on her own or how will the continuation of menstrual cycles beyond the natural time affect a woman's risk of diseases such cancer or heart issues? The implications, both medical and ethical, could be enormous.

At this point, it is still just an interesting idea. Still, the prospect of being able to restart a menopausal ovary is intriguing to fertility specialists and their patients.

Egg freezing- the controversy continues

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Egg freezing- Is it effective and is it a "fertility insurance?"

Several years back the American Society for Reproductive Medicine declared that the freezing and storage of unfertilized eggs (oocyte cryopreservation) was no longer experimental. Reproductive science specialists have worked out the kinks and figured how to freeze, thaw, fertilize and grow these eggs, and from them get healthy live born children. The initial focus was to help women who wanted to have children, but were facing cancer treatment (surgery, chemotherapy or radiation) that might render them sterile. The data on pregnancy rates was very sparse but it in comparison to the alternative in these women, moving forward was a no brainer.

Now researchers in in Canada, have published on the outcomes in couples based on US data. The pregnancy rates range from 4-12 %, and that is in young women under 30.  The rates are likely much lower in women in their 30s and 40s. While not great, it does offer some hope where there was none before. The problems is that now egg freezing is being used to delay childbearing in women for social reasons. With the announcement by google that they will pay for the procedure in their employees and the advent of "egg freezing parties," this is becoming more widespread.

As reproductive medicine specialists, we all want to offer our patients reproductive freedom, the ability to have children at a time that works out in their lives. Undoubtably, freezing and storing eggs for future use will enable some women to have children well into their 40's and early 50's. However, those who are unsuccessful with frozen eggs, and there will be many of them, will be left little choice other than using eggs from a donor, knowing that their biologic clock ran out while they had other priorities in life.

The problem is this: Is egg freezing an answer to a real problem? or is it giving women false hope? It may be a little of both. Only time will tell as the technology moves forward.

How old is too old to try IVF ?

With stories of 45 year celebrities having babies (and sometimes even twins and triplets) with high tech treatments, most people think that age is not a barrier to successful treatment.  When using donor eggs from a young egg donor, that is definitely true. The chances for success with donor egg ivf is excellent, even for women in their late 40's. However that is not the case in women using their own eggs. Pregnancies in women undergoing fertility treatment without the use of a donor over 45 are very unusual.  A recent report from Florida describes a 46 year old woman who is reported to be oldest woman to conceive from IVF with her own eggs. Is this a major breakthrough? Not really. The main determinant over whether a fertilized egg will develop into a healthy baby is whether the embryo is genetically abnormal. Genetically normal embryos are common in 25 year olds but pregnancy rates are never 100%. Likewise, the vast majority of  45 year olds' embryos are abnormal, and so the pregnancy rates would be expected to be quite low but not exactly 0%. When confronted with these odds, most couples would chose not to try.

Time lapse video: from egg to blastocyst

Did you ever wonder what happens from conception until implantation? This video from the NIH website shows a time lapse video of the egg and embryo as it moves from the pronuclear stage, to the cleavage stage, to the morula stage and finally to a blastocyst, ready to implant in the uterus. Click here to view the video.