From exploring the metabolic factors impacting egg quality to the genetics of embryo implantation, researchers at the Family Fertility Center at Texas Children’s Pavilion for Women are engaged in several studies to help infertile couples achieve successful pregnancy outcomes.
For couples struggling to get pregnant, often times their only hope is through in vitro fertilization (IVF) in which a healthy embryo is transferred to the uterus for implantation. If the window of implantation has passed – the crucial time when the endometrium or inner uterine lining releases chemical signals that allow the embryo to attach – the chances of getting pregnant are very slim.
“Until now, the endometrium was kind of a black box,” said Dr. William Gibbons, director of the Family Fertility Center and chief of reproductive endocrinology at Texas Children’s Pavilion for Women. “While studies have been done on embryos, limited research has focused on the important role of endometrial receptivity prior to implantation. With advanced technology, we can uncover innovative techniques to improve IVF success rates.”
In collaboration with Dr. Carlos Simon from the University of Valencia, Spain, Drs. Gibbons, Paul Zarutskie and Cecilia Valdes are exploring the use of Endometrial Receptivity Array (ERA), a biopsy that analyzes the DNA patterns of more than 240 genes in the endometrium to determine when it is the most receptive to obtain a successful embryo transplant. For some women, this fertility window can be earlier or later than the typical window of implantation.
“The cells in the uterine lining are constantly changing,” Zarutskie said. “No matter how healthy the embryo appears, if the embryo transfer happens when the endometrium is not fully prepared or has passed its peak receptivity, implantation will not occur. In this study, approximately 70 percent of women who failed to get pregnant after an IVF transfer of a genetically normal embryo were not at the implantation window.”
In addition to ERA, Dr. Neil Chappell is spearheading a study to see if marker proteins in cervical mucus can evaluate the optimal timing of the implantation window.
“As the lining of the uterus changes in the phase where it receives the embryo, changes in the expression of genes and proteins are evaluated via ultrasound or by doing a biopsy of the endometrium,” Chappell said. “Hopefully by examining cervical mucus proteins, we can eventually develop assays that can be performed in the office in a matter of minutes through a very low risk procedure like a pelvic exam.”
Additional research studies are exploring the impact of metabolism on egg quality and development:
- Drs. Amy Schutt, Cecilia Valdes, Chandra Yallampalli and Farook Jahoor will examine the effects of protein restriction on egg quality before pregnancy occurs. In rats, a diet low in protein appears to reduce the egg’s ability to protect itself from damage by affecting the metabolic pathway responsible for producing antioxidants. This study will determine whether a diet rich in protein optimizes egg health and development.
- Drs. Schutt and Jahoor will investigate the effects of obesity on female fertility by studying the granulosa cells collected during IVF. These cells feed signals to the egg during the maturation process. Their hypothesis is that obesity-induced inflammation and oxidative stress markers are increased in obese women compared to normal weight women, which may affect female fertility.
- Drs. Zarutskie and Jessie Rubin will examine the impact of insulin and carbohydrate metabolism on the well-being of women in general, and specifically on their potential for fertility. Previous studies show insulin resistance can be present in lean and obese women with polycystic ovarian syndrome, indicating other factors may impact the imbalance in the insulin/glucose mechanism.
For women diagnosed with cancer, deciding whether or not to proceed with fertility-saving procedures before chemotherapy or radiation treatment can be difficult.
Dr. Terri Woodard, a fertility specialist known for her extensive work in fertility preservation, is developing an interactive computer-based decision aid for women with cancer. The website’s content will be driven by patient feedback obtained from focus groups and individual qualitative interviews, as well as feedback from oncologists.
“The website will contain basic information about different options that are available to help patients navigate through this delicate process,” said Woodward, who also sees patients at MD Anderson. “Even if patients decide not to do anything about their fertility prior to cancer treatment, just addressing these quality of life issues is crucial to ensure they make the right decision. This tool will help in this process.”
While these are snippets of fascinating research underway, click here to learn more about our Family Fertility Center at the Pavilion for Women.