Outi Hovatta wants to make assisted reproduction simpler, cheaper and easier for the patient. Soma feels the pulse of Karolinska’s Fertility Unit.
Text Susanne Bergqvist
The Fertility Unit at Karolinska is one of the largest in Sweden, performing 1,200 in vitro fertilisations per year. A third of all these is successful and the majority of treatments are now more or less routine.
“But even while we’re performing all these routine treatments, we’re still developing them. Our aim is to make assisted reproduction simpler and smoother. We try to reduce the effects of drugs because hormone therapy carries the risk of side effects and is relatively costly,” says Outi Hovatta, consultant at the Fertility Unit at Karolinska University Hospital.
One method Outi Hovatta hopes will become more widespread is IVM, In Vitro Maturation.
“If we had the option of using IVM treatment, it would be much easier on the woman. IVM involves retrieving immature eggs from the ovaries and maturing the eggs in the laboratory; this differs from IVF where eggs are matured before harvesting using intensive hormone therapy.
IVM is used in some developing countries. The method is relatively cheap but the success rate is not as good as that of IVF. Studies show that 20 percent of IVM treatments are successful, while about 35 percent are successful with a stimulated cycle.
“As long as we’re only allowed to perform three treatment cycles, the hormone-stimulated cycle is prioritised as having the best chance. At the same time, we can’t improve the method if we don’t use it, in the same way as we’ve been able to develop IVF in the last 30 years,” says Hovatta.
The County Council pays for three fertility treatments per year. However, not all couples become pregnant after three cycles. Couples being treated with the
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The aim of one of Outi Hovatta’s research projects is to fertilise eggs cultivated from ovarian tissue. |
standard IVF process have the option of visiting a private clinic for more treatment and paying for it themselves. Couples who can only get help at specialist clinics because they require genetic diagnosis, carry a serious viral infection or need donated eggs or sperm can go no further.
“These special groups have no possibility to undergo more treatment cycles. But since there are methods to help them it seems ridiculous that they can’t come to us, at least as self-funding patients,” says Hovatta.
She returns several times to the topic of people’s longing to have children and her desire to help when the knowledge is available. She mentions surrogacy as an example.
“Even surrogacy might be possible. It’s become a controversial matter since it’s been tainted by commercial activity in some countries. But it can be less controversial than you might think,” she says.
There are women who have no uterus, congenitally or due to cancer therapy, but who have eggs in their ovaries. These eggs can be harvested and fertilised with their partner’s sperm. The embryo could be carried by and born to someone else.
“We meet these women here before they search elsewhere. And we have the knowledge but not the opportunity to help them.”
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The aim of one of Outi Hovatta’s research projects is to fertilise eggs cultivated from ovarian tissue.
Unique methods at Karolinska
Preventive freezing
It is now common to freeze eggs, ovary tissue and embryos as well as sperm for those at risk of losing their fertility as a result of cancer therapy or another type of therapy.
In prepubertal boys and girls, pieces of tissue are removed from the ovarian cortex or cells are removed from testicles so that they can hopefully receive fertility treatment in the future using these early egg or sperm genes.
“Here we’re already able to retransplant frozen ovarian tissue to the ovary of a woman who’s recovered from cancer,” says Outi Hovatta.
But women with malignant leukaemia cells would risk getting the cells back again if ovarian tissue was retransplanted.
“For these women we cultivate all the way from the smallest ovarian follicles to the mature egg. It’s challenging research work but we’ve made great progress in recent years. This is going to be the alternative of the future,” she says.
PGD for genetic disorders
Preimplantation genetic diagnosis (PGD) is used when someone has a high risk of having a child with a serious genetic disorder. Prior to PGD, the parents undergo a genetic analysis. It is not uncommon for families who have already had children with a disorder or who have lost a child to be treated. A few days after egg harvesting and fertilisation, the geneticists perform biopsies and remove one or two cells from the embryos.
“In the genetics lab we analyse the cells from the embryos and test for the genetic disorder. The technique for finding the genetic problem at cellular level is sophisticated and PGD requires a large genetics laboratory. We sometimes need to customise analysis models for specific genetic disorders,” says consultant Margareta Fridström.
An embryo that is free of the disorder is then transferred back to the woman. About 100 PGD treatments are performed each year, and 25 percent are successful. The law permits genetic testing for serious diseases for which there is no treatment. Screening is not permitted.
Sperm washing for those with viral diseases
Men with HIV and Hepatitis B or C that could be passed on to the child or woman can have their sperm washed using a special method before assisted reproduction. The washing method is a routine procedure. For these patients the sperm is washed twice instead of once, as is customary in other cases.
The sperm is then tested to see if any part of the virus remains to select which sperm can be used. Couples requiring this treatment have succeeded in becoming pregnant. The Fertility Unit is the only clinic in Sweden where this is possible.
“At Karolinska we have the knowledge to treat serious viral diseases and we’re not afraid. These people also need help, just like everyone else we can help,” says Outi Hovatta.
Donated eggs and sperm
Women who need donated eggs can also recruit donors themselves. Egg donors undergo drug-induced hormone stimulation prior to egg harvesting.
By talking to social workers and midwives, the health service ensures that the donation is voluntary. There is a shortage of egg and sperm donors, although it is not as great as it was previously.
“Women who donate eggs are selfless in their desire to help others,” says Outi Hovatta and points to studies that show that women who donate eggs are driven by a desire to help other people have children. They are often women who work with children in some way.