Assisted Conception

Lead: Dr Paul Serhal

The Assisted Conception Unit is a leading clinic within the field of infertility. To enable us to continue to achieve excellence we are constantly at the forefront of technology to improve success rates even further. As such, our research interests are focused on a number of both clinical and embryological aspects of human reproduction.

Clinical Research

Assessment of the impact adenomyosis on endometrial receptivity and reproductive outcome of IVF/ICSI

We have just completed a prospective observational screening study in which we used established transvaginal ultrasound criteria for screening for adenomyosis in women presenting with infertility who were due to start IVF/ICSI and assessed the impact of adenomyosis on the outcome of IVF/ICSI. The results of this study show for the first time that adenomyosis has a direct negative impact on the outcome of IVF/ICSI.

The presence of abnormal vascularity and heterotopic glands in the myometrium may potentially be a source of cytokines and immunological factors that may have a negative impact on endometrial receptivity and placentation. The endometrial-myometrial interface is a highly specialised tissue that has its own population of immunocompetent cells which when disrupted, as occurs in adenomyosis, may potentially have an impact of endometrial function. There is accumulating evidence that shows the effect of adenomyosis on endometrial cell antigen expression, cytokine production and production of free oxygen radicals, all of which a suggestive of disruption of endometrial receptivity Although, much work has been done into investigating the effects of endometrial factors in infertility, there remains little consensus regarding the significance of each factor.

The uterine model of adenomyosis provides an opportunity to target research towards investigating endometrial receptivity in women with adenomyosis. In the light of the evidence obtained from this first study we intend to investigate the uterine endometrial receptivity in patients with adenomyosis undergoing assisted conception

Embryology Research

The impact of DNA fragmentation (DFI) and high DNA stainability (HDS) on reproductive outcome

DNA fragmentation (DFI) and high DNA stainanbility (HDS) are measured by adding acidified Triton X-100 followed by buffered acridine orange and subjecting the suspensions to flow cytometry. This procedure determines the percentage of sperm containing denatured DNA (red) and those with high DNA stainability (intense green).

Both raised DFI and raised HDS are found to adversely affect the success rate of IVF and ICSI procedures. Work is continuing on the stages in the IVF or ICSI cycles that are most affected (i.e. fertilisation/implantation).

Granulocyte-macrophage colony-stimulating factor (GM-CSF)

An ongoing focus within the field of embryology is to develop an in vitro culture system that more closely mimics the female reproductive tract. By further optimising embryo growth we will continue to improve our success rates.

Granulocyte-macrophage colony-stimulating factor (GM-CSF) is a multi-functional cytokine synthesised in the female tract during early pregnancy which has been shown to promote blastocyst development in vitro. Initial studies have shown media containing GM-CSF has led to enhanced inner cell mass proliferation and increased implantation rate. Through allowing enhanced selection of more competent embryos, blastocyst transfer may help to reduce the frequency of multiple births resulting from IVF.

The Assisted Conception is intending to undertake a randomised clinical trial utilising culture medium containing GM-CSF versus standard IVF media.

Non-invasive metabolmic profiling of embryos

Currently, embryology methods focus soley on embryo morphology and cell number. The Assisted Conception Unit intend to combine both morphological assessment of the embryo with its’ metabolomic profile to enhance embryo selection. In this way, we can successfully predict those embryos with the highest implantation potential granting higher success rates and a confident single embryo transfer programme. The metabolimic profile of an embryo represents the collection of all its’ metabolites, which are the end products of its gene expression.