Fertility Friday, is our new weekly blog series where someone from the fertility team shares information about their work, fertility, assisted conception and everything in between. So today its my turn… 🙂
It was 9pm on a Thursday night, before I finished in my clinic. It was one of those days that turned into one of those weeks, which just felt like a months work in one day. I was tired, I was drained. And I had to get up at 5am to catch a train in the morning to Dublin, for my visit to the Sims clinic. Of course it had to be the one night I was going to induce a night of insomnia…… Murphys Law I suppose. I was hoping to go up there bright eyed and bushy tailed…. But that was not to going to happen…
Fast forward a train trip, a stale Irish Rail sandwich and a crazy taxi driver…. And Google maps for my lost driver… We got there 2 minutes before my scheduled meeting. Seriously what a beautiful clinic… While waiting in reception, I popped out my Kindle to pretend that I wasn’t nervous about meeting Dr Omar, I’ve been following his work through my patients for a number of years now, and I have to say, I am a big fan of his work… This man, is like the pioneers of the wild west, going into the unknown lands of fertility, stretching the boundaries of reproductive medicine. So for me, this was a once in a life time opportunity. Hopefully he didn’t notice that I need glasses to read my kindle, which of course I couldn’t find…..
I love being around gifted and amazing people, its what I have done from the beginning of my career in fertility acupuncture, its an unhealthy obsession for those around me where I can drop everything in a moment and head three quarters of the way around the world to meet someone who i want to learn from. Dr Omar, has a very gentle approach to how he explains his speciality, where the bodies immune system can potential prevent pregnancy or cause miscarriage from anywhere from 4 weeks up to 12 weeks.
So we start talking about the Immune Systems normal response to pregnancy. He gives it a very cool sexy term known as ‘The Immunological Paradox of Pregnancy‘, Im suddenly floored by his explanation, I have to tell you, its really difficult at this stage to maintain my composure of professionalism, or as I like to call it, my ‘Fertility Poker Face’, he must know that this is information overload for me, but Im like a sponge, Im just soaking it all in…. I don’t know why I did what I did next, but I did, I tried to sound intelligent… Do you ever get those moments where one part of your brain says something to you and the other side of your brain, the logical side says no, don’t say that, jez, no…’ And by the time your logical brain has got the message through, its too late, well, yep… its too late… So 2nd fast forward of the day past that embarrassing moment, and back to the immune system and fertility.
When the body is exposed to a foreign body, the immune system does an amazing job in removing it. What its looking for is a type of marker that tells it, this is ok, please relax… or destroy.. now… with a process called the “Pro-Inflammatory Effect” is enabled in the body, think of the negative effects experienced by a patient when a donor organ is being rejected by their immune system post transplant, producing immune cells and antibodies. This is where things gets very cool. So within this we have what are called ‘Cytokines‘ and there are two main types, TH1 and TH2. The TH1 cytokines have the ability to produce toxins that can damage an embryo and create an immune response, where as our TH2 is our ‘Super Hero’ as it has the ability the counteract this rejection by the TH1, therefore creating a beneficial reaction to the embryo…..
So an optimum balance is needed between TH1 and TH2 to ensure a proper immune response to a healthy pregnancy. In a pregnancy where this ratio is out of balance, it has the potential to lead to a miscarriage…
So if you think about it, when an embryo is created it has DNA from both the mother and father, and this in turn creates a whole new DNA structure for which the immune system needs to evaluate, which could be defined as a foreign body by the immune system. Depending on the ratio of TH1 and TH2, the immune system can act differently.
Dr Omar then went on to explain the process of “Reproductive Immunophenotype” which I’m going to leave for my next blog as this is a fascinating area, where the functioning of white blood cells in a body, keeps that person healthy…. And at this stage my brain was seriously overloading, so I think it’s a good time to take a break from all the science stuff…..
Having worked in the area of fertility for over 8 years, four of those in the US and 1 years in the UK. I had never been into the belly of the beast…. And now I was getting a chance to see the insides of my fist IVF clinic. I have seen pictures of labs, theaters and recovery rooms, so I had an idea of what to expect…. Am, no Gordon you didn’t….
While like a mini hospital, with doctors, nurses and patients, what I was stunned and surprised to see was the human side… It’s weird, I forgot how these people were all human, with connections, personalities and a massive massive massive want and desire to help those in need to have a baby… The whole facility is just amazing…. So thank you Grainne for arranging all that for me.. 🙂 My visit into the lab was scheduled for after lunch, where all the magic happens, and I was finally going to get to see the Eeva Genie…..
Heading up to the top floor to the board room, Dr Walsh was having a meeting with his team and their top secret plans for Cork….. I would love to have been a fly on the wall for that…. If they do 10% of what they do in Dublin, in their new Sims Cork centre, it’s going to serious provide an amazing service for us in Cork.
Lunch was yum… With some great banter, I off course was doing my best to remain professional…. Thinking back there was no need. But I suppose at the time I was still thinking of my morning in the clinic, and super excited to be heading into the labs that afternoon.
I was met by Graham, back at Sims Clinic, I was given my white coat and paper hat, I can admit it now but I wasn’t sure what to do with it. When you first look at it your not 100% sure is is for your mouth or your head… Jez I hope no one from Sims Clinic reads this… 🙂
The lab is broken into three fictional areas, the andrology unit, when the sperm is stored and worked on, is at the entrance, the middle unit deals with the IVF and ICSI protocols and where the EEVA unit is stored, Its a beast of a machine, which I couldn’t wait to get my hands on. And the room at the far end is the Cryo room where the frozen embryos are stored. Its an amazing unit, and I have to admit if I was going through IVF, I’d be very happy for my sperm to be there….
So Graham, introduces me to Eeva, and explains the process of what it does, and the algorithms that have been created for the evaluation process of embryo development. I have at this stage fallen head over heals in love with Eeva, and yes it is a computer but wow. In front of me I was able to see on screen 3 days of development in 3 minutes, from where the sperm and egg fertilise, to the cell split into 2 cells, 4 cells, 6 cells and 8 cells…. This process was developed in Stanford and is one of the most amazing things I have ever seen.
Whats so special about Eva is its ability to take photo snap shots every 3-5 minutes and then compile them together, monitor cell splitting times, for example, lets say we have 2 embryos at 8 cells prior to IVF transfer, its up to an embryologist to decide which is best. Which under normal conditions is fine, but what if one of those embryos has an 8% chance of success and the other has a 40% chance of success, how do you choose. Well on day 3, its down to a trained eye, however with Eva, you can within 3 minutes see how the embryos have developed, so lets say one of the embryos goes from 1 cell to 3 to 5 to 6 to 8 cells, and the other is 2 cells, 4 cells, 6 cells then 8 cells, believe it or not the second embryo has a much better chance of success up to 40%. Dr Walsh talks about it here : How Eeva works.
These are huge in IVF, the trained eye is still a major part in the decision process but now there is more information to work with, and this is amazing for a couple going through IVF. So on the day of transfer, the patient knows they are making the best decision on the day. Unfortunately once the transfer is compile its up to mother nature, which we can’t and I hope never will be able to control….