Science has made great leaps in genetic research, test-tube babies, infertility treatment, and fertilization. It is now possible to intervene in determining the gender of the embryo, work on its safety, and protect the newborn from some genetic diseases. It also became possible to transfer and transplant wombs and fulfill the wish of pregnancy for women who were impossible to think of that dream.   

                               

How did this development happen?

This is what we will know from Dr. Basil Noah, a fertility consultant at the Dubai Fertility Center of the Health Authority, in the following interview:

When did In-vitro-Fertilisation (IVF) technology appear?

This technology appeared about 35 years ago. In 1978, the first test-tube baby was born, the girl Louis Brown, in Britain. She grew up and got married in 2004. She gave birth to two children in a natural way.

What are the reasons behind the phenomenon of infertility?

The causes of infertility could be both men and women. The most common causes in women are ovulation disorders, blockage in the fallopian tubes, damage in the uterus, and others.

As for men, it may be congenital or acquired, and it is numerous, such as inflammation in the testicles, blockage of the reproductive tract or after surgery, swelling of the testicles, and others. These may lead to sperms weakness or even a complete absence of them.

How does IVF take place?

IVF has become common, but it is done only in specialized centers approved by the health authorities in any country. The process starts by giving the woman a hormonal treatment to stimulate the growth of ovarian follicles for a period of 10-12 days. When these follicles grow, ovulation is stimulated by injecting the hormone HCG. In the middle of the process, about 14 days later, the follicular fluid containing the ova is made by a simple process through the vagina and under ultrasound control. 

On the same day, the husband’s semen fluid is obtained after processing it in the laboratory. Then it is kept in incubators and a special environment for later insemination. Insemination is done in two ways. In the first, the ova and sperm are placed in a nutrient fluid where fertilization takes place naturally outside the body. 

The second way is called microinjection. One sperm from the husband’s sample is selected microscopically. Then it is injected into the ova.

 In both methods, the ova are kept in a nutrient medium. The medium is inside special incubators in the laboratory to develop and reproduce. This process is done after fertilization for 3-5 days.

The last step: the best-growing embryos are selected and returned to the uterus through a special catheter. There is a possibility to store the extra ova or embryos for later use. As for the number of embryos that are transferred to the mother’s womb, this depends on the woman’s age and the degree of embryo development. 

We are keen to reduce the number of embryos and choose the best based on the development and the ability to implant in the endometrium. This leads to greater chances of success. At the same time, we are keen to reduce the rate of pregnancies with multiple twins. This is because of the problems this pregnancy causes for the mother and the newborn.

Two weeks after returning the embryos to the uterus, we start selecting the pregnancy by blood analysis.  If the test is positive, this confirms pregnancy. After two weeks, the development of the pregnancy inside the uterus and the number of fetuses are confirmed using ultrasound.      

To which stage did you get in the field of genetic testing?

We have made great strides in this field, especially about avoiding some familial genetic diseases that exist in the Middle East and the Arabian Gulf, such as thalassemia or sickle-cell anemia and others. Affected children need frequent blood transfusions (every four to five weeks). With the assistant team, I had my first successful experience at the level of the UAE during the past year. We returned embryos to a mother’s womb after genetic testing and reassurance of her safety from thalassemia.

The embryos are examined for the histological match between them and one of the affected children in the family. All of this is for using the embryos as a cure for their siblings. It is done after the embryo’s development and birth after nine months of pregnancy.  This is done by using stem cells that exist in the umbilical cord and transferring them to the affected child. The higher the percentage of histological match between embryos and siblings, the higher the success of stem cell transplantation for the affected child, and the lower the disease rate.

What is the treatment that is available for children with thalassemia with the help of fertility medicine? And how does it is work?

If the family has a child with thalassemia, and blood is transfused to him every four weeks for two years, and the family decides to end this suffering, then we do an IVF operation for these families. 

The ova are fertilized in the laboratory, and embryos are obtained. On the third day of fertilization, a fetus becomes a group of 6-8 cells. One of them is taken and genetically tested. The test is done to ensure if the cells are normal blood, thalassemia minor, or thalassemia major.

Then, histocompatibility is tested with the affected child in the family. In case of matching, this fetus is transferred to the mother’s womb. If the pregnancy takes place, it is followed up for nine months. During childbirth, umbilical cord blood is obtained, which is rich in stem cells. These cells are frozen in a specific bank. They are used later in the treatment of an affected child in the family or any child whose tissue group matches.

Various research and studies are currently being conducted to treat many diseases using stem cells, such as diabetes, blood cancers, and others.

What is the strangest case you have experienced during your career in treating infertile women?

In fact, many cases can be mentioned, but the last of them succeeded last week. A woman has been wishing for pregnancy for more than 16 years without despair.

Finally, God answered her prayers. We succeeded in treating her even though she is over 41 years old. Note that the best age for childbearing is 20-30 years, where the ability of ova to become pregnant is higher. The percentage of genetic disorders associated with the age of women, such as Down syndrome, is also reduced. This lady is now pregnant with twins. We wish her to continue her pregnancy to the end to enjoy the feeling of motherhood. 

After your success in determining the gender of the newborn, where did you arrive in evaluating the fetus?

Genetic testing has evolved considerably. We do it not to determine the sex of the baby but to achieve a balance between males and females within the family.

After your success in determining the gender of the newborn, where did you arrive in evaluating the fetus?

Genetic testing has evolved considerably. We do it not to determine the sex of the baby but to achieve a balance between males and females within the family.

Some women ask for a female because their children are all males or vice versa. We perform a comprehensive chromosome test of the embryos to verify that there are no abnormalities in the number of chromosomes. Some women ask for a female because their children are all males or vice versa. We perform a comprehensive chromosome test of the embryos to verify that there are no abnormalities in the number of diploids. The traditional number for all people is 12 diploids per fetus. If we find an additional diploid, the fetus will have Down syndrome. If there are less than 12 diploids, that will cause a disease to the newborn. As we mentioned before, when the parents are carriers of one of the genetic diseases such as blood diseases (anemia), there is a 25% chance of children getting the disease.  But if one of the parents is a carrier and the other is infected with it, then the infection rate in the children is 50%. The genes that cause the disease are identified in the parents. Then examine the embryos and exclude the infected. This reduces the number of children candidates for the disease. Thus, we relieve a huge burden on the family and the state.