Dr. Emily S. Jungheim: In Vitro Fertilization (IVF)
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Seventeen states have some form of fetal personhood law—and the potential implications of such laws gained international attention in Alabama last year, when that state’s supreme court ruled that frozen embryos had the same rights as children, resulting in IVF clinics pausing their services.
On December 11, 2024, SciLine interviewed:
Dr. Emily S. Jungheim, the Chief of Reproductive Endocrinology and Infertility in the Department of Obstetrics and Gynecology at Northwestern University Feinberg School of Medicine. See the footage and transcript from the interview below, or select ‘Contents’ on the left to skip to specific questions.
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Introduction
[0:00:20]
EMILY S. JUNGHEIM: My name is Emily Jungheim. I’m a professor at Northwestern University Feinberg School of Medicine, where I’m the chief of the Division of Reproductive Endocrinology and Infertility. I study modifiable factors that can impact reproductive health and fertility treatment outcomes.
Interview with SciLine
How does in vitro fertilization (IVF) work?
[0:00:47]
EMILY S. JUNGHEIM: The term in vitro basically means in glass, or—in the way I like to think about it—that’s where the term test tube baby comes from. And so in vitro, again, in a test tube, as opposed to in the body, which is in vivo. In vitro fertilization involves making embryos outside the body in a dish by placing eggs and sperm into that dish. The way it works clinically is we give women injections of hormones for about two weeks, and our goal is to get multiple follicles to develop at one time so that we can then go in and get the eggs from those follicles and hopefully make multiple embryos to use for her future use. Once the follicles on the ovaries get to the right size, we bring the patient to the operating room, where she’s put to sleep, and we gently place a needle into all the ovarian follicles, drain that fluid out, hand the fluid off to the lab, and the lab looks through, finds the eggs, and then places the eggs with sperm in a dish that’s placed in an incubator overnight so we can watch to see which of those eggs fertilize and then follow those fertilized eggs to get embryos. And then those embryos can either be transferred back into the uterus or frozen for her future use.
What are some other forms of assisted reproductive technology?
[0:02:17]
EMILY S. JUNGHEIM: When we use the term assisted reproductive technology or ART, it refers to any procedure where we’re manipulating gametes outside of the body. IVF is one form of ART, again, where we’re taking eggs and sperm and putting them in a dish to make embryos. But other forms of ART include intracytoplasmic sperm injection, or ICSI, where we take an egg and inject it directly with a sperm cell. Or preimplantation genetic testing, where we’ll biopsy some of the cells from the part of the embryo that becomes the placenta and then send those biopsies off for genetic testing and also embryo cryopreservation.
Why do some people have trouble conceiving naturally?
[0:03:08]
EMILY S. JUNGHEIM: When people are younger, I would say it’s really a matter of time and space. And what I mean by that is you’ve got these microscopic structures, the egg and the sperm, traveling within the reproductive tract, and they need to meet in the right place at the right time. Women only ovulate one day out of the month, and so essentially, you’re talking about two days where you could potentially get pregnant out of 30. So that’s part of it. And then in order for an oocyte to fertilize normally, the chromosomal pairs within the oocyte or the egg need to separate. As we get older, these chromosomal pairs don’t separate as well, and a resulting embryo can end up with too many copies of a chromosome or too few copies of a chromosome. This is this is called aneuploidy. Most aneuploid embryos stop growing early in development. This is why it’s harder to get pregnant as we get older, and then also, if someone does get pregnant, they’re more likely to miscarry at older ages. There are actually only a few types of aneuploidy that are capable of becoming a live birth. So you know, again, just the limited opportunities to actually conceive a natural conception are part of the inefficiency. And then the fact that these are microscopic cells that are trying to meet in this huge space, and then they have to implant normally and develop and grow normally. I mean, there’s so many steps involved, but that aneuploidy piece, that abnormality in chromosome separation, that’s a huge piece as people get older.
Why does IVF involve producing extra embryos?
[0:04:54]
EMILY S. JUNGHEIM: Even in the best of circumstances, the chance of becoming pregnant in a normal menstrual cycle, where we’re trying to conceive without assistance, is only about 20% per month. With IVF, we stimulate the ovaries to get multiple eggs to work with. So, for example, if you get 12 eggs from ovarian stimulation, it’s like a whole year’s worth of trying to get pregnant. This can help improve the probability that we’ll get an embryo that’s actually capable of becoming a live birth. Sometimes we end up with embryos in excess of what we’re going to transfer, because our goal is to transfer one embryo at a time and get one healthy baby at a time. If we have embryos in excess, those embryos can be cryopreserved and used for future pregnancies, so that women wouldn’t need to go through multiple oocyte retrievals. But I think it’s important to keep in mind that many people who go through IVF don’t have excess embryos. You know, they may not have that potential to get multiple eggs to be recruited.
What options do fertility patients have for managing extra embryos?
[0:06:09]
EMILY S. JUNGHEIM: Historically, the options have included donating the embryos to research, donating the embryos to someone else who’s trying to conceive, keeping the embryos in cryostorage indefinitely, or discarding those embryos. So again, those are kind of the four general options that folks will pick. Some people will transfer the embryos at a time when they’re unlikely to get pregnant. This is called a compassionate transfer. And I’ve had more and more people ask about this, as I think word has gotten around about this as being an option, but the bottom line is there are a lot of folks who struggle with what to do with their extra embryos. Patients are generally enthusiastic about donating embryos to research, but in reality, there aren’t a lot of programs doing embryo research due to limited funding for reproductive health research. Also, survey work shows that people view their excess embryos as potential siblings to their children, and because of this, some folks struggle with that idea of donating their embryos to someone else who’s trying to get pregnant. At the end of the day, the number of embryos in cryostorage is growing exponentially, and keeping embryos in cryostorage indefinitely is contributing to this problem that we’ve got. So, it’s important to discuss and get people thinking about, what might I do if I have excess embryos early on. At the end of the day, most patients don’t have embryos in excess of what they’re going to use for their own family-building purposes, but many do. And so again, it’s just an important topic for folks to be aware of as they enter the process of IVF.
How many children are born via IVF in the United States each year?
[0:08:05]
EMILY S. JUNGHEIM: Right now, it’s about 2% of newborns in the United States are born as a result of IVF. If you look at countries where there’s universal health care and coverage for IVF, it’s about 4%. So, it’s definitely significant. And this number is going to grow as people have more access to IVF, and as the procedure and the techniques involved continue to improve. I once heard somebody compare it to the prevalence of red hair, which is about 1 to 2% of the population. So, we all know somebody with red hair out there, and I think it’s kind of interesting to think about, gosh, we may be encountering that many people on a day-to-day basis who’ve been born and who wouldn’t be here without IVF.
How might fetal personhood laws impact fertility medicine practitioners and patients?
[0:09:02]
EMILY S. JUNGHEIM: What I’ve seen and how it impacts patients and their fears and concerns—laws are often written with specific scenarios in mind, but they can be applied in unintended ways. In the case of fetal personhood laws and fertility medicine, if embryos are deemed people, clinicians might fear that they could be held criminally liable if embryos are damaged or lost when treating patients. This could limit access patients have to life-changing technology. If infertile patients are led to believe that embryos are people, this can lead to a misunderstanding of what the treatment is, how it works, and they may be inclined to choose less efficient and potentially ineffective fertility treatments. So you may see more and more people who are misinformed about the process who are left involuntarily childless as a result.
