Humans hatch. Seven to 10 days after fertilization, the cellular sphere embryologists call a human blastocyst hatches from a protective membrane analogous to the shell of a bird egg and implants in the mother’s uterine lining.
For reasons not fully understood, sometimes the pre-implanted blastocyst-still smaller than the period at the end of this sentence-remains trapped inside the membrane and fails to make that vital connection with the uterus. Miscarriage results.
Now imagine a live 3-day-old embryo, conceived through IVF (in vitro fertilization, in which the ovum is fertilized in the laboratory, producing a “test tube baby”), undergoing delicate microsurgery to prick open the membrane with a glass needle so fine that the tip is barely visible to the naked eye.
Such high-tech assisted hatching is one of the latest cutting-edge embryo micromanipulation (microscopic-handling) techniques added to the medical bag of tricks used by reproduction specialists. In doing so, they help infertile couples realize their take-home-baby dream-or, in the case of Mike and Mary Lyons, realize their take-home-babies dream.
Michael and Thomas, the Lyonses’ healthy twin sons born May 20, weighing 4 pounds 10 ounces and 5 pounds 6 ounces respectively, are the first assisted-hatching progeny of the Hinsdale Center for Reproduction, which was opened in July 1991, by reproductive endocrinologists Drs. Michael Hickey and Jay Levin. Seven other center patients whose embryos have undergone assisted hatching in the last six months are currently pregnant.
It wasn’t long ago that Mary Lyons, who worked as an ob/gyn nurse at Hinsdale Hospital for 14 years, wondered if she would ever bear children. Five years of treatment for infertility (three at the center) that included fertility drugs, three failed IVF attempts and surgery to remove a uterine fibroid growth had left her baby-craving arms empty. “When I was working in labor and delivery, I took care of women with IVF pregnancies, and I’d think, `Is that going to be me someday?’ ” she said. “At the same time, I took care of women who were giving up babies for adoption, and I’d think, `Or is that going to be me-the woman waiting to adopt her baby?’ “
Mary’s angst was made all the more poignant to Hickey, her physician and friend, during the birth of his third child. “Mary helped deliver our son in August 1992 at the same time she was undergoing treatment at the center,” Hickey said. “My wife delivered at Hinsdale Hospital, and Mary was our labor coach. She was great. But I was very aware, and she was very aware, how much she wanted to have a baby.
“Mary is clearly the most difficult case of infertility we’ve ever treated. We rarely get to four (IVF) cycles before we have success. With three transfers (of fertilized eggs) we’ve never failed to produce a pregnancy. With Mary, our hunch was some part of the interface between the (membrane) and the uterine lining wasn’t clicking.”
The click that occurred via assisted hatching is echoed in Mary Lyons’ joy, which apparently remains undiminished by the round-the-clock care and feeding demands of twins and the years of sacrifice-“no big vacations, no big house”-she and Mike made to cover the $20,000 they paid out-of-pocket for treatment (health insurance paid another $20,000). “I don’t let a day go by that I don’t appreciate the miracle our sons are,” she said. “It hits me every time I think about how they got started.”
The boys’ first photos were shot when they were six-cell embryos. The photographer was embryologist Andrew Ruiz, the hands-on microhatcher of the center’s assisted hatching program.
Cracking the egg (assisted hatching) is the laboratory equivalent of flipping a master switch that in turn opens up an intricate communication network between mother and embryo. Before implantation can take place, the embryo must make direct contact with the lining of the womb. That cannot happen if the embryo’s membrane remains intact. “The lining of the uterus sends hormonal signals to the early embryo, and the early embryo actually sends hormonal signals back to the lining,” Levin explained. “The conversation that takes place is not like this conversation (two-way, with one other person) but more like the AT&T network lighting up on Mother’s Day. It’s extremely complex. This is where some couples fail to conceive; the embryo fails to be able to send those signals because it can’t escape from the membrane.”
Some experts view assisted hatching as an important refinement of IVF technique. “We now do assisted hatching routinely for all IVF patients because we feel it increases the implantation/pregnancy rate,” said Dr. Yury Verlinsky,” director of the Reproductive Genetics Institute at Illinois Masonic Medical Center, Chicago.
Not everyone agrees with that approach. Assisted hatching is an extra step, an added variable in the IVF process that should be done only when indicated in cases of one or more failed IVF attempts, Levin said.
Assisted hatching requires a near flawless ability to operate in the ultra-Lilliputian world of an embryo where size is measured in microns (a millionth of a meter). The success of the procedure turns on the experience and expertise of the micromanipulator.
“The embryologist is key, the make-or-break person, in procedures from basic IVF to assisted hatching,” said Suzanne Blessette-Smith of Wheaton, president of Resolve Illinois (800-395-5522), a group dedicated to providing education for men and women dealing with infertility problems. Although the Hinsdale Center for Reproduction is definitely well respected (both Levin and Hickey are on Resolve’s physician referral list), “we caution people that infertility science is constantly changing,” Blessette-Smith said. “Some of the techniques truly represent advances, but some techniques don’t always work out as well as the medical community originally hoped.
“Assisted hatching is one of the newer ones, and it does seem to be (associated with) some pretty good statistics, but, who knows, this is crazy stuff we’re messing around with. We’re all trying to fool Mother Nature.”
And Mother Nature appears to be getting a comeuppance at the center. The center’s IVF pregnancy rate is 40 percent. That compares to a national rate of about 28 percent. (The center submits reports of treatment results to the Society for Assisted Reproductive Technology, a national association that tracks the results of infertility programs.) Levin attributes much of the difference to the center’s sophisticated laboratory. “One of the most crucial components in our program is the laboratory; we take it very seriously,” he said.
The clean room where Ruiz does assisted hatching is protected from contamination by a separate air filtering system. “A speck of dust falling on an ovum is like a boulder falling on your eye: There’s a lot of damage,” Levin said. It also contains an incubator for the eggs with an emergency power supply and a microscope with high resolution optics. The investment in high-tech equipment that made assisted hatching possible cost the center $50,000, yet the center does not charge patients more for IVF with assisted hatching than IVF without assisted hatching.
“It’s a losing venture for us,” Levin said. “Everything we do here is not about black ink or red ink; it’s about couples creating families. We believe there should be no financial incentive to do assisted hatching when it’s not indicated. That way it’s only done when it’s needed.”
(Depending on the clinic and what procedures and medications are used, an IVF typically can cost from $5,000 to $12,000.)
For Mary Lyons, assisted hatching began to look more and more like her last chance at motherhood. When the pregnancy test was negative after her third IVF attempt, “we were getting at the end of our rope,” she said. “You don’t want to keep trying if it’s not going to work. You’re thinking, `Am I just caught up in this whole thing?’ We were horribly discouraged. But the doctors encouraged us to hang in there. They never promised us they could get me pregnant, but they said they’d try different things.”
Mary sought advice from Ruiz. She knew he and his wife, Letitia, had two children (Alexandra, 5, and Nicholas, 3), both conceived by IVF, and she felt he would understand her frustration. “He was probably one of the most comforting persons I talked with,” Mary said. “I asked him, `How do you know when it’s time to stop, to give up?’ He said, `You have to listen with your heart, then you’ll know.’ I said, `I don’t think it’s time to quit yet.’ And he said, `Well then, that’s the right decision for you.’ “
On the fourth IVF attempt, the one that ultimately produced the twins, after several mature eggs had been gently suctioned from Mary’s ovaries with an ultrasound-guided needle inserted through the vaginal wall, she headed home with a nagging sense “that something was missing,” she said. “It’s a strange feeling to just leave your eggs behind. And you know they’re being fertilized. It’s like having an out-of-body experience.”
Three days later, Mary was scheduled to return to the center to have four fertilized embryos transferred into her uterus. “I was so nervous. I didn’t ask as many questions as I had the other three times. I didn’t even ask them, `Did you do micromanipulation (assisted hatching)?’ I just put it all in their hands, and said, `You guys do it.’ “
Mary returned to the center for a pregnancy test on the morning of the 12th day after the embryo transfer. Hickey was to phone her with the results sometime after 3 p.m. that day. Waiting was agony. “It was a horrible morning,” she said. When the tests were negative after the three previous IVFs, Levin or Hickey waited until early evening to phone, when they knew Mike would be home so Mary wouldn’t be alone when she heard the bad news.
But the phone rang about 1 p.m. that day. It was Ann Hickey, the wife of Mary’s doctor, who also works at the center, the same woman she had coached through childbirth about 13 months earlier. “Ann said, `I hope you’re sitting down. You’re pregnant!’ ” Mary recalled. “My first thought was there’s been some mistake; this is someone else’s test. I went crazy. It took her five minutes to convince me I was pregnant. Then I started crying.
“I called my husband and because I was crying, he thought it was bad news. So he said, `It’s okay, we’ll try again.’ I said, `Oh no, this is it. So far so good.’ He was in shock.”
The downside of being a nurse is having the medical knowledge to feed your health anxieties, Mary said: “After the initial elation of finding out I was pregnant, I woke up every day and prayed that I was still pregnant. Even though they were monitoring me closely and I was getting (hormone) shots, I had cramps and occasional twinges, and I’d worry.”
The moment of truth came about six weeks later. Mary was scheduled to have an ultrasound test at the center to detect the presence of a beating heart in her womb. Mike stood at Mary’s side in the examination room. “Dr. Hickey said, `Okay here’s one (implying he could see more than one heart beating).’ Fortunately I was lying down. My husband gripped my hand.”
“I felt a rush go through my whole body,” Mike said.
“Then he said, `There’s just two.’ Twins! We were ecstatic. We were thrilled,” Mary said. Then her nursing expertise kicked in: “I immediately started worrying because twins are a high-risk pregnancy (for premature birth).” For Mary that meant bedrest for 12 weeks.
On the afternoon of May 20, Mary went into labor. She called Mike at his office in Libertyville, where he is a district sales manager for Wallace Computer Services. He immediately headed home.
The twins were delivered by Caesarean section at Hinsdale Hospital without complication. Four days later, the Lyonses were an at-home foursome.
Mary Lyons is now passionate about spreading the good news about assisted hatching. “I’m willing to stand out on Ogden Avenue and (the Tristate Tollway) and tell this story to anybody who wants to hear it,” she said. “Even when I’m looking right at Michael and Thomas, I still have a hard time believing all this has really happened. Finally.”
