Dr. Ester Polak de Fried, a pioneer and expert in fertilization in Latin America, told Infobae about the latest developments in treatments and the dilemmas faced by the increase in life expectancy and the postponement of motherhood. Recently returned from the 40th European Congress of Reproduction and Embryology in Amsterdam, she said: “There is no need to be afraid of innovation.”
Achieving pregnancy and the development of the embryo until birth is one of the most beautiful miracles of life , but often the search does not prosper and thousands of couples in the world face situations of anguish and frustration when time is too long. In the golden age of longevity , the increase in life expectancy further encourages the postponement of motherhood, although reproductive aging is a natural process that is difficult to stop.
At such times, science becomes a fundamental support: advances in assisted fertilisation have transformed the possibilities of conceiving and offer a new perspective on the path to motherhood and fatherhood. Thus, the chances of achieving that longed-for miracle multiply .
For decades, reproductive medicine specialist Ester Polak de Fried has been a reference in Argentina and the world in fertility studies and , what a paradox of fate, a large part of her vocation to bring life was born from the inspiration of her mother Meri, who spent years captive in the concentration camps of Nazi Germany and never gave up in the face of the horror of death . Her childhood was forged with the example of the resilience of a survivor, a woman who, despite the traumatic years, transmitted joy and educated her without mandates or impositions.
At the forefront of her generation, Dr. Polak de Fried is considered an eminence in the field of assisted fertilization in Argentina. She graduated from the Faculty of Medicine of the University of Buenos Aires (UBA) and specialized in Gynecology, Endocrinology, Obstetrics and Reproduction. She gained experience in universities and health centers in Switzerland, Australia and the United States , among others, and for four decades she has directed the Specialized Center for Reproduction ( CER ) that she founded in Buenos Aires.
Verbose and passionate, she spoke to Infobae just after returning from Amsterdam , the Netherlands, where she participated in the ESHRE 2024 Congress of the European Society of Human Reproduction and Embryology, an annual summit that in this edition brought together more than 12,000 experts from 140 countries.
What are the latest developments in the field of reproductive medicine that will shape the coming years? What debates are still raging on about the limits of science in human reproduction?
For Infobae , Dr. Polak de Fried reviewed the most relevant highlights discussed at ESHRE 2024 that will mark the next steps for the discipline. The specialist delved into the latest innovations in egg cryopreservation , a procedure that is becoming more and more common in increasingly long-lived societies that decide to postpone motherhood and fatherhood.
He also anticipated how AI is applied in embryology and ovarian quality studies , creating new techniques that allow us to anticipate, based on the comparison and analysis of hundreds of thousands of images, which eggs will have the greatest chance of achieving a successful pregnancy.
Finally, she detailed the new papers that were presented at the international meeting of experts and that reinforce a concept that is gaining ground in new research: the importance of epigenetics and a risk factor for fertility that is increasingly present in today’s world but little researched: environmental pollution .
The field of assisted fertilization has been a field of vigorous debate and discussion since its inception . The Argentine specialist postulated that egg cryopreservation is not only useful for future fertility, but also for the development of gene therapies from these embryonic cells .
What to do with stored eggs that are not used is one of the current debates among experts in human reproduction. “Saving eggs can provide valuable material to generate stem cells in the future that can be used for advanced medical treatments, but they are also key to creating donation banks today, and helping women who do not have good ovarian quality,” Polak de Fried told Infobae .
Precisely, cryopreservation and egg donation are two areas in which Dr. Polak de Fried paved the way for the specialty: a pioneer in fertility treatments in Latin America , she created the first egg donation program in the region and assisted in the first Latin American birth by egg donation. She was one of the first scientists to use egg cryopreservation techniques and achieved the first birth in the world with cryopreserved eggs in a patient with premature ovarian failure; in addition, she performed the first ovarian tissue transplant in Latin America and created the first egg bank in the region.
Longevity, cryopreservation and precision medicine
“Our goal in human reproduction is to help all couples who have problems achieving a pregnancy naturally. Currently, there is no technique that guarantees 100% success in a fertility treatment. However, evolutionary fertility rates , which were very low (close to 10%) in the early 1980s, now reach between 50 and 70%. It is a major advance ,” described Polak de Fried.
— We live in an era marked by longer-lived societies, and this scenario also modifies priorities and times linked to motherhood and fatherhood. How does longevity and the postponement of the desire to have children impact assisted fertilization?
— Ester Polak de Fried: Postponing motherhood and fatherhood is a reality all over the world, driven by professional and personal commitments. Longevity and cryopreservation are increasingly at the centre of the debate on preserving reproductive health . Both women and men should consider preserving fertility at an early age. In women, the quantity and quality of eggs deteriorates considerably after the age of 30. Many women seek advice at the age of 35, but the chances of achieving successful pregnancies decrease. It is essential to preserve good quality eggs before that age to ensure their future usefulness. If eggs can be saved , they can be useful in the future, but they have to be of good quality.
Men delay fertility much more than women. Many women give up and end up having children alone.
— In recent years, there has been an increase in the number of consultations related to cryopreservation in order to choose the most appropriate time to have children. What are the risks or limitations?
— Yes, I have seen a revival in recent years of the desire to preserve fertility. The vast majority of young women who save their eggs do so because at that moment they do not want to, cannot, or do not have a stable partner . Many others have been in a relationship for a few years, but feel that it is not yet time to think about pregnancy. And I am not talking about girls in their 20s, but about women in their 35s . Many come to the consultation to find out about preserving fertility because a friend did it…
At age 28, an average of 14 eggs can be obtained in a single attempt, while after age 35 the average is eight eggs, and this may require repeating the induction procedure .
The debate on cryopreserved eggs
Dr. Polak de Fried led the team that pioneered egg preservation in Argentina and achieved the world’s first birth with eggs cryopreserved for four years in 1997.
“In studies with cryopreserved eggs, it has been observed that they can be activated without the need for a sperm, and generate a blastocyst and, therefore, embryonic stem cells identical (immunohistochemically) to the person who saved the egg. This finding, which we published some time ago in collaboration with Harvard researchers, shows that the preserved material is very valuable, even compared to umbilical cord cells. Saving eggs can be useful not only for future fertility, but also for future treatments or gene therapies ,” he said.
The debate was also present at the last European conclave in Amsterdam. “The president of the local Organizing Committee also addressed this issue, highlighting that there are a large number of cryopreserved eggs in the world that are not used because patients achieved pregnancy spontaneously . There is a debate about this . What she proposed is the possibility of donating these eggs to create an international bank in the face of the shortage. However, this also conflicts with the possibility of using them for the possible treatment of future diseases, which could generate interesting discussions due to the valuable content of these eggs, whether for the person who preserved them, other recipients or research,” described the Argentine specialist.
Environmental pollution, a risk factor for fertility
At the 40th ESHRE Annual Meeting in Amsterdam , a groundbreaking study was presented that revealed the link between air pollution and decreased success in assisted fertilisation births .
“It was revealed that exposure to fine particles before oocyte retrieval and during the in vitro fertilization procedure reduces the probability of having a live birth by 40% . This has to do not only with the timing of the clinical procedure, but also beforehand,” commented Dr. Polak de Fried, who participated in the presentation of the results.
And she emphasized that this research is relevant because it evaluated the participants for 2 to 3 months before the collection of eggs for fertilization and evaluated whether they lived in environments where environmental pollution had a certain quality, and they showed that in places where women were more exposed to pollution, the pregnancy rate was lower .
According to data published in Human Reproduction , one of the most important journals in reproductive medicine, the study, conducted over eight years in Perth, Australia , analyzed more than 3,600 frozen embryo transfers to 1,836 patients.
The odds of a live birth were found to decrease by 38% when comparing the highest levels of PM 10 exposure to the lowest. Furthermore, exposure to PM 2.5 in the three months prior to oocyte retrieval was also associated with a decreased odds of a live birth.
Researcher Sebastian Leathersich, lead author of the paper, noted that this was the first study to separately analyse the effects of exposure to pollutants during egg development and at the time of embryo transfer. The results showed a negative association between exposure to particulate matter and live birth rates , revealing that pollution affects egg quality.
“This is a clear example of epigenetics , where environmental factors influence male and female germ cells. Plastics and other pollutants are an important factor. It is essential to take care of ourselves and preserve ourselves not only for the climate, but also for the future of human reproduction,” said Dr. Polak de Fried.
Regarding epigenetics, the Argentine specialist postulated that the environment is also correlated with nutrition and with diseases of previous generations, especially those related to the endocrine system: “For example, endocrine diseases in grandmothers can affect the future fertility of their granddaughters. Everything is interrelated and it is important to consider these factors to preserve reproductive health.”
The impact of AI
“I have lived through several milestones in human reproduction, from in vitro fertilization , which emerged in the late 1970s, to the incorporation of ICSI (sperm microinjection). Then, research into embryonic genetics , how technology advanced to better study embryos has been crucial. This includes all the preimplantation genetics techniques, which were a huge advance. And now, since the end of 2019, artificial intelligence (AI) , which can help us improve the results of assisted fertilization,” he told Infobae.
New big data platforms and devices that process thousands of data and imaging studies in minutes are very useful for speeding up medical treatment processes.
Dr. Polak de Fried told Infobae that several of these cutting-edge technologies are already being applied in the country in different practices and mentioned the most notable ones so far: laboratory techniques to identify which embryos can develop in a healthier way, genetic tests that are performed to prevent future illnesses in the baby and also to evaluate the quality of the eggs most suitable for cryopreserving .
Furthermore, AI algorithms , designed after analyzing large volumes of information, can anticipate some results , which promises to improve clinical practice, with less invasive procedures during assisted fertilization treatments.
Excited about the new present, she is convinced that AI will change the biomedical scenario: “I think we are experiencing a revolution, the latest great milestone in reproductive medicine is linked to artificial intelligence tools that favor human reproductive results. It is comparable to what in vitro fertilization meant more than 50 years ago . ”
But he also argued that it is necessary to “ be aware of its limitations and ethical considerations.”
Source: Infobae
Authors: Daniela Blanco y Maria Eugenia Cazeneuve
Date: 19 Jul, 2024 07:00 a.m.
19 Jul, 2024 12:24 p.m. ESP
Note: Instituto Nutrigenómica no se hace responsable de las opiniones expresadas en el presente artículo.
