In women with previous failed IVF due to poor embryo development including fragmentation and arrest, decreased mitochondrial energy production may be a problem. Previous clinical trials of cytoplasmic transfer from healthy donor oocytes into the oocytes of women with poor embryo quality resulted in the births of dozens of healthy children. The beneficial effect of cytoplasm injection could be due to several components of the donor cytoplasm including proteins, mRNA or cytoplasmic organelles. Attention was focused on the mitochondria in the cytoplasm with the discovery that some of the children born from this procedure were heteroplasmic with regard to mitochondrial DNA and cytoplasmic transfer and donor mitochondrial injection were put on hold.
The recent discovery of oocyte precursor cells in the outermost cortex of the ovary and the observation that the mitochondria contained in these cells are morphologically identical to mature oocyte mitochondria has led to the development of a new therapeutic procedure for women who have failed to conceive because of poor embryo quality. The AugmentSM procedure involves the isolation of autologous mitochondria from oocyte precursor cells obtained by laparoscopic ovarian biopsy and injection at the time of ICSI. We have preliminary experience with autologous mitochondrial injection in 34 women who had undergone 71 previous IVF/ICSI cycles with a 10% clinical pregnancy rate but only 1 live birth (1.4%). Following a single Augment cycle, there were 12 clinical pregnancies (35% per cycle start) and 9 ongoing pregnancies including 1 live birth to date (26% ongoing PR per cycle start). Nine of the women have remaining vitrified blastocysts. We believe these results are extremely promising for women under age 40 and we are presently gaining experience with the treatment in women over age 40.
TCART Fertility Partners and University of Toronto, Canada