Engineering solutions for infertility

In this episode, we speak to Chloe He, Postgraduate Research Fellow, who discusses various aspects of fertility treatments. There's a lot we cover! From the 50-50 split between male and female infertility, the rise in infertility, and the impact of pollution on male fertility. 

We also address the the "postcode lottery" effect in the UK and the challenges in accessing fertility treatments. There's a lot more that we cover so listen in to hear how we're helping solve some of the problems faced by different communities when it comes to having a baby. 

About Chloe He

 Chloe works in the Department of Computer Science, trying to understand the 3D structures of early human embryos. She's also a great advocate for inclusive health services, especially for the LGBTQ+ community. Chloe's deeply committed to inclusive reproductive healthcare, working with fertility providers to better serve LGBTQ+ patients. Her interdisciplinary background spans projects in beekeeping, safe reinforcement learning, computational argumentation, diversity & inclusion, maritime defense systems, and game development.

Transcript

Ferdouse Akhter  00:05

Hi and welcome to Health in a Handbasket. I'm your host, Ferdouse Akhter,  Marketing and Community Manager at UCL's Institute of Healthcare Engineering. In this podcast, we sit down with an expert to learn about all the wonderful and impactful things happening in Healthcare Engineering. Today we're picking out the topic of fertility treatments from our hand basket. We'll be covering how these treatments work, is it accessible, and what we're doing at UCL to give people more options. I'm joined by Chloe Ho, researcher at UCL working on fertility treatments. They're also a scientist at a fertility clinic in London. Hi, Chloe,. This is such an interesting topic. As a female in my 30s, it's something that I think about. So what are some of the issues that people come into the clinic for? I would have thought it was a lot of PCOS related things, because I have a few friends with PCOS, and it's one of their biggest worries in having children. 

Chloe He  00:54

I mean that the thing is, with like PCOS and stuff, is that it's possibly the one that gets the most media attention, but we see people who come into us for a range of issues. Oftentimes it's a male factor thing. So that is when there's like, Azoospermia which is there's no sperm, or Oligospermia, when there's very little sperm, and generally speaking, on like the male and female factor infertility, like the split between them, you're looking at something about 50:50 split generally speaking. Within the female factor, you've got tubal factors, so that's for example, that fallopian tubes are blocked. You have an ovulation, which is when no eggs are, like, released. We also see patients for stuff that isn't like directly in fertility related I guess. So, for example, you have a couple where they're both carriers of a specific disease, and you want to basically make sure that any embryo, or like, any pregnancy that you have is not going to like, carry that mutation that can, like, lead to debilitating disease in later life, or even like cause, like the baby, to have an awful life and die before it's even, like, two.

Ferdouse Akhter  02:00

I didn't know you could do that so you can, like, take out recessive genes. 

Chloe He  02:04

So this is called pre Implantation Genetic testing for monogenic diseases, and that's basically when you've got like, a single allele contributing to a genetic disease. And it might be that both parents have the disease and they don't want their kid to have it, or it might be that both are like carriers. Neither of them have it, but there's a decent chance that, if they decide to have a kid together, that kids go and have it. 

Ferdouse Akhter  02:28

It's interesting. You said that there's a 50:50, chance of both men and women having fertility issues, because you don't think of male fertility problems as much as you think of female fertility problems.

Chloe He  02:38

Yeah, and I think that that's just one of the things where, like, fertility as a concept, in like, the popular imagination, is something that's very much tied up with femininity and womanhood. You have, like people feeling shamed, like, societally, like you're not a woman if you, like, don't have kids, or like you're less of one with like, the image of pregnancy. So you go into, like, any fertility clinic, even these days, and a lot of the imagery that you see on the websites and like in their brochures, and even like as pictures on their walls are going to be of, like, pregnant women, baby bumps, all of that stuff. Men are very much like, then they're getting like more more like rep now, but like, still, there is, like, quite a bit of under representation, and you have a lot of men going around, like, not really, like, knowing about their fertility. 

Ferdouse Akhter  03:28

I've been reading a few things about how pollution is affecting male fertility. We're talking about the chemicals found in the food chain, plastics, medication, or just in the air. Are you seeing any indicators of that in the fertility clinic?

Chloe He  03:40

I mean, the number of people coming for being treated for infertility is increasing. The World Health Organization says it's around one in six. Now, the rate was a lot lower, so it was one in something bigger than six a couple decades ago. It's due to a myriad of factors, though. I mean, first off, people were having kids later, especially in the developed world, or like, even the developing world, people are having fewer kids because those kids are surviving longer, and also because, like, I guess, women are just, like, empowered to do things that aren't just having babies. However, you also do see, like, sperm counts decreasing. That's that's a pretty well known general trend now, whether or not that's like, particularly damaging to like, IVF outcomes, or like even just natural like conception outcomes is like, I guess you only need one sperm basically to fertilize an egg. But there is evidence showing that, like microplastics, for example, which are now in our water supply and everywhere, are like making their way into testicles, and that potentially disrupt sperm like production, you also have quite a few chemicals that are endocrine disruptors floating around, especially in certain like cosmetic products. Although, as far as I remember, and this is knowledge from a presentation I saw in like 2020 - 2021 they found that certain chemicals in like cosmetics can cause, like, early puberty or delayed puberty in, like male mice, but I don't think that they managed to transfer those findings onto humans.

Ferdouse Akhter  05:13

So the normal stereotype is older people getting IVF. But that's not really true, is it?

Chloe He  05:19

I mean, yeah, like, I'm born in the 2000s It shocks me every time we have a patient that is younger than me coming into the clinic, and it's not even like, it's not even like something that's that rare, to be honest, we have quite a few couples, especially like couples where you've got, like, a younger female and an older guy who, like, are coming in for fertility treatment? Yeah, Infertility can hit anyone, as you mentioned before. PCOS can, like, cause, like, an ovulation or, like, really irregular periods, so it makes, like, timing of sex very, like, difficult, and at the same time, like, you also have to, like, have some money coming from somewhere, especially if you're going into the private sector, because the NHS, as you know, is like, kind of creaking right now. And one of those services that has really unequal access is fertility services, and it's very much described as a postcode lottery. So depending on where you live, your access to IVF can range from like, just like one cycle. They might even like, they have different like, age cutoffs on, like how old you can be, or, like, the maximum age, all sorts of things. And it's basically just unfortunate that the vast majority of people are who, like, suffer from infertility, are either going to have to wait really long times on the NHS or have to basically pay up for private fertility treatment, and like, I think that quite a lot of people are doing the latter. 

Ferdouse Akhter  06:46

What do you mean by postcode lottery? So depending on where you are in the country, more well off? 

Chloe He  06:50

I guess basically, the way that the NHS runs is that there are these ICBS which basically decide where, like, the pot of money that the local NHS services have go. Some of them prioritize fertility treatment more than others, and as a result, you have like, difference in coverage depending on where you live in the country. It is also like, worth noting that the majority of IVF clinics are going to be in the big cities, London, Manchester, Birmingham. There's also like, way worse coverage, like up north. And it's essentially just like, like, there's, there's way more patients than any of the clinics and treat even if they were, like, basically given free IVF to everyone who wanted it. So even if, like, we wanted to treat everyone, I don't think there's the capacity within the UK to actually do it. And part of that is the fact that we have a massive lack of embryologists. That's because the way that you become an embryologist is quite a strange one. So there are two routes. There's the like official route, which is funded by the NHS, and then the there's like the film actor kind of route, where you have to start us like a lowly, like patient chaperone or something, and you have to work your way up, which kind of sucks, because, like, within embryology, you're also supposed to have like, qualifications and, like, essentially working as a patient chaperone after having done a masters. There's something that puts a lot of people who actually need the money to survive from entering into the field. And then on the STP side, which is the scientist training program, which is an NHS funded thing. I had a couple of my students go into this program, and last time I checked, they were only sponsoring less than 20 new embryologists a year.

Ferdouse Akhter  08:32

Just at UCL or...?

Chloe He  08:33

No, in the whole country. Oh, okay, yeah. So, like, there is a shortage of embryology talent. So like, even if we wanted to expand our labs and stuff, we'd have to import embryologists from around the world. And like, I think basically one of the only countries that doesn't have a shortage is Spain, everywhere else, basically, with a decent sized IVF sector has a shortage of embryologists. 

Ferdouse Akhter  08:57

Can we go back to the basics a little bit? So how does IVF, work? 

Chloe He  09:01

Okie dokie, yes, so, IVF, so back to biology class. You remember that to make a baby human, you need sperm and eggs. Those sperm and eggs need to come from somewhere. So if you are a cis heterosexual couple, then you're basically looking at the guy is going to, like, essentially produce a sample. To put it delicately, the woman is then going to have to undergo stimulation of the ovaries. And basically, the point of stimulation is to cause the ovaries to not just release one egg, but to release several, like, mature eggs at the same time, and those are recovered through a bunch of, like, hormone injections. So basically, you inject yourself every couple, like a couple, like, I think it's twice a day with stimulation medication, and that causes the ovaries to create, like, to produce eggs. Once the eggs  are large enough, which is monitored through various like scans, so typically ultrasound through the vagina, you are given a trigger shot, which basically triggers the release of all of these eggs, and they're basically collected in a procedure known as egg retrieval, where a long needle is basically inserted through the wall of the vagina into the ovaries, and the eggs like exist in these little sacs.

Ferdouse Akhter  10:28

So the needle goes through your vagina into your ovaries?

Chloe He  10:33

So it's done under conscious sedation.

Ferdouse Akhter  10:35

I mean, I also didn't know that we released more than one egg at a time, which isn't something they always tell you in GCSE biology. So as a woman, you release, like, what, 12 - 15 eggs. So does that mean you get 12 to 15 chances of fertilizing them?

Chloe He  10:48

Yeah. So this is specifically in IVF, normally in, like, the regular menstrual cycle, without the help of, like, loads of hormones that they inject into you, you only get one. And that's basically because, like, the success rates are pretty abysmal. So 12 chances to, like, produce an embryo is pretty like, it makes it a lot more like, likely to be successful. 

Ferdouse Akhter  11:12

I know that the chances of getting pregnant through IVF is really quite slim. So like, you need about three rounds of IVF.

Chloe He  11:18

Yeah. So I believe the official recommendation from, like, the regulator on fertility is essentially that you need three attempts for a 45% chance of getting the pregnancy. It's worse than the coin flip. So like this, this, like feeds back into it's really, really expensive, because each attempt is going to be like, 6000 7000 pounds more if you've got, like, complex stuff, if it's like, male factor, and you need to, like, I guess, go fishing around in the testicles surgically to find sperm, because none of it's actually being ejaculated. It can be way more expensive than that as well. 

Ferdouse Akhter  11:56

What do you mean fishing around like?

Chloe He  11:58

It's a brims procedure called surgical sperm retrieval. What you do is you basically take the testicle, cut scrotum open, find a testicle, and, like, essentially, you have, like, a surgical microscope, and you go looking around inside the testicle for sperm. It's like a last resort, basically, where, like, we really can't, no matter what drugs we prescribe. So now we have to, like, go in. Now you've got your sperm and your eggs. You basically, if you're doing IVF, the OG way of doing it is to mix them in a petri dish and just let the best sperm win. You can see them swimming around. You can see them go to the egg, and then they try to go in. And there's this, like, little fun, like, pointy bit at the top, the acrosome, which, like, basically allows it to go through the membrane of the egg and, like, burrow its way in. So it's actually a really, really cool, like thing to look at. In the case where the sperm isn't, like, moving or something or like, it's just like having a hard time getting through, you can assist it by basically getting the needle and then sucking the sperm in and then basically stabbing the egg, leaving the sperm inside. And that also works. That's intracytoplasmic sperm injection, which basically just means sperm injected into the egg.

Ferdouse Akhter  13:12

So the the needle kind of does the swimming. 

Chloe He  13:15

Yeah, it's becoming more popular just because, like, it's a guaranteed, like, you're pretty much guaranteed that sperm is in there rather than IVF. But like, again, it like, is slightly more expensive. Not as expensive as adding on, like testicular sperm injection or something, as far as I'm aware. So once you've got the eggs that have been fertilized by the sperm, we let them grow for like five days, typically, at the end of the five days, a couple of them will have basically stopped growing, because human reproduction is incredibly inefficient, like our embryos just die off, and then you end up, usually, if you have like 12 or 15, like eggs, you end up with like three to four usable embryos. I mean, it depends on your age and stuff as well. But yeah, three to four is a good number. You basically look at them then, and you grade them, and you basically say, Okay, this one is probably the one that's most likely to lead to pregnancy. Let's put that in first. So then you basically take a catheter, which is like a little tube, you get the patient, you lie them down, and then you basically pop that embryo back into the uterus, and fingers crossed, Two weeks later, you do a blood test and hope that it's a positive.

Ferdouse Akhter  14:30

How does the embryo selection work? So the embryologist, does you do it by sight, or is there like a chart that you need to go through? 

Chloe He  14:39

Yeah, and also it's usually a she. Actually, embryology is incredibly like female dominated, at least in this country, from what I've seen. But typically what you have is the one that's most commonly used as a Garner scale. So you have like three main things that you look at in an embryo at that at like, five days old, the first one is. The trophectoderm, which is basically the part of the embryo that becomes the placenta. You want that to be looking really nice. The second bit is the inner cell mass, which is basically the bit of the embryo that becomes the baby. You also want that to look pretty nice. And then the last bit is like the expansion. So just how much has the embryo actually expanded? Is it like, almost hatched? Yeah, that's that's basically how embryo grading works, although these days we're trying to get computers to do it, because we find that with humans, there is quite a bit of variation depending on who's looking at the embryo, what time of day it is, whether they've had their morning coffee or not, and it's also just super time intensive, because you have to, like, inspect each and every embryo. 

Ferdouse Akhter  15:44

You're also working on your own version for embryo selection?

Chloe He  15:48

So my research, and this is, like the main research that I'm actually doing, is looking at making embryo selection more biologically grounded. So the current way that a lot of embryo selection has been done is you have a picture of the embryo or a video of, like, the whole embryos development, and you basically say, what's the probability that this leads to a pregnancy? This is great because, like, it seems to work in, like, the studies and stuff. But what's not so great is that the embryologist, or whoever's like, even looking at it, doesn't really know what the algorithm is looking at. That's a problem, because, like, how are we supposed to, like, trust the grades that's assigned to the embryo when we don't know what the reason for like this grade being assigned is? A lot of them are, like, a human and computer collaboration where, like, the embryologist has the power to override a grading at any time, but generally speaking, like from what I've seen, it's a big debate going on in embryology right now. I guess my approach to this is essentially not having like image in prediction out without any like reasoning, and instead, like building these biologically informed embryo selection algorithms that are able to basically predict based upon this really biologically relevant measurement. So one thing that we have found, for example, is the more like the cells are touching each other, the more likely it is that said embryo is going to lead to a pregnancy. I think that one advantage of these AI embryo selection algorithms is that, like some research that we've been doing on sex data in embryos is that we find that female embryos are typically graded lower than male embryos, specifically on the trophectoderm. When we looked at artificial intelligence solutions, this didn't really happen. Now, why is this the case? There is a biological reason. Essentially, we know that female embryos have X X chromosomes. So we cannot have, like, a double dose of X chromosomes. That's too much x so a process called X inactivation has to happen where one of those chromosomes is basically shut down, silenced. And if that process doesn't happen, then the embryo, like, basically disintegrates.

Ferdouse Akhter  18:00

By the end it's still xx, no?

Chloe He  18:02

You still got both of the chromosomes by the end of it, it's just that only one of them is going to be active during that X inactivation process. It takes a lot of energy to actually, like, tell an entire like chromosome to shut up, and as a result, that energy is not used in, like, dividing nicely, growing as quickly as like a male embryo would have, and as a result, when you get to like, day five, the female embryo might look slightly less developed than a male embryo. 

Ferdouse Akhter  18:33

Men are normally x y?

Chloe He  18:34

 Yeah, they are normally x y, but that's like a whole other discussion, because, like, we saw a patient recently that's a really cool one with an SRY translocation. So basically they have male genitalia and like all of the male characteristics, but it's but they're genetically xx. SRYi literally is like sex determining like bits of the Y chromosome. And sometimes bits of the chromosome can just jump onto like other chromosomes. And that seems is what happens. It's pretty rare. And what happens is like, if all of the genes that determine that basically leads to, like a male developmental phenotype have, like jumped from the male from the Y chromosome onto the X chromosome, what you get is, like masculinization, despite having 2x chromosomes, but actually X chromosomes with a bit of y. 

Ferdouse Akhter  19:25

Oh, that's so interesting. I didn't even know that was a thing. 

Chloe He  19:30

It's a thing. It's just super rare. 

Ferdouse Akhter  19:32

We can talk about trans fertility, which is also something you're working on.

Chloe He  19:36

In terms of that, trans people are, like, as we pretty much all know, like underserved in the healthcare settings. This is no different in fertility. If we look at like studies of trans people's like family building aspirations that are more or less the same as like their cisgender counterparts. The only difference is that in a lot of cases, they're not going to be able to conceive naturally. They're going to need to have some form of medical assistance. It also is a thing that, like, if you are on hormone replacement therapy, which is part of, like transitioning, for a lot of people, that does have, like, some pretty bad knock on effects in terms of fertility. So in trans men, what you get is, like, the ovaries basically stop ovulating. You have like, irregular periods. I mean, ovulation stopping isn't like something that happens in all cases, but it just becomes really irregular. And it also is worth noting that you don't need to have a period in order to ovulate. It can just happen, which is why trans men, who are listening to this, you still need contraception. And then in trans women, you get like, atrophy of the testicles, atrophy of like, the penis, which and like, reduced sperm production really impaired, like, ability to make semen. So, like, the stuff that comes out is usually, like, of a much smaller volume than you'd expect out of a cisgender man. And it's usually clear and there's a lot less sperm, if any. So ideally, what should be happening is that people should be like before they embark on medical transition, essentially preserving their fertility if they even have, like, an inkling of a feeling that they might want to have kids in the future. 

Ferdouse Akhter  21:15

So that's like storing your sperm in a blank or your ovaries in a eggs. Yeah, eggs.

Chloe He  21:22

Although ovaries in a bank is something that's happening, yeah, it's experimental right now, but like, they're trying to figure out, like, especially this is more in like cancer patients, because chemotherapy also nukes your ability to reproduce. What you do is you take a bit of ovary especially in like younger patients who are like childhood cancer, people who haven't like yet hit puberty. The hope is that if we just freeze them, that one day, the technology will come back to a place where we are able to essentially transplant that tissue back into the hopefully cancer survivor.

Ferdouse Akhter  21:57

But with trans people at the moment, the recommendation is to freeze your eggs?

Chloe He  22:03

to do fertility preservation. As far as I'm aware, within the NHS, they are quite good at like telling people to do that, but within the private sector, it's much more of a grab bag. And the thing is that the NHS is not great at helping trans people. And at the end of the day, I guess most people are going private or even just, like, getting hormones off the dark web, because the waiting list for NHS transgender care is somewhere around the region of like, five to seven years. 

Ferdouse Akhter  22:34

Especially when you're looking at fertility, that's quite a big Yeah,

Chloe He  22:37

I think that there's a systemic issue of, obviously, of like, gender clinics and fertility clinics need to talk, especially in the private sector. But also, the bottom line is that some people that I know and some people that we've done, like research with and like essentially catalog their experiences of like fertility care, even when they're like, offered fertility care on the NHS, it's usually so traumatic because, like, there's a lack of like cultural competence as well as like clinical competence, I guess, in terms of making them feel safe, making them feel welcome within the fertility field, that a lot of them just forgo fertility preservation despite having it like, put in front of them. 

Ferdouse Akhter  23:17

What kind of like experiences have they said they've had? 

Chloe He  23:20

Effectively, what happens is, like, you have, like, just a lot of like discrimination going on within the healthcare setting. You have, like, the awkwardness of being in a gynecology unit while presenting like a man. Here's a challenge for you walk into a sperm bank and just sit there like you belong. 

Ferdouse Akhter  23:36

Yeah, I guess if you're already in a situation where you're anxious about having a kid, and then you're also going to a place where it's not very welcoming. It just adds to the anxiety.

Chloe He  23:46

I mean, not just that, but like, at the same time, it's also seen as something that's just blocking, because, like, the amount of time that people have waited before they reach the gender clinic, it's a significant amount of time, and oftentimes, a lot of them just want to get started as quickly as possible, and this has just seen us like a barrier.

Ferdouse Akhter  24:04

But you're working on something that's going to help improve ultrasounds for trans people, yeah,

Chloe He  24:09

So this is particularly for trans men. What we're looking at is one of the big barriers to a lot of trans men is that they have a very complicated relationship with like their vaginas. So some of them will have already started hormones while on the waiting list to the gender clinic, and they will have had some of the effects of the hormones already kicking in, and that's usually in the form of like in trans men, like vaginal atrophy, so like the thinning of like the vagina, and it Just makes doing the ultrasound scans incredibly painful. One thing that we're like trying to do is we're trialing out a number one at home and number two, like rectal ultrasound service. So why at home and why rectal are the two questions? Because the regular way that you do it is in the clinic and through the vagina. So. So at home is essentially to kind of, like, relieve, like, get rid of a lot of the stress that you get from a very CIS heteronormative like care environment. So essentially, yeah, if you're able to do at home, I guess you might feel less anxious about, like the receptionist being like a transphobe, and then the rectal stuff, obviously, what you have is you have a lot of, like, other than the psychological factors, a couple of, like, physical factors that may make it, like, a lot more difficult to do a vaginal scan in a trans patient. A lot of them, for example, have vaginismus. A lot of them, or, like, a decent number of them have sexual trauma. Basically, the reason why we're doing rectal ultrasound here is to avoid going through the vagina and instead going through the butt and like, the amount of space between the rectal wall and like, like the vagina is like, it doesn't change the imaging. Basically, all you get is, like, an extra inch of like tissue between the ovaries and like it shows up at the bottom of the scan. And I guess what we're trialing right now is to basically see whether or not people prefer it to a traditional in clinic, like experience. Some clinics already use this in particular, like in Southeast Asia, or like, even just East Asia, and sometimes in the Middle East, there are like issues surrounding, like virginity. So you want to scan someone, you want to check, for example, if they've got like, PCOS, but you also want to make sure that they're still a virgin. These countries kind of like developed trans rectal ultrasound as, like, a pretty, like standard procedure, because, like, you don't want to damage the hymen.  IVF isn't the only solution available. I once looked into egg freezing, but it's like, super expensive, like you said, even with IVF. So what are the other alternative solutions available? Depends on the kind of infertility. Sometimes you can, like, make lifestyle changes. So one big thing that it's like people can do is like, be a healthy weight, have a healthy diet, the regular don't drink too much alcohol, don't smoke, and essentially, just keep trying. The bottom line is, and this is not medical advice, because I'm not qualified to give that. In most cases, like it can, it can just happen by essentially living a healthy lifestyle. But in many cases it doesn't, and it's just very unfortunate that access to infertility treatment is something that's so unequal.

Ferdouse Akhter  27:27

So this is such an interesting topic. So how did you get into fertility treatments in the first place?

Chloe He  27:33

It's something that was like relevant to me, because I'm myself, I'm infertile at the same time, there's it was just like serendipity. I met my PhD supervisor, essentially at an event where I mistook her for someone else, and that someone else happened to be going through like had left the company that at the time I was working for to do IVF, and I was like, Oh my god. How's the IVF going? It was like an insane like stroke of luck that she also did IVF. And was like, that obviously wasn't the patient this time. We ended up just talking. And then I kind of like, this, this seems cool. So I kind of left my job in maritime defense to work on this. I went from working with seamen, ie. men at sea to seamen.

Ferdouse Akhter  28:22

Where do you see the future of fertility health? 

Chloe He  28:24

Well, I think that infertility is going to, like, get worse before it gets better, and that's just because, like, people are going to start, like, having fewer kids. And like, you're already starting to see these trends in like South America and like the African continent, and like even China. China's possibly one of the most like, crazy examples of this, where they went from like, loads of kids to the one child policy, and now, like, the government's trying to, like, prevent a demographic collapse by, like, encouraging people to have kids. It's going to continue being a problem. It might be in the even worse problem. What's most likely is that capitalism will run its course, and IVF clinics that don't adapt, like AI and like robotics for like, a lot of their procedures to basically increase their bandwidth and workflow, they're kind of going to get, like, replaced by the clinics that actually do so again, we're looking at like, a way more automated and like efficient IVF lab, because at the moment, it's very much a cottage industry, where each clinic has its own way of doing stuff. I think that also, like just on the scientific side, the very spicy stuff that's going on, in vitro gametogenesis, I have heard along the grapevine that we are getting very, very close to human trials of IVG, which is this technology that allows you to create egg cells and sperm cells out of, like, skin cells. So, like, literally unlimited eggs. I mean, obviously limited by the number of cells in your body.

Ferdouse Akhter  29:50

But how would it have DNA? Like, isn't it specialized DNA for egg cells and sperm cells?

Chloe He  29:55

Yes and no. So basically, what you can do is, they're these things called Yamanaka Factors which are like this special source. I'm simplifying this a lot, but it's like the special source that you add to the existing cells. So like skin cells, whatever cells, once you add it, it basically forces that cell back into a state of like being a stem cell. And you know that stem cells are the cells that can turn into any cells. Then you basically cajole it, that stem cell, into thinking it's an egg or sperm, and the way that you typically do that is that you just surround it with friends. 

Ferdouse Akhter  30:25

That's really cool. 

Chloe He  30:26

Yeah, and that's like, from what I've heard, it's closer than we think. One of the things that's going on in IVF, that's especially in the states, like taking off, is this idea of PGT p, which is polygenic PGT, pre Implantation Genetic testing. And what it basically does is it looks at like entire, like swathes of genetic data, builds correlations between certain things that you want and the genetics of the embryo, and essentially allows people to select embryos based upon stuff like intelligence. I've even seen that like presented at a conference, like a test for college admission? Like, the likelihood of your college admission based upon your genes.

Ferdouse Akhter  31:08

Yeah, it sounds a bit like eugenics. It's a bit of a tricky...

Chloe He  31:12

it's tricky, for sure. Personally, I just don't think that, like, we understand the human genome enough, because, like, these are by the name polygenic scores. They're caused by 10s, if not hundreds, if not 1000s of genes, different genes, and each individual gene contributes 1% and when you're selecting for like, stuff like intelligence, who knows what else you're selecting for, like, you might also be selecting for a gene that increases the risk of like, mental health disorders and stuff like that. And then there's also obviously, like the issue of, we want to maintain genetic diversity within the population, because genetic diversity is a good way of essentially preventing disease outbreaks or pandemics from killing us all. 

Ferdouse Akhter  31:53

On that scary thought, thank you for speaking to me today. It's been very interesting to hear everything that you're working on, you know, including the drawbacks of IVF, which I didn't know. I didn't know that the rates were so low, how it affects the trans community, and how unfair I guess fertility treatment can be. Thank you, Chloe, for coming along and teaching me lots of new things. 

Chloe He  32:10

You are most welcome. 

Ferdouse Akhter  32:16

This has been held in a hand basket produced by UCL Institute of Healthcare Engineering and edited by Shakira Crawford from Waltham forests. Feature formed. What's the Institute of Healthcare Engineering? Well, let me tell you, the Ihe brings together leading researchers to develop the tools and devices that will make your life better. We're using this podcast to share all the amazing work taking place, but there's so much more going on, so please check out our website@ucl.ac.uk forward slash health dash in Dash, a dash hand basket to find out more, and please share with your friends and family if you found this interesting, we're available everywhere, especially where you've just listened to us. 

Keywords

fertility treatments, male infertility, preimplantation testing, genetic diseases, IVF process, embryo selection, trans fertility, fertility preservation, NHS access, embryology shortage, AI in embryology, infertility causes, lifestyle changes, fertility clinic, embryo grading