Part 5 - Embryology in the 21st Century: Breakthroughs and Innovations

Mitochondrial replacement therapy (MRT) & Stem Cell Therapy in IVF

Michael B. Yakass, Ph.D.

Mitochondrial replacement therapy (MRT)

Mitochondrial replacement therapy (MRT) is an advanced technique in IVF aimed at preventing the transmission of mitochondrial diseases from mother to child. These diseases, caused by mutations in mitochondrial DNA, can lead to severe health issues affecting energy production in cells. MRT involves replacing defective mitochondria in a mother’s egg with healthy mitochondria from a donor. This can be achieved through techniques such as spindle transfer or pronuclear transfer. The resulting embryo contains nuclear DNA from both parents and healthy mitochondrial DNA from the donor, significantly reducing the risk of mitochondrial diseases. MRT allows women with mitochondrial DNA mutations to have genetically related children without passing on these potentially debilitating diseases.

MRT raises ethical questions, particularly regarding genetic modification and the implications of having DNA from three individuals. To date, only one clinic in the UK, the Newcastle fertility Centre is licensed to perform MRT and there are reports of a successful live birth following MRT in the UK (Wise, 2023).

Stem Cell Therapy in IVF

Stem cells have the unique ability to develop into various types of cells, including those needed for reproductive health. In IVF, stem cells can be used to generate healthy eggs or sperm in individuals with infertility issues. They can also be employed to create a supportive environment for embryo development.

For individuals with low-quality or insufficient eggs and sperm, stem cell therapy offers a potential solution. By generating viable gametes from stem cells, this therapy can help those who previously had limited options for biological children. 

Stem cell therapy can potentially rejuvenate damaged ovarian tissue, restoring its ability to produce healthy eggs. This is particularly beneficial for women with premature ovarian failure or those who have undergone treatments like chemotherapy. Although in its infantile stages of research and experimentation, there are trials that involves injecting either umbilical cord stem cells or platelet-rich plasma (autologous PRP derived from the blood of the patient) directly into the cortical region of the ovaries to rejuvenate egg production in advanced age women. Ovarian rejuvenation treatments are currently available in some clinics in the USA, UK and India. In Ghana, I know of one centre that has done some initial stem cell therapy for ovarian rejuvenation and currently monitoring for success.Stem cells can also improve the culture conditions for embryos during IVF, leading to better quality embryos and higher implantation rates when stem cells are transplanted in the endometrium to correct conditions such as endometrial adhesions and Asherman’s syndrome (Tan et al., 2016). 

While promising, the application of stem cell therapy in IVF is still largely experimental and faces several challenges. These include ensuring the safety and efficacy of the treatments, as well as addressing ethical concerns. Ongoing research and clinical trials are crucial to overcoming these hurdles and making stem cell therapy a viable option in reproductive medicine.

In this series of 6 articles, we will take a daily look at some of the most recent advancements and innovations (in no particular order) in this rapidly growing field of medicine.