Issue link: https://tmcpulse.uberflip.com/i/818598
t m c » p u l s e | m ay 2 0 1 7 22 Facing page: Back row, Marco Vasquez with his arms around his daughters, Veronica and Anjelica. Seated left to right, Enrique Vasquez with his son, Evan; Nora Vasquez, with her niece, Lilienne; Adrian de Luna holding daughter, Vivienne, and niece, Monica. T he first major breakthrough with in vitro fertilization (IVF) came in the late 1970s, when two British researchers, gynecologist Patrick Steptoe, M.D., and physiologist Robert Edwards, Ph.D., performed the first successful IVF in a human. Lesley and John Brown had been trying to conceive for nine years, but an obstruc- tion in Lesley's fallopian tubes prevented pregnancy. Steptoe and Edwards success- fully implanted a fertilized embryo, grown in culture in a lab, in Lesley's body, resulting in the first IVF pregnancy. On July 25, 1978, Lesley gave birth to a healthy daughter, Louise, the first "test tube baby." "Around that period of the genesis of IVF, we really didn't know how to culture embryos, so the results were really abysmal," said Mazen Abdallah, M.D., a repro- ductive endocrinologist at Memorial Hermann Hospital and medical director of the Houston Fertility Institute. "You had to do several cycles to get one live birth. It was around 5 to 10 percent chance of live birth per treatment." But the science evolved and researchers improved their techniques. By the mid-1980s, IVF had a success rate of 10 percent. By the mid-1990s, IVF had a success rate of 25 percent. By the early-2000s, researchers learned how to effectively grow embryos in culture to the peak implantation stage. "Now we're at the stage where we're putting one or two embryos at a time rather than putting the average for the 1980s, when you would put as much as you have because the results were not that good," Abdallah said. "We all remember Octomom. Octomom is basically a mishap. … It's a risk you take when you put as much as you can at once." Another major breakthrough in the field of IVF occurred in 1992, when Gianpiero Palermo, M.D., Ph.D., developed intracytoplasmic sperm injection (ICSI), a method to help overcome male infertility by injecting a sperm into the egg to induce fertilization. "We used to notice that, when the sperm numbers were low, even if you put a lot of sperm to surround the egg, the egg wasn't being fertilized," Abdallah said. "It's not only sperm numbers. It's sperm function." Using the ICSI approach, scientists were able to fertilize eggs even if sperm quality was poor, effectively expanding the scope of IVF to help infertile men. Around the same time, scientists developed a procedure called preimplantation genetic diagnosis to test for genetic defects within embryos prior to implantation. By scanning the number of chromosomes in the embryo, scientists can select embryos that are chromosomally normal to use for implantation, improving the delivery rate to 70 percent, Abdallah said. Today, 1.6 percent of all infants born in the United States are conceived using assisted reproductive technology. A DVA N C E M E N TS I N I V F Her feet were swollen and her legs hit her stom- ach when she walked. She felt sleepy all the time and experienced dizzy spells and palpitations, a sign that her heart was working on overdrive to support the twins. Cramps left her in agony and she would cry in the middle of the night from the pain. Then the hemorrhoids came. "It was unbearable to lie down, sit up, walk, anything," Nora said. "It was so painful that I was crying all the time. I couldn't sleep. I couldn't even move because the pain would wake me up." But Nora never complained to Vasquez and de Luna, who had moved back to Houston after learning they were expecting twins. She knew how important her role as a gestational surrogate was and felt protective of the babies. "Every time I was on the road when I was pregnant with their kids, I was always like, 'God, please make me come back home safely because I'm carrying very valuable babies right now,'" Nora said. As Christmas Eve 2016 arrived, both families gathered at the home of Vasquez and de Luna to celebrate, make tamales and unwrap presents. When the festivities ended, de Luna tucked Vivienne into bed while Vasquez went to look for his two Yorkshire terriers, who had scam- pered away at the sound of fireworks going off in the neighborhood. Suddenly, at 2:37 a.m., they heard someone ringing the doorbell and banging on a window. "It's time! It's time!" Marco yelled through the window. The twins were on their way. They rushed to the delivery room, where a nurse wearing a sparkly Christmas ornament headband prepped Nora for delivery. Their excite- ment quickly turned to concern when they learned Nora needed an emergency C-section: One of the babies, the girl, Lilienne, was in a breech position. The medical team needed to retrieve both babies immediately. "All I knew was that they were going to cut into my sister-in-law, who didn't want to get cut into," Vasquez said. "I thought, 'She's not going to talk to me. She's going to hate me the rest of her life because these are my kids, biologically speaking.' Petty things, but those were things that were run- ning through my head." Around 8:40 a.m., the doctor made an incision in Nora's abdomen, reached in, and carefully pulled out Lilienne. Then the doctor went back in for her brother, Evan, who had inhaled some fluid and was having trouble breathing. A team of specialists from the NICU tapped Evan on the back with a neonatal percussor to help him cough up the fluid from his lungs. The team reassured the family that the babies were okay, but they needed to be taken to the NICU right away. (continued) Mazen Abdallah, M.D., a reproductive endocrinol- ogy and infertility specialist with Children's Memorial Hermann Hospital and McGovern Medical School at UTHealth, also serves as the medical director of Houston Fertility Institute.