Noted Embryologist Oversees Dartmouth-Hitchcock's "Embryo ICU"
When you visit embryologist Navid Esfandiari, PhD, HCLD, in Dartmouth-Hitchcock Medical Center's Embryology and Andrology Laboratory it's clear why he refers to his lab as the "embryo ICU." In the section of the lab where he performs preimplantation genetic testing and other in vitro fertilization (IVF) procedures, the lights are dimmer than in most labs because, he says, "embryos don't like light—eggs and sperm meet in the dark."
"Navid wants every single patient to have the best outcome she can possibly have and for every embryo to be treated with the utmost respect and care," says Leslie DeMars, MD, chair of Obstetrics and Gynecology and vice president of the women's health service line. "He individualizes his care not only down to a patient, but also down to individual embryos."
What is preimplantation genetic testing?
Esfandiari sits at a large microscope in his lab, with an embryo in a culture dish projected onto a computer monitor with 400 times magnification. Using a laser to perform microsurgery, he cuts four to six cells from the embryo, which are then tested for abnormalities in the genetics lab. Preimplantation genetic testing, which enables him to select a normal embryo for transfer to a mother's womb thereby increasing the chance of pregnancy, is one of the services Dartmouth-Hitchcock (D-H) began offering when Esfandiari became lab director in August 2014.
Preimplantation genetic testing encompasses two areas: preimplantation genetic diagnosis and preimplantation genetic screening. Preimplantation genetic diagnosis offers testing for couples with a known genetic disease, such as hemophilia, who want to ensure that the disease is not passed along to their child.
"For patients who have a genetic illness in the family it's incredibly important," says DeMars. "And it's probably going to be more important potentially for cancer patients who may have a gene that predisposes them to cancer. They now have a way to select, if they choose, embryos that don't carry the gene mutation."
Preimplantation genetic screening tests for egg quality and is used by couples who have had repeated implantation failure, which is often due to embryo chromosomal abnormality. "They might have an abnormal number of chromosomes," says Esfandiari. "Using this technique, it ensures that a normal embryo is transferred to avoid implantation failure or miscarriage." He notes that women in their late 30s or early 40s are candidates for and frequently utilize preimplantation genetic screening because 80 percent of embryos in that age group can be abnormal.
Egg freezing for cancer patients or young professional women
D-H also now offers egg (oocyte) freezing for cancer patients, who want to bank eggs before they begin chemotherapy, and for patients in their 20s or early 30s who have chosen to defer pregnancy but want to harvest and bank their healthier and less genetically abnormal eggs. "We have a lot of women who are of reproductive age but who need to postpone conception," says Esfandiari. "They're professional women who are developing their career; graduate students, physicians, fellows and women who aren't emotionally ready or do not have the right partner to start a family with. We're harvesting a couple of dozen eggs when a patient is in her late 20s or early 30s, and cryopreserving them for future use when she is ready to establish a family in her 40s. Young women of reproductive age who have been diagnosed with cancer or some other medical condition that may affect their egg production or quality may also benefit from egg cryopreservation."
Esfandiari brought with him to D-H "years of clinical experience in truly the most up-to-date infertility laboratory practice," says DeMars. He was formerly director of embryology, andrology and immunoassay clinical and research laboratories at Toronto Centre for Advanced Reproductive Technology (TCART), a University of Toronto affiliated fertility program where he developed successful oocyte freezing and trophectoderm biopsy programs. Named "Embryologist of the Month" in September 2015 by the American College of Embryology, the highly-regarded Esfandiari also brings a great deal of humility and empathy to his D-H role, says DeMars.
"He came from a center that did far more IVF cycles than we do here, but he understands that every cycle is precious, and it is a privilege to help couples achieve a long sought-after baby," says DeMars.
Helping reestablish the University of Vermont College of Medicine IVF lab
Esfandiari has also helped to reestablish the IVF lab at the University of Vermont (UVM) College of Medicine. He has been traveling from Lebanon, NH, to Burlington, VT, one day a week to oversee the lab and train their embryologists, and to work with REI fellows on their research projects and embryology procedures. The clinic had been dormant for over a year, stranding several Reproductive Endocrinology and Infertility (REI) fellows who had been training in the three-year REI fellowship program. D-H Medical Director for Assisted Reproductive Technologies and Infertility Misty Blanchette Porter, MD, who trained in the UVM program, assumed the on-site directorship and began training the third-year REI fellows and also secured a four-year approval for the continuation of the fellowship program from the American Board of Obstetrics and Gynecology.
"UVM and Dartmouth-Hitchcock have a very similar mission and we have collaborated on maternity outcomes for years through a consortium called NNEPQIN (Northern New England Perinatal Quality Improvement Network)," says DeMars, who earned her medical degree from UVM. "After the departure of some senior faculty, the REI division at UVM had to stop doing IVF procedures. We were able to develop a very productive collaboration with UVM that allowed them to bring their lab back up to speed, and brought their senior REI fellow to Dartmouth-Hitchcock for important clinical training. I'm glad that we're able to do some of the clinical education for their REI fellows, thanks to Dr. Misty Blanchette-Porter's work, and also help UVM take care of women's IVF needs in northern New England again thanks to Navid, and his role as their laboratory director."
Thankful to his team, fulfilled by his work with infertility patients
Esfandiari, who is an associate professor of Obstetrics-Gynecology and Pathology at the Geisel School of Medicine says he is thankful for and proud of his embryology and andrology teams at D-H and UVM. Now that the UVM lab is operational again and staff are being trained, he hopes to devote more of 2016 to his embryology and IVF research to "help increase the quality of embryos and pregnancy rates, and to continue providing service excellence to our patients at both sites.
"It's very fulfilling, exciting and encouraging to work with infertility patients," Esfandiari says. "I've been doing IVF for a number of years, had thousands of cases, and it's great to see the babies when they bring them to clinic. You can't imagine the feeling of seeing a baby that was a few cells under the microscope and to have it now staring at you. It's a feeling that I'm very grateful for."