For Dr. Crystal Chan, a Mount Sinai Hospital researcher in the MSc Clinician Investigator Program, improving the chances of ‘happy outcome’ for couples trying to conceive is her mission.
“It’s highly rewarding and fulfilling to have a continuous therapeutic relationship with a patient, from helping them to conceive to labour and birth,” says Dr. Chan, who recently successfully defended her MSc research.
In addition to her love of medicine, Dr. Chan passionately pursues research, an interest she developed while studying microbiology and genetics during her undergraduate degree in British Columbia. Her residency and medical school experiences have fostered her interest in reproductive biology and infertility, and she is now pursuing obstetrics and gynaecology with a focus on the treatment of infertility.
“The advancement of women’s health through science is a true passion of mine,” says Dr. Chan. “Infertility is a common condition and its incidence is increasing in our society due to trends in delayed childbearing in women. Assisted reproductive technology is a new and exciting field that has allowed many couples to conceive who would otherwise be unable to. The technologically driven aspect of this field and the privilege of helping couples create families are what drew me to the specialty.”
One of the most challenging clinical problems associated with in vitro fertilization (IVF) is multiple pregnancies and the resulting complication of premature birth. Dr. Chan’s research goal is to reduce the rate of multiple pregnancies by improving the success of single embryo transfers.
“We are using molecular techniques to identify unique markers predictive of embryo competence and viability, and of uterine receptivity,” says Dr. Chan.
Current methods to assess uterine receptivity—or the ability of a woman’s uterus to ‘accept’ a viable embryo—involve uterine biopsy, which is invasive and unable to accurately predict pregnancy. However, Dr. Chan’s new method, developed in collaboration with her supervisors Dr. Ted Brown and Dr. Ellen Greenblatt, assesses the uterus non-invasively by gently suctioning fluid from the uterine cavity.
“Our method allows us to determine molecular factors involved in uterine receptiveness, by comparing genes activated in the receptive versus non-receptive uterus and without causing potential damage” says Dr. Chan.
Following fluid aspiration of a woman’s uterine cavity, Dr. Chan and her colleagues use gene array technology—a way of analyzing the activity of thousands of genes in a single sample—to compare the various levels of 30,000 genes in non-receptive versus receptive uterine samples. This allows them to determine how similar the samples are genetically, and to pinpoint which key genes may be involved (and at what level of expression) during the narrow ‘window’ of uterine responsiveness to viable embryo implantation after IVF.
“We have identified 250 candidate genes that are involved in the receptive phase of the uterus,” says Dr. Chan. “These genes will guide the development of clinical tests that can determine if the uterus is receptive and to help predict pregnancy. Our ultimate goal is to improve IVF outcomes and decrease the need to transfer multiple embryos, leading to a reduction in multiple births and better health for women and their babies.”
“Dr. Chan is a truly exceptional individual and a highly motivated and skilled clinician and researcher,” says Dr. Brown, an Associate Scientist at Mount Sinai Hospital’s Samuel Lunenfeld Research Institute. “Her work is addressing a critical issue in IVF that should lead to overall improvement of IVF success rates, and facilitate the acceptance of single embryo transfer. Dr. Greenblatt and I are honoured to be her supervisors.”
Dr. Chan’s research is funded by the Association of Professionals in Obstetrics and Gynaecology of Canada (APOG) and the University of Toronto Department of Obstetrics and Gynaecology.
She won an award this year from the American Society of Reproductive Medicine and was also recently selected as the inaugural Fellow forVenture Sinai Women 2, a group begun last month in support of research at Mount Sinai Hospital and the Lunenfeld.
One in eight Canadian couples seeks medical treatment for infertility, most often requiring the help of assisted reproductive technologies (ART). Current pregnancy rates after ART average around 30 per cent, a figure that has improved only marginally over the past 20 years. New research in this area—including the project being pursued by Dr. Chan—is helping to improve the health of women and increase their chances of conception and full-term healthy birth.