In vitro fertilization (IVF) was first introduced in 1978 to redefine the propagation ability of humans. Infertility has increased over the last few decades, owing to stressful lives, hectic work culture, an increase in average childbearing age among the population, and a shift in the dietary habits of people. Thus, fertility treatment is needed.
Increased access to women’s education, career opportunities, and effective contraception has resulted in a delayed childbearing age and a decline in overall fertility worldwide. Furthermore, changing demographics and societal norms have led to an increase in infertility cases. Individuals with various medical conditions, cancer, and a familial history of genetic disorders also look forward to viable fertility treatments beyond IVF for enjoying parenthood.
Fertility treatments are all about managing the release of ovum, regulation of female cycles, artificial insemination, and IVF, as some might believe. However, at the tip of the iceberg, fertility treatments today have a broader approach and promising future advancements. The journey to parenthood has become increasingly challenging and complex, leading to a surge in the demand for effective and innovative treatments.
The field now recognizes and treats fertility issues in both male and female counterparts, providing tailored solutions for individual problems.
With delayed childbearing becoming increasingly common, fertility preservation has gained importance. In many countries, especially the US States, fertility is subsequently low, with the average age at first birth exceeding 30 years. Inadvertently, an increasing number of women delay childbearing beyond the age of peak fertility, i.e., mid 20s, to a point where age-related fertility decline contributes to the prevalence of infertility. This has resulted in a high demand for fertility treatments like IVF and oocyte cryopreservation.1
Techniques, such as egg and sperm freezing, are adopted by individuals who wish to safeguard their reproductive potential for future use. Additionally, research is ongoing to explore the possibility of preserving the ovarian tissue in women undergoing cancer treatment.
MedBound Times connected with the Dr. Jashan Chhatwal Sharma for her opinion on ART
ART protocols are being tailored to each patient's needs and their affordability of treatment. The emerging trends in Assisted Reproductive Technology (ART) are enabling us to provide more personalized care.Dr. Jashan Chhatwal Sharma, Obstetrician & Gynecologist, Dua Hospital, Karnal, Haryana
Assisted reproductive technologies (ART) are fertility-related treatments where eggs or embryos are manipulated. Procedures where only sperm are manipulated, such as intrauterine inseminations are not considered under this.
Assisted reproductive technologies are most frequently performed in patients with 'tubal factor infertility', IVF directly bypasses the fallopian tubes.
Other infertilities where IVF is advised include male factor infertility, diminished ovarian reserve, ovarian failure (with donor eggs), ovulatory dysfunction, and unexplained infertility.2
IVF can also be used in patients desiring genetic testing before conception, such as those with known family history of genetic disorders, fertility preservation before chemotherapy, radiotherapy or gender affirmation surgeries, or in patients desiring to delay childbearing.
These women can opt to freeze their eggs or embryos if they are in a stable relationship.
The blanket approach for fertility treatment has been losing ground since the last decade. Tailored treatment plans, focused medicinal approaches, and ease of access are gaining worldwide traction. Fertility specialists can now optimize treatment protocols by analyzing a patient's unique biological profile, personal genetic blueprint, hormonal profile, and lifestyle factors, thereby increasing the chances of a successful conception.
Dr. Jashan Chhatwal Sharma, Obstetrician & Gynecologist at Dua Hospital, Karnal, told MedBound Times that, "ART protocols are being tailored to each patient's needs and their affordability of treatment. The emerging trends in Assisted Reproductive Technology (ART) are enabling us to provide more personalized care."
"By using genetic testing, individualized ovarian stimulation, advanced embryo selection techniques, and AI-driven analytics, we can modify the treatments to cure patients' unique health issues. These innovations enhance success rates, reduce risks and offer more precise interventions, ensuring that our approach is as individualized as possible." she added.
Advanced IVF Techniques
In Vitro Fertilization (IVF) remains the cornerstone of fertility treatment, and constant advancements have enhanced the efficacy of the procedure. Some of the current trends in IVF include:
Time-lapse imaging: This technology helps monitor embryo development in real time, ensuring the selection of the most viable embryos for transfer.
Preimplantation genetic testing (PGT): This is an umbrella term for techniques used to screen embryos for genetic abnormalities before implantation of embryos during IVF.
Cryopreservation
The process involves cooling the cells to extremely low temperatures (-196°C or -320 °F), which effectively stops all biological activities. It is a crucial technique used in fertility treatment to preserve reproductive cells, such as eggs, sperm, and embryos, for future use.
Egg freezing: also known as oocyte cryopreservation, allows women to preserve their eggs for future use, thus preserving their fertility. This process includes freezing one or more unfertilized eggs (eggs that have not been combined with sperm).
Sperm freezing: also known as sperm banking, preserves male fertility. Fertility preservation involves collecting, freezing, and storing sperm for future use. Sperm can be thawed and used for future vitro fertilization (IVF) or intrauterine insemination (IUI).
These approaches aim to reduce the intensity of hormone stimulation during IVF cycles, minimizing potential side effects and improving patient comfort. While still under investigation, these methods hold promise for a more gentle approach to fertility treatment.
There is a growing interest in incorporating complementary and alternative medicine (CAM) into fertility care. Practices such as acupuncture, yoga, and dietary modifications are often used alongside conventional treatments to support overall well-being and potentially enhance fertility.
Mitochondrial DNA diseases are a group of inherited genetic disorders coming from mother, that have no known cure. MRT techniques allows to replace a woman’s defective mitochondrial DNA with that of a donor.
The DNA of the embryo to a great extent comes from the two parents who supplied the egg and sperm, and a tiny proportion comes from the donor. It is also referred to as 'three-parent reproduction' with baby having three biological parents.
The future of fertility treatments is brimming with exciting possibilities. Here are some potential breakthroughs on the horizon:
AI has the potential to revolutionize fertility treatment. By analyzing vast amounts of data, AI algorithms can monitor hormone fluctuations in real-time, provide rapid, objective, and accurate assessment of gamete and embryo health, identify patterns and predict treatment outcomes.
This could lead to more accurate diagnoses, personalized treatment plans, and improved success rates.
Santiago Munné, a pioneer in reproductive genetics, is now working on automating IVF laboratory processes. He believes that automated platforms can address inconsistencies, reduce labor costs, and improve convenience.4
Stem cells are undifferentiated cells capable of differentiating into specialized cells. Scientists are exploring the possibility for using stem cells to generate eggs and sperm in the labs, which could benefit individuals with infertility caused by genetic disorders or premature ovarian failure.3
This groundbreaking technology aims to create mature sperm and eggs from stem cells. While still in its early stages, IVG has the potential to transform fertility treatment by providing an alternative source of creating sperm and eggs from somatic cells.
Human IVG may also present a unique solution to individuals undergoing cancer therapy which tends to subsequently shortens their reproductive timespan.5
Advances in genetic engineering offer the possibility of screening embryos for a wider range of genetic diseases. Recent studies also indicate a possibility of modifying genes in future to prevent certain conditions. However, ethical considerations surrounding genetic modification is debated.
The field of fertility treatment is rapidly evolving, offering increasing hope to individuals struggling to conceive. From personalized medicine to cutting-edge technologies, the future holds immense promise for overcoming infertility challenges. However, it is essential to approach these advancements with caution and ethical considerations. As research progresses, it is crucial to balance scientific innovation with the well-being of patients.
1. Kushnir, Vitaly A., Gary D. Smith, and Eli Y. Adashi. "The future of IVF: the new normal in human reproduction." Reproductive Sciences 29, no. 3 (2022): 849-856.
2. Jain, Meaghan, and Manvinder Singh. "Assisted reproductive technology (ART) techniques." (2022).
3. Wang, Jing, Chi Liu, Masayuki Fujino, Guoqing Tong, Qinxiu Zhang, Xiao-Kang Li, and Hua Yan. "Stem cells as a resource for treatment of infertility-related diseases." Current molecular medicine 19, no. 8 (2019): 539-546.
4. Curchoe, Carol Lynn. "Proceedings of the first world conference on AI in fertility." Journal of Assisted Reproduction and Genetics 40, no. 2 (2023): 215-222.
5. Pathak, Subhajit, Pratiksha Sarangi, and Giridhara R. Jayandharan. "Gene therapy for female infertility: A farfetched dream or reality?." Cell Reports Medicine 3, no. 5 (2022).