Fertility Treatments and Technology: What's New in Assisted Reproduction?
▫️WRITTEN BY DR RAELIA LEW
✅ REVIEWED BY DR SYLVIA ROSS ON SEPTEMBER 12, 2024
In the world before IVF, our society also looked very different.
Women married young and often gave birth to their first children in their early 20’s.
Infertile couples really had very few options besides adoption. However, back in those days, there often were babies available to adopt as society held unmarried motherhood as taboo, in a world with limited access to birth control or abortion, and with no government sponsored child support for single parents.
Sperm donation via artificial insemination was available to fertile women whose partners were the reason for a couple’s infertility. Problems like blocked fallopian tubes or severe endometriosis and major sperm problems really had absolutely no medical solution.
From there, IVF (In-vitro fertilization) changed everything. The vast majority of infertile couples within the normal fertile age bracket can expect to ultimately conceive through IVF. Infertile couples today can choose to undergo technologically advanced fertility treatments, with a goal to conceive a genetically- related child despite facing major biological and physiological challenges to their natural fertility.
IVF technology can do less to combat pathologies associated with advanced human aging, particularly when it comes to egg aging. However even where a woman’s eggs are no longer viable, she can still seek assistance to conceive via IVF using egg donation technology.
Assisted reproductive treatments were first successfully applied in the 1970’s where a scientific race happened across the world to achieve the first IVF baby or as it was called back in those days, test tube baby.
The first IVF pregnancy happened for the pioneers of a Melbourne fertility clinic, but sadly it was ultimately an ectopic pregnancy. The first intrauterine IVF pregnancies happened in Cambridge in the United Kingdom. The doctors involved were Steptoe and Edwards and what they created was a miracle proof of concept. IVF quickly went from a very experimental technique to a global phenomenon. Today, more than 8 million babies have been born via IVF worldwide.
At first, IVF medications could not be fabricated. Instead FSH and LH were collected and purified from either the urine of menopausal females or the pituitary gland from cadaveric sources. As you can imagine these hormones were hard to come by and very limited in supply.
IVF medications as we know them today have been empowered by recombinant DNA technology and the culturing of hormones in laboratory cell lines (often using cell lines from the Chinese hamster no less). We now also have many biosimilar IVF medications that can also be artificially made.
Originally, eggs and sperm and embryos could not be successfully frozen. Innovations and changes in the development of cryoprotectants and cell-friendly freeze methods like vitrification have majorly changed the practice of IVF today. Today it is considered best practice to perform single embryo transfer whereas in the past, multiple embryos were very often returned to the womb. The practice of multiple embryo transfer gave IVF a bad reputation for causing multiple pregnancies which can often be associated with premature births.
The confidence to freeze embryos and expect them to survive the freezing and warming process intact has changed IVF practice to make it safer for both patients and their babies.
Another revolution in IVF practice has been the development of the technology to enable blastocyst culture. An embryo reaches the blastocyst stage on day five to day seven of its development, instead of using a day three embryo which was previously routine. This means an embryo is replaced into the uterus at the time it would in a natural conception as the first days of development occur in the fallopian tubes.
For many years, as biologists, doctors and IVF scientists, we have studied the environment of the fallopian tube and uterus, learning lessons about what an embryo needs to survive and develop in culture conditions outside of the human body. We have developed incubator systems that allow us to control elements of the embryos' surroundings, including temperature, gas concentrations, pH, concentrations of metabolic substrates like glucose and puyruvate to allow embryos to thrive and develop normally in culture. Culturing embryos and observing them has been a game changer, both in developing selection algorithms and tools so that we can better predict embryo outcomes and choose the best embryo for transfer, but also embryos at the blastocyst stage are much stronger and more competent when it comes to surviving being frozen and warmed to create a pregnancy in the future.
Thus the development of laboratory technology and new enhanced embryo culture methods, has empowered specialists to more commonly choose to transfer a single embryo at a time. This move, without compromising a person’s chance of ultimately conceiving has more than halved the number of babies requiring intensive care admissions for reasons of premature birth, and has helped us transform the holy grail of IVF to be the conception of a single healthy baby, born at full term.
Confidence in freezing embryos has also allowed women and couples to plan for a larger family over time by choosing to freeze embryos for future use. While nothing can stop our IVF patients getting older and their egg and sperm quality deteriorating with age, frozen embryos retain their intrinsic potential from the time they were frozen. Thus if a couple freeze embryos, and use them later in life, they may retain predicted IVF success rates of a younger age bracket - the age they were when their embryos were created. Over a ten year period the chance of a successful conception can drop from 50% to less than 10% in an IVF cycle meaning less treatment burden for the parties involved and more chance of achieving a healthy baby.
IVF is a fast moving field. Technology innovations in IVF are ongoing and continue to offer increased success rates and new hope for individuals and couples experiencing challenges with fertility.
LATEST ADVANCES IN FERTILITY TREATMENTS
Recent advances in IVF include continuous culture methodology where embryos are undisturbed by scientists during their early development. Embryo imaging techniques are also developing and with this, the novel opportunity to apply machine learning and artificial intelligence to embryo selection has arisen and is being explored.
Novel substances developed for IVF may improve the success rates of embryonic implantation. The development of adhesion molecules to help embryos stick such as Embryo glue or hyaluronic acid has been shown to improve IVF success rates. Embryoglue is now implemented routinely in our practice for every embryo transferred,
Studies of the human microbiota are underway, giving us insight into how our body’s natural bacteria can both positively and negatively affect fertility when these are in or out of balance. Scientists are developing novel tests and therapies to diagnose and correct disturbances in the fertile female microbiome with a goal to enhance implantation rates in IVF.
Advanced sperm selection techniques are being explored and implemented to help scientists in the lab choose the best sperm for IVF and ICSI. IMSI techniques (where sperm are examined at very high power under the microscope) are being superseded by new ways of selecting sperm including via the use of microfluidic devices and via medical means such as using “sperm-slow” media.
Genetic testing techniques have been adopted in IVF to identify and exclude embryos from transfer that may be carrying serious genetic diseases. Genetic testing of embryos can also detect conditions associated with a chromosome imbalance including translocations, deletions, chromosome inversions or random spontaneous chromosome aneuploidy (wrong number of chromosomes occurring by chance due to random mistakes being made in an egg, sperm or early embryonic cell division).Genetic testing technology can considerably add to the cost of IVF but can in many cases be cost effective for an individual or couple, depending on their clinical circumstances and needs.
The amazing technology of egg freezing or oocyte cryopreservation is arguably the most radical change we have seen in the past decade of IVF practice. While the first baby made from a frozen egg was born in the late 1980’s, up until 2012, the science of egg freezing was considered “experimental”. This is because even though we knew how to freeze eggs with slow freeze techniques, most eggs did not survive using older technology. Vitrification methods and devices now allow the expectation that the vast majority of eggs we collect for freezing will in fact survive and will perform well in IVF when warmed for use at a future date. Incredible when you consider than an egg is a single cell. Egg freezing has become a game changing advanced reproductive technology for women whose major challenge is the effects of aging and their desire to keep doors open for planning a family at a later age and life stage. We can now freeze eggs in our 20’s or 30’s and use them in our 40’s or even 50’s. Egg freezing technology will allow a greater number of women to have babies over their lifetime, using their own eggs with their own DNA. It will allow more families to be completed with the number of children they truly want rather than the lower number that they have had to settle for. Frozen eggs are also potentially a brilliant source of donor eggs for egg donation as naturally many proactive planners who freeze their eggs may not ultimately need them or need to use all of them themselves. Some women may choose to donate their frozen eggs to help other women who can’t have babies using their own eggs to become mothers via IVF.
One of the most amazing breakthroughs of IVF technology that happened in the 1990’s was called ICSI. This stands for Intra cytoplasmic sperm injection, which means the microinjection of sperm into an egg to overcome severe male factor infertility.
Now even men with the lowest sperm counts can potentially become fathers via IVF using ICSI.
Some men have absolutely no sperm in their ejaculate at all. This finding used to be the end of the road for a man’s fertility and advice used to be to seek out a sperm donor.
Microtese techniques have been developed over the past few decades, where high power microscopes and delicate microsurgical techniques are used to extract tiny regions of sperm making tissue from a man’s testes through careful dissection. A microtese is a big operation and it is important to note that sperm will be found in only a proportion of cases where microtese is attempted.
Computer technology and the use of data has become front and center for every scientific IVF laboratory. We constantly gather and analyse data that look at and study patient outcomes in real time throughout the IVF process. Quality management systems may identify problems, improve scientist and specialist performance, or alarm to let us know if there arise any unfavorable or imperfect laboratory conditions.
The nightmare scenario for any IVF laboratory, scientist or doctor is the possibility of mixing up eggs, sperm or embryos so that an embryo might be transferred to the wrong patient as a critical error. While we have always had many human systems in place to prevent such mix ups, electronic witnessing systems have now been invented as an additional line of defence to guard against human error in the identification of gametes and embryos. Every single dish or straw containing an egg, sperm or embryo is electronically labelled and barcoded. Unless the labels match exactly with the intended patient, systems will alarm and all processes will halt until the source of any error is identified.
WILL WE ONE DAY DEVELOP AN IVF “LAB ON A CHIP”?
Microfluidics technology is moving from the research realm to potentially being routine in clinical practice in the next few decades. Microfluidic technology has the potential to streamline IVF laboratory procedures, providing an alternative updated method to achieve many steps involved in IVF as we currently practice it.
Microfluidic technology may one day be used to improve motile sperm selection, automate the preparation of oocytes for fertilisation, grow eggs in tissue culture of ovarian follicles outside the body, culture embryos and cryopreserve eggs sperm and embryos.
One day, we may all be using a “lab on a chip”.
Much research is currently underway looking into how we might design and implement automated machines to support embryologists. This means our IVF scientists will be able to streamline daily clinical tasks more effectively, creating more time for research and development of further improvements in IVF success.
Emerging technologies:
Polygenic trait PGT is today being investigated and even offered clinically in some countries around the world. This technique extends embryo testing to look not just at specific genes in question that might cause a disease but instead generate a profile of the embryos whole genome.
This information can be used to create a polygenic risk score, and use this to create new classifications for embryo ranking. Characteristics can be chosen to select the best embryo for transfer where multiple embryos are available, taking all this information into account. Traits that might be considered include an embryo’s lifetime risk of heart disease, diabetes or cancer.
Polygenic risk scoring in IVF has not been approved in Australia and is unlikely to be approved in the near future. Debates about the ethics and practicalities of using this technologies and concerns about the idea of choosing “designer babies” will need to take place and reach consensus before this advanced embryo selection technology is allowed to be offered to Australian patients.
MITOCHONDRIAL TRANSFER
Mitochondria are important cellular organelles (known as the cell’s batteries or energy source). Mitochondrial diseases are maternally inherited and until recently had no cure. Until recently, mitochondrial transfer was considered very experimental. However after years of research and the passage of Maeve’s Law, this technology is now allowed in Australia for the avoidance of mitochondrial disease. So called “3 parent IVF” involves either transplanting the nuclear genetic material from the intending parents fertilised egg into a donor egg (also fertilised by the man’s sperm) but with the nuclear material removed; or alternatively transferring the mother’s egg’s DNA into the egg of an egg donor that has been enucleated and contains healthy mitochondria (it’s own DNA removed).
Some studies have found other uses for mitochondrial transfer - such as to rejuvenate older women’s eggs. However this application is not approved for clinical use in Australia.
THE ROLE OF MICROBIOTA IN FEMALE INFERTILITY, TESTS AND THERAPIES
The introduction of advanced DNA technologies in medicine has significant future application for Assisted Reproduction Technology.
One new scientific revolution relevant to IVF has been the discovery of the human genital tract microbiota. The female reproductive system is not sterile. The female reproductive tract in fact hosts a myriad of interesting and important bacteria.
Next-generation DNA sequencing techniques have allowed the identification of complex microbial communities distributed in the female genitourinary system. The microbiota, the genetic imprint of our symbiotic bacteria, is key to controlling the homeostasis or natural balance of the fertile female biological environment. Disharmony, dysbiosis or imbalance can disrupt the physiological state of health and can negatively impact natural fertility and fecundity (the chance of getting pregnant each month).
Changes in female reproductive microbial communities in the vaginal and endometrial ecosystems affect natural fertility. Disturbance of vaginal, cervical or endometrial flora can actually negatively impact the outcome of assisted reproductive technology procedures. This includes IUI (intrauterine insemination) and IVF (in vitro fertilization).
The success of egg and sperm meeting and acting ideally in the body, and in IVF, egg collection and embryo transfer procedures can be negatively impacted by a pathological disturbance in the female urogenital tract microbiome.
Importantly, studies have now investigated the role of endometrial bacteria causing imbalance and infection in IVF recurrent implantation failure.
Lactobacilli are the dominant genus and Firmicutes, Proteobacteria, Bacteroidetes and Actinobacteria are the most abundant phyla in the human endometrium.
The vaginal microbiota is not static but undergoes normal fluctuations with hormone levels, age, BMI, behaviour and environmental factors. Vaginal pH changes with the levels of lactic acid produced by resident lactobacilli. Lactobacilli exert protection against pathogen invasion and their dysbiosis or imbalance has been associated with different disease conditions that can impact IVF implantation. These include chronic thrush, endometritis, endometriosis and pelvic inflammatory disease. Ongoing research in this area is needed and is hoped to provide explanations to patients who have had unexpected poor outcomes in particular.
ASSISTED REPRODUCTION TECHNOLOGY (ART)
ART stands for assisted reproductive treatments. The main elements of ART today is the manipulation of medical science and human biology to assist humans to have more babies.
The term ART encompasses treatments such as ovulation induction, intrauterine insemination, fertility preservation techniques for both males and females including egg freezing, sperm freezing, embryo freezing and ovarian and testicular tissue freezing options, IVF (In vitro fertilisation) and associated technologies such as PGT (genetic embryo testing), donor egg and sperm related conception, which in turn can facilitate third party reproductive options like gestational surrogacy.
Because of the development and evolution of modern forms of ART, the solutions available to help women and couples conceive today have been revolutionised compared to generations past.
ROLE OF TECHNOLOGY IN IMPROVING SUCCESS RATES
Methods of in vitro fertilization (IVF) have dramatically advanced in the 5 decades that have passed since the first human IVF baby came into the world in 1978. It’s hard to believe now, but in the 70’s and early 80’s IVF embryo transfers had single-digit success rates.
IVF is now so successful in comparison where a good prognosis patient aged under 35 transferring a genetically normal embryos may have up to a 50% chance of a live birth from one transfer.
Improvements have been immense, in many categories impacting IVF success rates overall. Laboratory techniques and technological advances, medication breakthroughs, surgical techniques and the development of powerful specialised equipment have revolutionised our abilities as fertility doctors and clinical embryologists to manipulate reproductive physiology. All of these factors together, gradually and continually have facilitated ongoing significant improvements in IVF success rates.
For an example of IVF technique improvement, we need only look to methods of egg collection
The first IVF practice involved laparoscopic egg collection, This technique involved a significant anaesthetic. Instruments were introduced through a woman’s abdominal wall and eggs were aspirated without imaging assistance.
This method was far less accurate and also far more invasive than egg collection procedures today.
With the development of ultrasound technology, transabdominal US guided egg retrieval developed. This technique was later finessed with the development of transvaginal ultrasound probes allowing transvaginal ultrasound guided egg collection as we perform most IVF and egg freezing egg collection procedures today.
Ongoing developments and improvements in ultrasound resolution and quality have made transvaginal ultrasound guided egg collection procedures safer and more accurate.
CONTROLLED OVARIAN STIMULATION AND OHSS
One dreaded side effect of IVF medications has always been OHSS, or Ovarian hyperstimulation syndrome. However, modern developments in medication and IVF regimen design, together with improvements in outcomes achieved from vitrified eggs and embryos have allowed IVF specialists to radically reduce patient’s risks of developing OHSS.
By choosing safer, more modern medication with a judicious preference to freezing first rather than directly transferring embryos, OHSS risk can be reduced to significantly less than 1%.
EMBRYO CULTURE
Originally in IVF and for many decades, embryos were either transferred or frozen at the cleavage stage of development - on day two to three post fertilisation. At this time point embryos have between two and eight cells and are quite fragile.
Major breakthroughs in IVF laboratories world wide including the development of sequential media and continuous culture systems have allowed us to with confidence, culture embryos on to the blastocyst stage of development. Embryos reach the blastocyst stage at the five to seven day time point post egg retrieval. Blastocysts have between 200 and 250 cells. Blastocyst embryos are both more robust to freezing and warming and also more likely to translate to a pregnancy and live birth compared to a cleavage stage embryo like for like.
This is because although all babies were both once cleavage stage embryos and later blastocysts, not every cleavage stage embryo will make it to be a blastocysts and later a baby.
REDUCING MULTIPLE PREGNANCIES ASSOCIATED WITH IVF
In some cases advances in IVF success rates and safety have been synergistic. One such improvement is the correlation between our confidence in successfully freezing and warming embryos, our improved chance of pregnancy success per embryos and our commitment to single embryo transfer.
In the early days of IVF, contributing factors to the practice of multiple embryo transfer included low success rates per embryo and a fear that we might lose or compromise embryos if we tried to freeze them. However the practice of multiple embryo transfer is also strongly correlated with multiple pregnancy, multiple birth and premature delivery.
Infants born prematurely are more likely to require intensive care and are more likely to suffer from life long medical problems.
Increased confidence in IVF technology, IVF success rates from single embryo transfer, blastocysts culture and freezing survival improvements with vitrification have all been contributing factors to the change of practice in IVF aiming for the birth of one baby at a time, delivered at full term.
GENETIC TESTING /PGT
Genetic testing of embryos for inherited diseases to prevent passing severe conditions on to the next generation is an amazing technology. This is currently achieved by a sophisticated DNA interrogation process of single nucleotide polymorphism analysis known as karyomapping.
Similar testing can be used to diagnose spontaneous chromosomal abnormalities that arise in embryos as a result of metabolic fatigue affecting the processes of meiosis and mitosis. Random spontaneous DNA aneuploidies are more likely to occur correlated with advanced maternal age over 35 years.
Some couples choose PGT-A (preimplantation genetic testing for aneuploidy) testing even in the absence of a known genetic condition to improve their probability of pregnancy per embryo transfer and to reduce their risk of miscarriage or having a baby diagnosed with a spontaneous chromosomal aneuploidy such as Downs syndrome.
DONOR CONCEPTION AND SURROGACY
Donor conception can mean helping someone to have a baby using donor eggs, donor sperm or donor embryos. These options open the door to parenthood for people who were previously excluded from having a family.
Women can use donor sperm to achieve a pregnancy as a single mum by choice.
Women and couples who suffer egg quality related infertility can conceive via IVF using a male partner’s sperm and donated eggs from a healthy fertile egg donor.
Same sex male couples can use a donor eggs and one partner’s sperm to have genetically related children through gestational surrogacy.
Women and couples can also adopt donor embryos created and donated by other people who have completed their own families via IVF.
Donor conception is complex and requires counselling, education, support and preparation but is a meaningful way to help more people experience the joy of family.
AI AND MACHINE LEARNING IN PREDICTING VIABLE EMBRYOS
Artificial intelligence (AI) and machine learning are emergent technologies that can be applied to IVF.
One application of AI is to identify data trends in IVF clinical and laboratory personnel performance for quality assurance. Potentially this application may offer benefits in close to real time.
AI systems may be designed to flag concerns automatically that would otherwise be time consuming and require manual audit. For example if a scientist has a lower fertilisation or a higher oocyte degeneration rate using ICSI than other scientists that may be technically related, this could be picked up and flagged as an outlier observation by AI.
AI systems can be trained with extensive relevant key performance indicators (KPIs) and these may be used to optimise laboratory and staff performance, enhance systems and thereby improve IVF success rates.
AI systems are being developed to perform embryo selection for transfer where embryos are ranked by machine learning rather than or more likely in addition to the observations of a (human) clinical embryologist. This type of non-invasive embryo selection strategy won’t improve the number of births from an IVF cycle and has not yet been proven to shorten the time to conception (we always have to choose between the embryos we have available and this technology doesn’t enhance an embryo’s chances).
Some studies focusing on analysis of embryo morphology as a tool for embryo selection to predict clinical outcome suggest AI may be better than the humans in selecting “the best embryo first”.
Some AI embryo selection studies used analysis of still embryo photography while others studies assess timelapse photography.
AI embryo selection prospective studies evaluated in a clinical setting are lacking. Most of the data we have is based on retrospective analysis. Because the study methodology and AI algorithms used in retrospective cohort studies have all been very different, it’s hard to compare available studies. Studies looking into this have assessed heterogenous development of AI models, different databases employed, study design and quality. Most studies so far have looked at implantation as an end outcome where actually what we need to know about is live birth outcomes. Live birth outcomes are the true outcome of interest in IVF (actually having a baby rather than registering a positive pregnancy test as this can end in miscarriage). Existing AI models studied to date have focused on locally generated IVF outcome databases and lack external validation.
The development of AI integrated into assisted reproductive technologies clearly has considerable promise, both for analysis powerful in optimising laboratory and clinical elements of IVF care and in embryo selection. However, meaningful future studies should focus on live birth as the primary outcome measure and involve prospective randomised and blinded controlled clinic trial design with external validation of the models of AI utilised to ensure they are valid and robust.
In summary, in the IVF community, we’re all very excited about applications of AI and are keenly watching this space. Critically, this technology may one day allow greater automation of IVF laboratory technical services, meaning embryologists (humans) can focus more on research which in turn can help us as we strive to maximise IVF success rates for our patients.
FERTILITY APPS AND TRACKING OVULATION
Fertility apps and ovulation trackers can be technologies that patients love.
These are technologies that like an electronic diary allow patients to track their periods and infer when cyclic events, like ovulation, is likely occur.
The rationale behind these technologies is to alert women to when they are most fertile so that they can target trying to get pregnant each month at the most likely time for conception.
While this technology can be user friendly and tempting to use, from the clinician’s perspective there are certainly also some drawbacks.
Apps suffer from the weakness of the fact that data entry integrity impacts data output and interpretation. Women may fail to recognise important clinical signs or may enter data inaccurately in a way that deeply confuses their interpretation of results.
Human bodies are not machines and many women do not ovulate at exactly the same time each month like clockwork. Rather than helping women interpret physical signs in their own body with confidence, apps can sometimes encourage women to ignore or wrongly interpret signs, trusting instead in computer algorithms which can be flawed and inaccurate.
A big misconception is that sex must happen on a particular day at a particular hour to achieve a pregnancy. From a biological perspective this concept is simply inaccurate.
Actually sperm can live for up to 5-7 days in the human female genital tract. It is much more important to have sex around and ideally in the days preceding ovulation that it is to have sex at exactly the moment a woman is ovulating.
Apps can be helpful but don’t let them stress you out. Be comforted with the realization that your mum and grandma conceived without ever using a fertility app. And although they have been shown in some grousp to decrease time to natural conception they are notoriously inaccurate in detecting the actual day of ovulation.
FUTURE TRENDS AND POSSIBILITIES
Trends in fertility practice react to needs of the population of people seeking to conceive with our help. With the uptake of egg freezing, we hope that instead of undertaking multiple costly rounds of IVF at more advanced age, more women will use their younger healthy frozen egg resources to have a family with a lot less if a struggle to do so.
It’s also predicted that eggs frozen by young women may not all be needed by those women individually and may serve as a new source of egg donation for other women who have been less prepared.
IVF strategically will move more towards long term family planning rather than focussing on having one baby at a time. Banking embryos for long term family planning can assist women and couples to grow their families as desired and should be considered up front as part of their IVF grand plan.
Genetic testing of embryos will hopefully evolve so that less invasive technologies become more accurate and widely utilised. This may in the future help, amongst other collaborative technological efforts to find healthy embryos that make babies faster for patients.
In the big picture, it is possible that gene editing techniques and stem cell culture techniques may one day allow us to use healthy eggs and sperm collected without hormonal stimulation and surgical egg retrieval. These ideas are still, for now, in the realm of science fiction and the reality of them is a long way off.
ETHICAL, EMOTIONAL, AND LEGAL CONSIDERATIONS
IVF has always raised ethical questions and consideration and is not universally supported in all social, religious and ethnic communities.
IVF can raise many serious ethical dilemmas that patients must consider.
When does life begin?
How do I feel about having frozen embryos in storage? If I don’t use my embryos, what will become of them? Am I comfortable with concepts such as embryo disposal, donation to another couple or to research?
What if I split up with my partner? Could I use my embryos?
What if one of us passed away?
There are many complex considerations and counselling prior to IVF for this reason is mandatory in Victoria and recommended in all states of Australia.
The laws and regulations that govern IVF practice are currently not uniform across our country.
More than 30 individual pieces of legislation govern the practice in of ART in Australia. Currently FSANZ (The Fertility Society of Australian and New Zealand) have proposed to develop a national framework to establish Australia-wide legislation for IVF and ART development. FSANZ is the peak body that represents scientists, doctors, researchers, nurses, counsellors and patients in the field of Reproductive Medicine in Australia and New Zealand.
We are very lucky in Australia to work in a healthcare environment with arguably the highest standards of care, transparency and accountability in regards to fertility treatment. We are also fortunate to have access to Medicare funding for many IVF services that patients need.
With the increasing age of first time mums and with the uptake of advanced technologies such as preconception genetic screening, ART births are expected to increase in the years to come.
Visit www.legislation.vic.gov.au to access the most up-to-date versions of the Victorian ART Act and Regulations.
CONCLUSION
Assisted reproductive technologies can now help more than ever to address the needs of women and couples building families in diverse contexts. We have better tools to overcome the obstacles on male and female infertility. Technology is ever evolving and IVF success rates are at record highs compared to decades past and continue to improve.
It remains true that younger patients tend to have an easier pathway to success in ART. Uptake of proactive fertility preservation strategies such as egg freezing is likely to ultimately result in more babies born and greater choice for women when it comes to family building. This is exceptionally important in a time where many countries have a declining birthrate to the point that population replacement is not being achieved with great economic consequences.
To find out more about ART, listen in to Knocked Up Podcast. Read evidence information about ART on the WHM website. Have conversations. The brave new world is now.
Sources and References
World Health Organization (WHO) - Provides comprehensive data and guidelines on reproductive health, including fertility and infertility treatment options.
Centers for Disease Control and Prevention (CDC) - Offers statistics and reports on the success rates of Assisted Reproductive Technology (ART) treatments in the U.S.
Journal of Reproductive Biotechnology and Fertility - Features cutting-edge research articles on the advancements in fertility technology and reproductive health innovations.
Fertility and Sterility - A peer-reviewed journal that publishes studies on the latest treatments and technologies in the field of reproductive medicine.
The American Society for Reproductive Medicine (ASRM) - Provides position papers and guidelines on ethical considerations in fertility treatments.
Recent study on embryo selection AI, "Artificial Intelligence in Embryo Selection: A Revolutionary Approach to IVF," published in the Journal of Fertility Technologies.
Testimonials and expert opinions have been sourced from leading fertility specialists through interviews and conference proceedings available on academic platforms like ResearchGate and Academia.edu.
Muzii L, DI Tucci C, Galati G, Mattei G, Pietrangeli D, DI Donato V, Perniola G, Palaia I, Benedetti Panici P. The role of microbiota in female fertility and infertility. Minerva Obstet Gynecol. 2022 Oct;74(5):419-433. doi: 10.23736/S2724-606X.22.04915-6. Epub 2022 Feb 11. PMID: 35147016.
Tomaiuolo R, Veneruso I, Cariati F, D'Argenio V. Microbiota and Human Reproduction: The Case of Female Infertility. High Throughput. 2020 May 3;9(2):12. doi: 10.3390/ht9020012. PMID: 32375241; PMCID: PMC7349014.
Kyono K., Hashimoto T., Nagai Y., Sakuraba Y. Analysis of endometrial microbiota by 16S ribosomal RNA gene sequencing among infertile patients: A single-center pilot study. Reprod. Med. Biol. 2018;17:297–306. doi: 10.1002/rmb2.12105.
Moreno I., Franasiak J.M. Endometrial microbiota-new player in town. Fertil. Steril. 2017;108:32–39. doi: 10.1016/j.fertnstert.2017.05.034.
Eskew AM, Jungheim ES. A History of Developments to Improve in vitro Fertilization. Mo Med. 2017 May-Jun;114(3):156-159. PMID: 30228571; PMCID: PMC6140213.
Salih M, Austin C, Warty RR, Tiktin C, Rolnik DL, Momeni M, Rezatofighi H, Reddy S, Smith V, Vollenhoven B, Horta F. Embryo selection through artificial intelligence versus embryologists: a systematic review. Hum Reprod Open. 2023 Aug 15;2023(3):hoad031. doi: 10.1093/hropen/hoad031. PMID: 37588797; PMCID: PMC10426717.
The Ethical guidelines on the use of assisted reproductive technology in clinical practice and research (ART guidelines) Reference number E79 ISBN 9781925129809https://www.nhmrc.gov.au/about-us/publications/art
https://www.fertilitysociety.com.au/media/australia-wide-legislation-for-ivf-and-art-in-development/
Written by Dr Raelia Lew
Dr Raelia Lew is the Medical Director of Women’s Health Melbourne. Dr Raelia is a Royal Australia and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) Board Certified CREI Fertility Specialist, and is President Elect of the Australia and New Zealand Society of Reproductive Endocrinologists and Infertility Specialists(ANZSREI).
Reviewed by Dr Sylvia Ross
Dr Sylvia Ross is a dedicated medical professional with over a decade of experience in the field of women's health. She is a specialist in Obstetrics and Gynaecology (FRANZCOG) and currently in the final stage of completing her Certificate of Reproductive Endocrinology and Infertility (CREI), a highly competitive program producing board certified subspecialists in infertility.