May 2015

The future of assisted reproduction

For the past four decades, in vitro fertilization - or IVF for short – has made millions of couples happy. They have been given a chance, a chance which biologically was not intended, perhaps, by Mother Nature. It is open to debate, that Mother Nature has made us into these scientific beings exactly for the purpose of bypassing certain hurdles on our path of evolution. Cancer, Parkinson’s disease, syphilis and HIV or even such old arch-enemies of humanity as the black plague have been there (and are there) to test our mettle as a species. There is no doubt in my mind, or anyone’s mind, that all of these hurdles will be overcome, just like the Black Death was eradicated and now remains but a page in history books.

The current state of technology in the field of assisted reproduction has been changing rapidly. If you are interested in this topic, then you must have heard already of different types of fertility treatments – fertility medication, artificial insemination, IVF and even surrogacy. Even in Babylonian times, it was a custom and a law which allowed infertile women to arrange for other women to bear their children in order to avoid divorce. Modern surrogacy dates back as early as the 1930’s. In the 1890’s, the first non-human embryo transfers were attempted. In 1959, Chinese scientists successfully gave birth to rabbits using the IVF procedure.

As you can see, the history of assisted reproduction is vast and rich. We’ve been doing this for generations. And why not? Who are we to tell couples they simply are not allowed to have children for any reason whatsoever? On the contrary, the miracle of life should be celebrated! This is why scientists today try to improve the current technologies to increase the chances of insemination. The current chances at our clinics (and these chances are at the top of all charts), have a success rate of 47% when going through the route of IVF. Not two decades ago, these chances were below 20%. Yet people still carried out these very expensive procedures. This is how much life is worth. Simply put, it does not have a price tag in any ethical terms.

Egg donation cycles at our affiliate clinics have a success rate of 67%. Again, this is way beyond anything imaginable two decades ago. Our affiliate clinic also has an egg freezing program. But, what does the future truly hold? Will we be able to have a 99% success rate one day in all of these methods? Penicillin helped us battle bacterial infections, which is one of the reasons why we are nearing 8 billion people on this planet right now. The most recent addition to the arsenal of assisted reproductive technologies has been MIST – micro-insemination sperm transfer, which is a zonal procedure. GIFT (gamete intra-fallopian transfer) and TET (tubal embryo) technologies have also seen some advances, as we try to improve the survivability of donor embryos and oocytes (a female germ cell involved in reproduction).

The general accessibility to these technologies by the wider scientific community has given rise to new micromanipulation techniques, such as intra-cytoplasmic sperm injection for treatment of male infertility, as well as embryo biopsy for pre-implantation diagnosis of both genetic disease and aneuploidy (a major cause of early embryo demise and miscarriage). Another problem we have faced from the start is that as we try to increase the success rate of embryo survival rate, we have had to rely on multiple gestations (which, ironically, sometimes give rise to twins and triplets – a statistical possibility not at all improbable). Research is currently focusing on methods to improve IVF success rates while reducing twin and triplet pregnancies and their associated increased mortality. What we want to achieve, is to have full control of the amount of babies born and at the same time improve the survivability of the said babies. There are several approaches, one of which is screening the potential embryos and choosing the most prospective candidates. We obviously also want to improve the safety of the parents involved in these procedures.

Regardless of the current state of affairs, rest assured, at one point in the not-so-distant future, there will be no aspiring parent left childless. History has taught us many things, and one of them reminds us that we always prevail, no matter the odds.