Successes today and tomorrow (#15)
Assisted Reproductive Technology is now an accepted part of the medical care provided to Australians. It has not always been that way and detractors still exist. However 32 years on from the first birth, >12000 children /year or 4% of all births are from ART. Last year more 60000 treatment cycles were performed in over 60 IVF units around Australia. Success rates continue to climb, primarily driven by the work of scientists working across the various stages of embryology and genetics.
Advances over the years have made the patient’s journey much easier through drug developments and reduced monitoring.
As we get closer to replicating the natural uterine environment in the laboratory, we have seen pregnancy rates rise. Pioneering Australian work in culture systems and incubator development have contributed to these changes.
More advanced technologies are being applied to identify the “best” gametes and embryos. Selection of the “normal” oocyte using polarized light visualization or polar body aneuploidy testing has been employed. Sperm morphology at an ultrastructural level at high magnification prior to injection can aid in selection. After fertilization, simple morphological observation of the embryo will be superseded by more sophisticated techniques eg time lapse photography, metabolic outputs, and genetic testing of embryo biopsies.
Fertility preservation is now in greater focus with the cultural shift of the age of first pregnancy moving many women into the years of declining fertility. In addition the increasing number of young survivors of cancer has led to efforts to preserve their fertility in the face of treatments that will potentially render them infertile. Cryopreservation of oocytes, sperm and embryos can now be offered.
All these technological advances come against a background of changing ethical views. In the early 80s the majority were against IVF. Now such issues as surrogacy, sex selection, donor gametes, mitochondrial transfer involving three “parents” trouble many. Assisted conception continues to be controversial.