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As part of our content series for World IVF Day, we sat down with Genea’s Director of Research and Science Education, Nicole McPherson to get her thoughts on what she thinks are the biggest breakthroughs in IVF over the last couple of decades and what some of the future advancements are on the horizon.

Assisted reproductive technologies have revolutionized infertility treatment, with nearly 1 in 6 couples in Australia seeking assistance to conceive. Since 1980, when the first Australian in vitro fertilisation (IVF) baby, Candice Reed, was born at Melbourne's Royal Women’s Hospital, innovations in assisted reproductive technologies have significantly improved IVF success rates.

Over the past two decades, several breakthroughs have enhanced IVF science and technologies, now standard in IVF laboratories worldwide. Innovations in how we grow and store gametes and embryos and improved genetic testing platforms are just some of the advancements that are now commercially available to couples seeking fertility treatment. Let’s look more closely at some of these technologies and how they have substantially increased the chances of pregnancy for patients’ requiring fertility treatment.

Time-lapse incubators and single step embryo culture has become mainstream in the past 5-10 years. The biggest benefits of time-lapse incubators and single step culture have been the non-invasive and continuous monitoring of embryos throughout development maintaining embryonic growth in their optimal environment. This has completely removed the need to manually check an embryo's progress or replenish its nutrient supply, a requirement of previous dual culture systems. This technology has enhanced the precision and efficiency of embryo selection and growth, through real time monitoring, leading to better clinical outcomes. Patients at Genea have had access to this through our world leading Geri incubator since 2016 where they even have their own individual chamber.

Vitrification of eggs and embryos, introduced in the early 2000’s became mainstream in the late 2000’s. It is a rapid freezing technique that preserves and protects eggs and embryos from cellular damage by inhibiting the formation of ice crystals normally formed during the freezing process. Due to this reduced crystal formation, vitrification thawing success rates are over 95% for embryos and 80% for eggs making it a more valuable option for those women/couples seeking to preserve their fertility, whether prior to medical treatments, career plans, or personal choices.

One of the biggest technological breakthroughs of recent decades has been the mainstream implementation of genetic testing of embryos – also known as pre-implantation genetic testing (PGT). With this technology has come the ability to genetically screen multiple embryos prior to implantation for instances of chromosomal abnormalities, single gene disorders, mitochondrial DNA testing and structural arrangements, revolutionising the ability of couples to have a genetically healthy child. While, the history of PGT started early in 1990s with techniques such as Fluorescence In Situ Hybridization, current platforms including Next-Generation Sequencing and Single-Nucleotide Polymorphism Arrays have allowed for faster, precise and cheaper options empowering couples to pursue genetically healthy pregnancies. In fact, Genea led the way globally introducing Day 5 embryo biopsy for PGT and the world followed, making it the gold standard.

So where to from here? Science innovation is continuously advancing, and recent breakthroughs in discovery science suggest promising future advancements for infertility treatment. Some of these include.
  • Artificial intelligence (AI) - algorithms for enhanced embryo selection prior to transfer, customised treatment plans and outcome prediction tools enabling personalised medicine. At Genea, by harnessing the power of AI, we plan to refine our techniques, better predict patient outcomes, and ultimately make the dream of having a family more achievable for patients.
  • Mitochondrial replacement therapy techniques, such as spindle and pronuclear transfers, have the potential to not only aid couples suffering mitochondrial disease, but also a tool for rejuvenating poor egg quality.
  • In vitro maturation of eggs, a technique where immature eggs are grown in a culture dish and fertilised in vitro, has the potential to reduce/restore chromosomal abnormalities of eggs associated with advanced maternal, increasing the viability of using one's own eggs for pregnancy.
  • Artificial eggs and sperm - there have been some major breakthroughs to the epigenetic changes required for turning a human cell (i.e. skin cell) into a sperm or egg. While still a long way off clinically, these types of technologies could see the removal or need for egg and sperm donors in the future. 

These technologies, though still in development, indicate exciting potential for future advancements in assisted reproductive technology.

Science and innovation have been at the forefront of assisted reproductive treatment success and will continue to drive IVF innovations into the future. Genea is proud to have been such an integral part of many of these advancements and excited to be at the forefront of IVF innovations into the future.

References

Al-Zubaidi U, Adhikari D, Cinar O, Zhang QH, Yuen WS, Murphy MP, Rombauts L, Robker RL, Carroll J. Mitochondria-targeted therapeutics, MitoQ and BGP-15, reverse aging-associated meiotic spindle defects in mouse and human oocytes. Hum Reprod. 2021 Feb 18;36(3):771-784. doi: 10.1093/humrep/deaa300.

Braun E. Mitochondrial replacement techniques for treating infertility. J Med Ethics. 2024 Feb 21:jme-2023-109660. doi: 10.1136/jme-2023-109660. Epub ahead of print. PMID: 38383152.
Cobo A, Diaz C. Clinical application of oocyte vitrification: a systematic review and meta-analysis of randomized controlled trials. Fertil Steril. 2011 Aug;96(2):277-85. doi: 10.1016/j.fertnstert.2011.06.030.
Cobo A, de los Santos MJ, Castellò D, Gámiz P, Campos P, Remohí J. Outcomes of vitrified early cleavage-stage and blastocyst-stage embryos in a cryopreservation program: evaluation of 3,150 warming cycles. Fertil Steril. 2012 Nov;98(5):1138-46.e1. doi: 10.1016/j.fertnstert.2012.07.1107. 

Kasaven LS, Marcus D, Theodorou E, Jones BP, Saso S, Naja R, Serhal P, Ben-Nagi J. Systematic review and meta-analysis: does pre-implantation genetic testing for aneuploidy at the blastocyst stage improve live birth rate? J Assist Reprod Genet. 2023 Oct;40(10):2297-2316. doi: 10.1007/s10815-023-02866-0. 

Gudapati S, Chaudhari K, Shrivastava D, Yelne S. Advancements and Applications of Preimplantation Genetic Testing in In Vitro Fertilization: A Comprehensive Review. Cureus. 2024 Mar 31;16(3):e57357. doi: 10.7759/cureus.57357.
Kirkegaard K, Agerholm IE, Ingerslev HJ. Time-lapse monitoring as a tool for clinical embryo assessment. Hum Reprod. 2012 May;27(5):1277-85. doi: 10.1093/humrep/des079. 

Letterie G. Artificial intelligence and assisted reproductive technologies: 2023. Ready for prime time? Or not. Fertil Steril. 2023 Jul;120(1):32-37. doi: 10.1016/j.fertnstert.2023.05.146. Epub 2023 May 18. PMID: 37210064.
Mauro Cozzolino, Gustavo Nardini Cecchino, Juan Antonio Garcia Velasco, Nuria Pellicer, Daniela Galliano, Antonio Pellicer, Preimplantation genetic testing for aneuploidy is not related to adverse obstetric and neonatal outcomes in singleton pregnancies, Human Reproduction, Volume 38, Issue 8, August 2023, Pages 1621–1627, https://doi.org/10.1093/humrep/dead123

Murase Y, Yokogawa R, Yabuta Y, Nagano M, Katou Y, Mizuyama M, Kitamura A, Puangsricharoen P, Yamashiro C, Hu B, Mizuta K, Tsujimura T, Yamamoto T, Ogata K, Ishihama Y, Saitou M. In vitro reconstitution of epigenetic reprogramming in the human germ line. Nature. 2024 Jul;631(8019):170-178. doi: 10.1038/s41586-024-07526-6.

Pribenszky C, Nilselid AM, Montag M. Time-lapse culture with morphokinetic embryo selection improves pregnancy and live birth chances and reduces early pregnancy loss: a meta-analysis. Reprod Biomed Online. 2017 Nov;35(5):511-520. doi: 10.1016/j.rbmo.2017.06.022. Epub 2017 Jul 10. PMID: 28736152.

M A Riegler, M H Stensen, O Witczak, J M Andersen, S A Hicks, H L Hammer, E Delbarre, P Halvorsen, A Yazidi, N Holst, T B Haugen, Artificial intelligence in the fertility clinic: status, pitfalls and possibilities, Human Reproduction, Volume 36, Issue 9, September 2021, Pages 2429–2442, https://doi.org/10.1093/humrep/deab168

Rienzi L, Gracia C, Maggiulli R, LaBarbera AR, Kaser DJ, Ubaldi FM, Vanderpoel S, Racowsky C. Oocyte, embryo and blastocyst cryopreservation in ART: systematic review and meta-analysis comparing slow-freezing versus vitrification to produce evidence for the development of global guidance. Hum Reprod Update. 2017 Mar 1;23(2):139-155. doi: 10.1093/humupd/dmw038.

F Spinella, F Bronet, F Carvalho, E Coonen, M De Rycke, C Rubio, V Goossens, A Van Montfoort, ESHRE PGT Consortium data collection XXI: PGT analyses in 2018, Human Reproduction Open, Volume 2023, Issue 2, 2023, hoad010, https://doi.org/10.1093/hropen/hoad010

Disclaimer: Please note that this is a Genea Group blog and as such information may not be relevant for all clinics. We advise that you consult clinics directly for further information. 

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