What is the latest in IVF research? We investigate.
The past three decades have seen a steady increase in vitro fertilisation (IVF) success rates, and new research promises to push numbers even higher. But a surprising barrier stands in the way of innovation: legislation. What do the experts have to say about the obstacles, and what can individuals do to boost their chances of growing their families?
When the first healthy
baby conceived through in vitro fertilisation — IVF, for short — was born
in 1978, it marked a distinct shift in family planning
options for couples dealing with infertility. While the birth rate in 1991 was just 8%, clinical and lab
advancements brought that number up to 22% in 2021.
Most societies hold
higher birth rates as a positive sign — and as more and older individuals are
turning to IVF to grow their families, there is more pressure than ever on
researchers to find ways to increase its success rate.
Despite this,
advancements in fertility technology are slow, and not just because good
science takes time. Experts in the field say that outdated laws make it
unreasonably difficult to perform research.
In the United Kingdom,
there has been no update to legislation since 1990, and in the United States, a patchwork system of
confusing state-by-state regulations vastly limit research options.
In this Special Feature, Medical News Today looks at how legislation hinders further advances in IVF research, what some exciting ways forward might be, and what individuals can do right now to improve their chances of embarking on a successful IVF journey.
Decades-old legislation limiting new research
In the 1980s and ’90s,
IVF technology was new and heavily stigmatized. And while much of that stigma
has now subsided, the legislation written during that time’s heavy restrictions
still remain, and they stand in the way of quicker and more innovative
research.
The British Fertility Society (BFS) is campaigning to change things, but progress is
slow. Treasurer for the BFS and Director of Embryology at Bridge Clinic
London Marta Jansa-Perez, PhD, feels that updating this legislation is essential to
move IVF forward.
At present, the law is
very restrictive on the use of embryos in research. “There’s a lot of very good
researchers […] but there is a shortage of material for them,” she told Medical News Today.
“The law has to change and allow patients to consent to generic research
projects, and that would allow us to understand how embryos develop.”
The BFS is aiming to
simplify time consuming and redundant consent forms, among other issues. They
are also trying to make it easier for people to donate their embryos to
research and streamline the process labs need to follow in order to acquire
research licenses.
In the U.S., a
convoluted state-by-state system means that embryo research is only legal
in five states and
“vaguely” legal in another 13, and a 1996 amendment banned the research from
receiving federal funding.
And of the hundreds of
thousands of unused frozen embryos in storage, just 2.8% are
available for research.
Experts say that
the case for using these embryos is an overwhelmingly positive one, citing the
opportunity for higher IVF success rates and more healthy babies. But until
lawmakers can be convinced to amend outdated legislation, research will remain
slow and challenging.
Does current
IVF research show promise?
Without easily available
embryos to research, scientists often choose other avenues. A quick
search-engine query shows a myriad of trials looking at everything from nutritional supplements to sound waves meant
perk up “sluggish” sperm, but it is important to consider how much these
factors can move the needle when it comes to IVF success rates — that is, to
getting pregnant and having healthy babies.
According to
Jansa-Perez, it takes a long time to gather evidence, analyze it, and determine
how much a certain technology or lifestyle change could actually make a
difference. And sometimes, enthusiastic retailers frame promising findings as
proven results.
“There’s lots of things
coming to market with limited research, and they’re being sold to patients before
we have enough evidence,” she warned. “This is a field where we can sell a lot
of things to patients and they will buy them because they’re desperate to do
anything to increase their chances.”
One particular area of
research that excites her though? The use of AI for selecting embryos.
Routinely, clinical
embryologists select embryos based on morphology and using their own
experience. New technology using AI models might be able to reduce
subjectivity, save time, and increase success rates
“If you can make [that
process] automatic and objective, that’s a great thing,” said Jansa-Perez.
However, she noted that while the existent research excites her, we still have
a ways to go.
“I think we need to
continue developing the technology and doing proper trials to see if we can
prove that those systems actually improve how we choose embryos,” she pointed
out.
Is IVG the
way forward in fertility research?
Using AI to choose
embryos might raise success rates, but it also raises ethical questions.
According to some recent research, the technology has moved faster than the ethical,
social, and regulatory issues involved, and this might pose problems when it
comes time to getting it approved for wider use.
Another exciting area of
research threatens to completely revolutionize the landscape of IVF — but it is
also a minefield of ethical dilemmas.
The very concept
of in vitro gametogenesis (IVG) sounds space age. It aims to take somatic cells (“normal”
cells) and turn them into gametes (reproductive cells). Then, it uses these
artificial sperm and eggs to create an embryo.
“If we were able to create
artificial gametes that are healthy and viable, we might be able to revert the
biological clock,” explained Jansa-Perez. They would also provide an exciting
option for same-sex couples and people unable to produce viable eggs or sperm
of their own.
However, experts note
that this technology is far from ready and comes with a slew of potential
issues.
“There is a lot of
regulation on research involving human embryology, and most initial studies
will be forced to work with animal models,” noted reproductive
endocrinologist Kassie Bollig, MD, FACOG. “If it works here, it doesn’t necessarily mean it
would work with humans,” she cautioned.
Scientists in Japan are
currently studying this technology mice, and one of the researchers leading
these efforts, Katsuhiko Hayashi, PhD, from Osaka University, predicts they will have a human egg to
fertilize in 5–10 years, as he noted in a media interview.
But questions still
remain. “Would they fertilize and grow into embryos? Would the quality of the
embryos be good? The questions and ethical implications are endless,” said
Bollig.
For her part,
Jansa-Perez, was excited by the prospect of giving couples of all sexual and
gender identities children that are genetically related to them, but noted that
this is still far off: “It’s not for tomorrow.”
How to boost
your chances of successful IVF
In the absence of
scientific breakthroughs, is there anything people can do to increase their
changes of getting pregnant via IVF?
Lifestyle factors
According to recent research,
general healthy lifestyle practices — like eating well, exercising regularly,
managing mental health, and maintaining a moderate weight — can help. Factors
that have been linked to higher IVF success rates include:
- maintaining
a moderate body mass index (BMI)
- eating a
balanced diet
- taking
folic acid
- exercising
at a moderate intensity
- getting
vaccinated
- avoiding
tobacco and alcohol
- managing
stress levels
- avoiding
chemicals like pesticides and organic solvents.
Racial disparities
According to the Human Fertility and Embryology
Authority (HFEA) report on ethnic diversity in fertility treatment, Black and asian parents had the lowest birth rates
following IVF.
HFEA notes that age at
treatment, underlying health conditions, and economic and structural factors
are at play. However, sociocultural factors also contribute to the issue.
“There are issues with
people feeling welcomed and recognized in certain fertility services when they
see websites,” Jansa-Perez pointed out.
“I
think it requires a cultural shift from the beginning, from the [family doctor]
point all the way through.”– Marta Jansa-Perez, PhD
She also noted that
classifying people in boxes oversimplifies the issue: “We know that
particularly Afro-Caribbean women have a higher incidence of fibroids, so it’s
being aware of that, and perhaps looking at referring that population earlier
on.”
Age and awareness
Most experts agree that
the crucial factor is timing.
“Age is arguably the
most important predictor of IVF cycle response and live birth potential,” said
Bollig. And the research agrees: Birth rates gradually decline in older age groups,
with those aged 18–35 having a 33% live birth rate and 43–50-year-olds having a
rate of just 4%.
Even if you are not
planning on getting pregnant yet, being aware of your fertility status and
options is key.
As people start families
later and later, being aware of potential fertility challenges ahead of time
can empower people to make decisions that are right for them. For example, an
ovarian reserve test can tell females how many eggs they have left.
Much like in other areas
of life, when it comes to fertility, information is power.
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