IVF_TOMORROW
2020 Vision
In vitro fertilization is the foundation of Assisted Reproductive Technology. Techniques used in the lab. today would have been thought science fiction a few decades ago. Below are a few thoughts from IVF experts what they believe ART will be like in the year 2020:
Patient friendly care
IVF has become more patient friendly over the years. In the beginning, patients would have to be subjected to blood tests through-out the night to correctly determine the time of egg collection!
Nowadays the fertility drugs are safer, purer, easier to administer, more reliable -and the protocols have been refined to reduce the burden to the couple undergoing IVF. Little or no adjustment to the couples daily routine is needed.
The drug regimes or the infertile couple have reached such a high level that most specialist agree all the new developments will come from inside the laboratory and not the doctors office.
K. Dimitropoulos MD.
Omics
This year the assisted reproduction unit at Mitera introduced the new technique “metabolomics” which detects biochemical markers that are excreted from the embryo itself while cultured in the laboratory. By studying these by-products it is able to select the best embryo for embryo-transfer.
This non invasive procedure is one of a series of similar methods of the “omics” family such as Genomics-the study of the genes, Transcriptomics (the study of the expression of the genes) and Proteinomics (the study of the cellular activity to produce proteins and enzymes), that will lead us in the near future to have a clearer picture of the viability of an embryo. This will enable the embryologist to select the best embryo –with the best chance of pregnancy-for embryo transfer.
P. Karantzis MD
Microfluidics
Giles Palmer, Εμβρυολόγος
The term test tube baby was first used in the advent of in vitro fertilization treatment.
This was because fertilization and the few days outside the body were conducted in test tubes.
I remember in my early days as a young embryologist in the late 80’s, placing eggs and sperm in test tubes and incubating overnight in huge incubators.
Nowadays eggs and embryos are cultured in small volumes or droplets in specially designed “Petri dishes”. Embryos are cultured in a static way-placed in polystyrene dishes, washed in sea of culture media not at all like the moist, ever changing micro-environment of the reproductive tract.
In the future I predict that embryos will be culture in conditions similar to their natural environment which should lead to better success rates!
A new bioengineering technology, with ever increasing applications, may hold significant promise for assisted reproduction.
“Microfluidics” is the science of handling, small volumes of liquids in microscopic environments and was first used for analyzing and isolating nanograms quantities of expensive chemicals and biological products.
Often referred to as “lab on a chip, these microfluidic devices no bigger sometimes than a 2 euro coin have tiny channels, gates and pumps directing the flow a liquids just like an electronic chip directs it electronic pathways.
Now Adapted for use in the cell sciences the attention is being focused on assisted reproductive technology with promising results in animal studies regarding better fertilization and embryo development.
These devices make it possible to mimic flow of fluids in in vivo conditions-
Physiological aspects such as secretion of beneficial factors and removal of harmful toxins in a dynamic environment could see that in the future this application being used for the incubation of gametes while in the IVF laboratory culture.
Artificial Sperm! Technique could help infertile men
British scientists have created human sperm from embryonic stem cells for the first time, an accomplishment they say may someday help infertile men father children.
They claim that with some minor changes the sperm could theoretically fertilise an egg to create a child.
Within 10 years, the scientists say the technique could also be used to allow infertile couples to have children that are genetically their own. It could even be possible to create sperm from female stem cells, they say, which would ultimately mean a woman having a baby without a man..
The scientific community is divided over its merits, with campaigners questioning the ethics and fellow scientists querying its validity, despite describing the work itself as 'very important'.
The medical breakthrough, which is reported in the Journal Stem Cells and Development, is the latest from the institute, whose team earlier produced baby mice from sperm derived in a similar way.
Professor Nayernia, who is calling for a debate on the use of his breakthrough, said the sperm created was not perfect but had all the essential qualities for creating life.: "This is very amazing and very exciting. They have heads, they have tails and they move. And contain the proteins for egg activation."
In the technique developed at Newcastle University, stem cells with XY chromosomes – containing both male and female characteristics – were developed.
Within a decade such a treatment could be offered to, for example, young boys who had received chemotherapy which can leave them infertile.
Dora Botzaki, Embryologist.
IVF for Free!
In Greece 3% of all children born are by assisted reproduction.
The cost of an IVF cycle can reach 4000 euros plus the expense of the fertility drugs, which may or may not be covered by national insurance.
In Belgium the nation health service has studied the impact and burden to their budget of multiple pregnancies ( high risk pregnancies with increased chances of pre-term delivery, special post natal care..etc ) after assisted reproduction and has come to the following conclusion:
It is more cost effective to cover all the expense of all IVF cycles (Free IVF treatments) so long as only one embryo is transferred!
A couple can have as many IVF attempts (fresh and frozen single embryo transfers) for free.
In Greece, as in Europe in general, an increasing number of couples need medical assistance to begin a family. Approximately 14000 IVF cycles are preformed resulting in 3000 children being born in Greece each year.
It is a basic human right to be able to start a family and every couple that faces this problem (1 in 5 of must be supported by the state.
More and more people are seeking medical help to conceive; the greatest investment any country can do is to safeguard the next generation, particulary in Greece where birth rates are falling- and to offer without charge assisted reproduction technologies.
In the future I hope this to be true.
Dimitra Stouksi Head Midwife, Mitera IVF.
to be continued......
