What to Know About the Latest Fertility Technologies
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“Assisted reproduction, or assisted reproductive technologies (RT), is a growing and dynamic field…It’s only in the last 20 to 25 years that it has become easily accessible and evolved to where the treatments result in more than half of our patients getting pregnant.”
Thomas Molinaro, MD, Clinical Assistant Professor, Department of Obstetrics, Gynecology, and Reproductive Science at Rutgers-Robert Wood Johnson Medical School
The modern era of reproductive technology began with the landmark birth of Louise Brown in 1978, the first baby born through in vitro fertilization (IVF). This groundbreaking technique, developed by Dr. Robert Edwards and Dr. Patrick Steptoe, represented a quantum leap in fertility treatments, offering new possibilities for couples struggling with infertility.
Since then, there have been many other advances, such as intracytoplasmic sperm injection (ICSI), preimplantation genetic diagnosis (PGD), and cryopreservation, that have further expanded the scope and success rates of fertility treatments.
“Assisted reproduction, or assisted reproductive technologies (RT), is a growing and dynamic field. This field is just a little over 40 years old, and for the first 15 years of its existence, it was largely just experimental achievements based out of university programs that were very small and unsuccessful. It’s only in the last 20 to 25 years that it has become easily accessible and evolved to where the treatments result in more than half of our patients getting pregnant,” says Dr. Thomas Molinaro, board-certified reproductive endocrinologist, obstetrician, and gynecologist for the Department of Obstetrics, Gynecology, and Reproductive Science at Rutgers-Robert Wood Johnson Medical School.
The necessity of fertility treatments cannot be overstated in today’s society, where many couples face challenges on their path to parenthood: “One out of six couples are going to suffer from infertility, and those are couples who are trying it on their own. Other patients can benefit from our services, such as patients in same-sex relationships, single women trying to get pregnant without a partner, and women interested in fertility preservation by freezing eggs,” notes Dr. Molinaro.
While IVF is the most well-known form of fertility treatment, it is by no means the only option available to those struggling with infertility. Treatments such as intrauterine insemination (IUI) involve placing sperm directly into the uterus to facilitate fertilization.
Dr. Molinaro notes that there are many other alternatives, including ovulation induction, where medications are used to stimulate the ovaries to produce multiple eggs. Families with a history of genetic illnesses can also benefit from genetic testing and embryo selection available in fertility clinics: “Access to care is improving at the same time that we have been able to improve the efficiency of the process and reduce the burden of care for patients,” he says.
The first thing patients need to know is that there is help: “It’s really important for patients who are struggling with infertility to know they’re not alone. The hardest part is making the first appointment. Come in and talk to a reproductive endocrinologist so you can understand your options,” Dr. Molinaro encourages. “Today’s technology can help you achieve the goal of having a healthy baby.”
Keep reading to learn about the latest technological advances in fertility treatments, as well as ethical considerations and career opportunities in this field.
Meet the Expert: Thomas Molinaro, MD
Dr. Thomas Molinaro is a board-certified reproductive endocrinologist, obstetrician, gynecologist, and clinical assistant professor for the Department of Obstetrics, Gynecology, and Reproductive Science at Rutgers-Robert Wood Johnson Medical School. He holds a master of science degree in clinical epidemiology from the University of Pennsylvania and his medical degree from the University of Medicine and Dentistry of New Jersey – New Jersey Medical School. He completed his obstetrics and gynecology residency and fellowship training in reproductive endocrinology at the University of Pennsylvania Hospital.
Dr. Molinaro’s areas of specialty include assisted reproductive technology and treatment of ectopic pregnancy. A confessed gadget aficionado, he believes the cutting-edge and high-tech resources available at Reproductive Medicine Associates (RMA) of NJ not only guide patients toward their goal of parenthood but also make his clinic second to none regarding true academic medicine.
Technological Advances in Fertility Treatments
Here are the top advances in fertility technology, according to Dr. Molinaro.
Improved Imaging Technology
One of the most significant advancements in fertility technology has been improved imaging techniques, particularly in the area of ultrasound: “Ultrasound has evolved significantly with more sophisticated imaging platforms. Now we have 3d imaging, and we’re starting to use artificial intelligence. This allows us to speed up the process of performing the ultrasounds and analyzing the images,” notes Dr. Molinaro.
Endocrine and Embryology Laboratory Efficiency and Speed
The endocrine laboratory has also undergone significant advancements in recent years, becoming more efficient and accurate. “From the laboratory point of view, there have been a tremendous number of improvements. It used to take several hours to get results. Now we can get results much faster because of the newer devices and expertly trained technicians help with ultrasound and blood work to streamline that process,” says Dr. Molinaro.
Likewise, embryology labs have undergone significant changes: “As part of the IVF process, we combine the eggs with sperm to make embryos. This field has come a long way, primarily in our ability to grow embryos. Initially, we could grow embryos for a day or two. Today, we’re growing embryos for five, six, even seven days in the laboratory,” he notes. “That allows us to select out the healthier embryos better because embryos that are capable of growing that far have shown themselves to be more competent.”
Advanced Freezing Technology
Another exciting advancement in IVF technology is advanced freezing techniques such as vitrification: “This technology, coupled with the ability to grow embryos longer, allows us the opportunity to freeze embryos with better survival rates. When we froze embryos that were only grown for a day or two, survival rates were 60 to 70 percent. By freezing larger embryos, they survive the freezing and thawing process 98 to 99 percent of the time, which allows us to preserve fertility,” notes Dr. Molinaro.
“For some patients, they are freezing embryos for the future. So a woman who is 39 or 40 can have embryos, not just to have a baby today, but to maybe have a baby in two years or to have a sibling.”
Pre-implantation Genetic Testing
Pre-implantation Genetic Testing (PGT) is a relatively new technology that has revolutionized the world of fertility: “We can perform genetic testing on embryos. We can screen for chromosomal abnormalities or for inherited diseases such as sickle cell anemia, cystic fibrosis, or Tay-Sachs disease,” says Dr. Molinaro. “At our clinic, more than 95 percent of our patients receive PGT testing.”
Genetic testing is not just to screen out problems; it can also be used to select the best embryos for implantation: “We perform genetic screening on their embryos to identify the healthiest embryo. That allows us to transfer one embryo at a time since we know that the embryo has grown five or six days in the laboratory and has shown itself to be competent,” he says.
Automation in Embryo Selection
Automation has also made its way into selecting embryos for implantation. “Our clinic is focused on the ability to select the best embryos. Most of what we do to select embryos is looking at a group of embryos under the microscope. So, a patient may have three viable embryos, and we just look to see which one is the prettiest. We’re getting a little more information with genetic testing, but now there is a growing interest in using artificial intelligence to do image analysis,” explains Dr. Molinaro. “In the IVF laboratory right now, it is all done by hand. Embryologists are sitting at a microscope, which is very time-consuming and requires a lot of training.”
One such technology, an embryoscope, takes images of the developing embryos at regular intervals without disturbing them in their culture environment, allowing for more accurate selection and better outcomes. Ultimately, the goal is to use AI or machine learning software to analyze the images and select the best embryo using data-driven decision-making.
Uterine Transplants
Though still in the early stages, uterine transplants are a promising fertility technology for women who were born without a uterus or have had it removed due to medical reasons. “It’s an incredibly complicated process. It’s a long surgery and requires antirejection medications. Not many centers are doing this type of surgery because of the complicated nature,” he notes. He also acknowledges that much research and refining is still needed before this technology becomes more widely used.
Stem Cell Treatments
Another promising technology is using stem cells to aid in fertility treatments. “There is a lot of interest in using stem cells to rejuvenate the ovaries. Women are born with all of their eggs eventually run out. That’s menopause. A woman doesn’t go from being fertile to menopausal overnight. It’s a transition that takes 12 to 15 years. As she’s getting older, the quantity and quality of eggs decrease,” Dr. Molinaro explains.
“There are a number of research projects within our company where we try to inject precursor cells to rejuvenate the ovaries. We’ve also done it with platelet-rich plasma. The results have been modest and are not really ready for prime time yet.”
Gametogenesis
Gametogenesis refers to the production of eggs and sperm. Traditionally, the process of creating embryos for IVF involves combining eggs and sperm in a petri dish. However, scientists are now exploring new ways to complete this process: “We are researching is we’ll be able to take skin cells or bone marrow from a person and transform those cells into either an egg or sperm. There’s a lot of interest, but nobody’s there yet. It will probably be at least five or ten years before we have our first in vitro derived egg or sperm,” speculates Dr. Molinaro.
AI Integration
AI technology has already been incorporated into many aspects of the world of fertility treatment. “We will keep leveraging artificial intelligence. In our field, we’re looking at new and exciting ways to leverage it not just in the laboratory, as I mentioned already, but also in patient care,” Dr. Molinaro says. “ We use AI to assist with patient communication to improve our ability to respond to patients and to identify patients who may need a different level of care.”
He continues, “We can also use AI to improve how we deliver care efficiencies so that, hopefully, patients will get a better experience. We’ll be able to measure what we do well and improve. At the end of the day, we hope it can shorten the time to pregnancy, and hopefully, more patients will walk home with babies. Today, the number one reason why a patient doesn’t have a baby is because they stop trying, not because we can’t help.”
AI is also used to help determine a patient’s best course of treatment. “There are so many different tests that we can order. We hope to leverage AI to parse those results and create a personalized plan for each patient. We have models that we use daily to predict how likely a patient is to get pregnant and how many IVF cycles they might need. Ultimately, we hope to use AI to decide who should go to IVF right away because they’re older or they are a harder case, and who can you know are better candidates for less aggressive therapies,” he notes.
Ethical Considerations in Fertility Technology
As with any rapidly advancing field, there are ethical considerations that must be taken into account when utilizing fertility technology. “Since the beginning of IVF, there has been a lot of ethical debate about the use of this technology and what it really means,” says Dr. Molinaro.
“The ethics of access to care, in particular, has become more relevant in the last few years. Many states now have mandated fertility coverage, helping to lower the financial barrier. But it is still a minority of states around the country. And you know we’re hoping that other states will come along. We believe patients should be able to access the care they need.”
Career Prospects in Fertility Technology
With the continued advancements and access to fertility technology, there is a growing demand for professionals in this field. “We have a shortage of embryologists in the United States. There are only a handful of dedicated training programs. Most of the training is done through an apprenticeship model. You get a job, work under a senior embryologist, and learn over time,” explains Dr. Molinaro. “With more and more genetic testing happening, we need laboratory technicians to be able to process the samples. We also need somebody to interpret the samples. Those are typically biostatisticians or geneticists.”
Other professionals who are in high demand in this field include genetic counselors, OB-GYNs, reproductive endocrinologists, nurse practitioners, and andrologists who do sperm preparation. “It takes a village to help these patients achieve their goals, but I think the hard work is all worth it in the end,” encourages Dr. Molinaro.
