Present and futuristic developments in fertility treatment | Dr N Layyous

Present and futuristic developments in fertility treatment

Nowadays fertility care is undergoing one of the most transformative periods in its history.

These advancements are improving success rates and makes treatment more individualized.

What is the importance of having these new advances:

• Make treatment less invasive
• Make treatment accessible

This article explores the most recent significant developments reshaping the future of fertility treatment.

Some advances of the present and future researches are:

1. To obtain eggs from the woman’s ovaries and freeze them for future use. 
2. taking part of the ovary containing immature eggs and freeze it, so that when the need arises maturing of the eggs is carried out in the laboratory.

 Using new methods to freeze the eggs that improve their survival rate after thawing, such as ultra-rapid vitrification and artificial intelligence-assisted freezing protocols.

These freezing processes could help the women who are at risk of losing their fertility as a result of exposure to radiation (during radiotherapy treatment) or chemotherapy.

3. To make improvement of the culture media used for growing the embryos in the IVF laboratory to reach the blastocyst stage (five days after fertilization) where the best embryos are selected, one or two embryos transferred to the uterus, consequently chances of pregnancy and success rates are increased without the need for transferring many embryos with risks of multiple pregnancy.

4. The advances in computer technology have enabled choosing the best sperms for doing intracytoplasmic sperm injection by a method called keiss method where the computer chooses the best sperms for use avoiding the human error factor thereby improving the success rates.

5. The use of artificial intelligence in fertility treatments:

** many AI models are being used for diagnosis and treatment.

** some models are used to predict which embryos have the highest implantation potential.

** there are models to predict live-birth success

** some models are used as tools to detect sperm DNA fragmentation

** Time-Lapse embryo monitoring (continuous imaging) combined with AI for embryo grading.

6. The use of stem cell for ovarian support:

Using pluripotent stem cells to create ovarian support that helps with egg maturation outside the ovary, leading to much lower hormone doses and shorter durations for stimulation

The use of stem cells to rejuvenate the ovaries to help women with weak ovaries.

The use of stem cells to rejuvenate the endometrium to help women with thin lining.

Stem cell research

is still confined to laboratories but it is greatly promising where it could be taken from the boys before maturity then frozen to be reimplanted (could be used for those boys who are going to be subjected to chemotherapy). And it will be helpful for infertile men by triggering the stem cells to produce sperms.

7. Uterine Receptivity Analysis (ERA): The use of advanced testing to determine the best day during which the endometrium is in its highest receptivity for embryos.

8. Microbiome-Based Treatments: testing the microbiome of the vagina and uterus to ensure having appropriate environment for embryo implantation.
9. In Vitro Gametogenesis (IVG): using non-germ cells (like cells from the skin) to produce eggs or sperms which helps men and women with severe infertility such as premature ovarian failure and azoospermia.

10- using splitting cells instead of sperms.

This method is still under research. The idea is that the 46 chromosomes present in human cells, 2 of which are sex chromosomes. In the women two XX chromosomes and in the man, XY chromosomes. When the egg from the woman (containing 22 +X chromosome) fuses with the sperm from the man containing either 22 +X or 22 +Y chromosome fertilization occur, so it could be possible to use any cell from the man’s body, such as blood cell, for example, split it in the lab and each half could be used (which contain half the chromosome number) to inject inside the egg’s cytoplasm using intracytoplasmic sperm injection method, which will solve the infertility problem for men with no sperms in their seminal fluid or testicles.

11-Using techniques that correct genetic abnormalities (gene editing) in the embryos before transferring them into the uterine cavity.

12-Artificial Wombs (Ectogenesis): developing external environments that mimic the inutero atmosphere thus supporting the growth of the embryo outside the uterus and supporting it till term.

where special plastic incubators are used to provide the suitable atmosphere for the growth and development of the fetus until maturity, the fetus takes what is needed whether for nourishment or oxygen and completely grown in the artificial uterus. This might be useful for prematurely delivered fetuses or for those women where pregnancy endangers the woman’s life or in those who congenitally the uterus is absent or women with uterine abnormalities.

13-Intra uterine culture of embryos

This method is still under research where the gametes (eggs and sperms) are put in a special container made from a dissolvable material and then transferred inside the uterus for the material to dissolve in one week to release the embryo inside the uterus at the same time naturally needed to be in the uterus. The difficulty is in finding the proper material for the purpose without being rejected by the uterus.

14-Robotic assisted procedures: using robots to perform certain procedures and sometimes surgeries.

There is a legal and ethical dimension to a number of technologies, and therefore some technologies may not be acceptable in some countries, but this does not negate the fact that they are useful in a number of cases.

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist