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The 2016 Fertility Landscape

The 2016 Fertility Landscape

What developments are on the horizon in the world of fertility and IVF

The world of fertility and IVF treatment is constantly evolving, with new advances hitting the headlines on a regular basis. So what are the newest techniques or technologies that we can expect to hear more about in 2016 and beyond?

The use of frozen tissue

Now: The technique of freezing tissue to be transplanted in later life as a method of preserving fertility still remains an experimental technique that has only really come to the fore in the last few years. However, the first birth from such a technique using frozen ovarian tissue was reported in 2004 and there have been a number of births since.

This method continues to give hope to those undergoing treatments such as chemotherapy which may damage their future fertility prospects. A 9-year old boy recently hit the news for having testicular tissue frozen before undergoing chemotherapy and radiotherapy. In 2015, a woman gave birth after doctors restored her fertility using frozen ovarian tissue removed before she underwent chemotherapy age 13.
Developments in Fertility

In the future: At present the standard fertility preservation technique is egg and sperm freezing. This is considered the most effective form of preservation, and advancements in technology mean that survival after thawing has greatly improved. Egg and sperm freezing are therefore the most ideal form of fertility preservation. However, scientists are hoping to continue to expand the usage of tissue freezing to help those where egg or sperm freezing is not suitable. For very young patients or those who are severely time limited due to medical reasons tissue freezing may one day give the best chance of fertility preservation.

Womb transplants

Now: Doctors and scientists have been working to perform successful womb transplants for several years now, and a number of women have been the recipients of a donated uterus. The first live birth from a donated womb was recorded in 2014 and in September 2015 a Swedish woman, who lost her uterus to cancer, received her mother's womb in pioneering transplant and fell pregnant via IVF before giving birth to a healthy baby boy.

In the future: This technique will continue to be perfected and expanded upon as a method of helping women who were either born without a womb or who have lost their womb to diseases like cancer. There has also been a suggestion that uterus transplants could be used to help transgender women and even men in same-sex relationships who wish to have a child. However, there are complex ethics surrounding this and whether it would be justifiable to subject somebody to such surgical intervention unless it is strictly necessary.

Three parent babies (and mitochondrial donation)

Now: In February 2015, the law in the United Kingdom was changed to allow mitochondrial donation for parents carrying mitochondrial disease.
Fertility-breakthroughs

Mitochondrial disease is where the body's cells do not produce enough energy for the cell. Sometimes they do not work at all, and sometimes they are not very efficient. If a cell does not get enough energy it cannot function properly and this can cause problems in any organ, with any degree of severity, at any age.

As a result of this legal change, those who have mitochondrial disease can undergo IVF and produce embryos, and then healthy mitochondria from a donor is introduced into the embryo. The donor's mitochondria replaces the existing faulty mitochondria so that the resulting baby does not inherit the mitochondrial disease. While this means that a baby born as a result of this method will have DNA from three different people, the mitochondrial DNA is not responsible for producing any individual traits.

In the future: The current use of this technology is limited strictly to those who suffer from medical conditions linked to mitochondria. It has the potential to eliminate these conditions.

Creating eggs and sperm (in-vitro gametogenesis)

Now: Scientists are working on techniques which would allow men and women to grow gametes (reproductive cells) from stem cells. Embryonic stem cells are those cells which are able to turn into any cell in the body given the right environment, meaning that these could theoretically be turned into sperm or eggs. As yet this technique is very new and has currently only been tested on mice.

In the future: If this technology was advanced to the point where it could be used routinely with humans, it could help many different people have children – even those who are currently unable to produce eggs or sperm. One of the possible uses is with same-sex couples, who could potentially have children genetically related to both of them, as this technology would allow any cell to be turned into a sperm or an egg.

by Professor Dr Geeta Nargund, Medical Director, CREATE Fertility
February 2016

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