A couple of years back I met a woman who had had quadruplets through an IVF program 24 years ago. I was delighted to find that all four babies were now healthy young people but amazed to find out that I had actually conducted the embryo transfer and had implanted all four embryos inside her womb.
IVF has certainly changed over the past 30 years in that things that were acceptable then are no longer practiced today – like implanting multiple embryos.
The most significant change over the past 30 years has been the improvement in IVF success rates; the clinic at which I work rarely implants more than one embryo and has a multiple pregnancy rate below 4 per cent, as compared to 40 per cent 25 years ago
About one in 25 babies being born today in Australia are born from IVF and most couples who experience infertility are not ashamed to tell their friends that they are going through an IVF procedure.
Whereas IVF may cost between US$15,000 and $20,000 for people going through treatments in parts of Asia and the United States, most people in Australia would pay less than AU$3000 of their own money for an IVF cycle, indicating that IVF is now mainstream medicine throughout our country.
So where are we headed over the next 30 years?
Intracytoplasmic sperm injection (ICSI) for treating male infertility, preimplantation genetic diagnosis (PGD) for prevention of genetic abnormalities in babies, innovative lifestyle programs for preconception care and new culture media have all stemmed from Australian scientists and research centres.
Some of the big advances in the next few decades include:
1. I anticipate that the role of the embryologist will become more and more technical as they continue to ensure that IVF programs are high quality, well managed, and work effectively and efficiently. University of Adelaide Professors Sarah Robertson, a reproductive biologist who has invented a new culture that improves IVF embryo implantation rates, and Tanya Monro, a physicist who is developing new sensing technologies for embryo selection, will make major contributions to this area as they introduce brand new technologies to the field.
2. I envisage in the future that we will be testing all embryos for a multitude of genes and also to make sure that they have all their chromosomes present – this is particularly important because missing chromosomes can result in a variety of impairments. New technology developed at a company called Reproductive Health Sciences promises to revolutionise the practice of choosing embryos in an IVF cycle.
3. During IVF patients have to go through many injections and, although there have been recent advances to minimise these, it will only be with the introduction of orally administrated drugs that stimulate the ovary that we will find IVF becomes much more tolerable. These types of drugs are already in development and under clinical trials.
4. Work in Adelaide and the rest of the world promises to revolutionise our understanding of what is a healthy womb and new sensing technologies will add to our ability to check out the lining of the womb before we put an embryo back. An embryo which has been frozen has a healthier outlook and so this may lead to all transfers being frozen embryos that have been genetically tested.
5. The big ethical questions of our day are in two areas. The first is in so-called ‘reproductive tourism’ where procedures that are banned in Australia can be obtained in other countries overseas. This includes anonymous egg donations, paid surrogacy, sex-selection of the embryo and other similar procedures.
The second area is in the question of interfering in the internal environment of the embryo such as adding mitochondria to the cytoplasm to improve the ability of older eggs to produce babies. In addition there are a host of new technologies in animals that can produce better offspring and the challenge is how much we will allow this to creep into our human embryology.
There has been a huge change in Australian IVF in the past decade in that university-owned clinics, as well as those owned by doctors, have rapidly been swept up by private equity as part of the commercialisation of the IVF arena. IVF as a splendid technology should be open to all strata of society, even those who struggle to pay for basic medical necessities, and not restricted to the elite, rich couples.
While Medicare has been very proactive in providing funds for IVF, every clinic in the country charges a gap which the patient has to pay. We should ensure that all members of society should have access to this wonderful innovation in reproductive science.
Professor Norman will be one of the presenters about the past, present and future of IVF at tonight’s free public event – Celebrating 30 Years of IVF in South Australia – to be held at 5.30pm in Elder Hall, North Terrace Campus, University of Adelaide. For more information and to RSVP visit the website or call 08 8313 8222.
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