The Future of Fertility Treatments Is Here

Artificial intelligence. Prognosticating future health. Transplants from cadavers.

These innovations may sound more like a science fiction movie than real life, but believe it or not, all these advancements are already here. And they’re changing the landscape of fertility treatments.

The bad news? More unbelievable achievements like eradicating illnesses completely via gene editing are still a long way off. The good news? The success stories that already exist are pretty hope-inspiring—and the incredible technologies that have made them possible may become more accessible in the near term.

“I think the more accessible and successful some of these advancements become, the better,” says John Zhang, M.D., founder and CEO of New Hope Fertility Center in New York, who adds that he expects some of the more attention-grabbing treatments to become more available in the next decade. Here is what is on the horizon.

Uterine Transplantation

In the last few years we’ve seen major strides in the transplants of uteri from both living and deceased donors. It works like this: following the administration of fertility drugs, a patient’s eggs are harvested and fertilized and then embryos are frozen, according to Baylor Scott & White Health. The womb and cervix are then removed from the donor and implanted into the recipient, who receives immunosuppressant drugs so the organs aren’t rejected. The goal is to ultimately pave the way for a successful pregnancy with one of the stored embryos.

The treatment has made pregnancy possible for patients dealing with absolute uterine factor infertility, who up until recently had been told they’d never be able to be pregnant. In March 2018, the second baby in the U.S. was born following a uterine transplant as part of a clinical trial from Baylor University Medical Center and Baylor Scott & White Research Institute. And astonishingly, in December 2017, the first child born via a uterus transplanted from a deceased person came into the world.

In a YouTube video in which she shared her experience, one of the mothers from the Baylor trial described her experience in the delivery room this way: “The birth of my miracle baby was the best day of my life…none of this would have been possible without my donor, my amazing team of doctors, nurses, and of course the love and support from my husband and family.”

Three Biological Parents

When it comes to fertility treatments, three may not be a crowd. Zhang is one of the doctors who has successfully used a mitochondrial replacement technique (MRT) to allow wannabe parents to have a biological child without passing along illnesses, by adding a third person’s genetic material into the mix. This process swaps in mitochondria from a third person to replace ones with mutations that can cause mitochondrial illnesses like Leigh’s disease or Barth syndrome. About 10 babies have been born using the technology, Zhang says. He calls the possibility of infertile couples having their own biological children without passing along inherited diseases one of the two most exciting innovations in the field right now. (The other? Genetic editing. But more on that later.)

Two of the MRTs that have garnered the most attention are maternal spindle transfer (MST) and pronuclear transfer (PNT). Through MST, the nucleus is removed from the eventual mother’s unfertilized egg and placed into a donor egg that has had its nucleus removed, according to the Universitat de Barcelona. After that, the egg is fertilized and then develops into an embryo.

These innovations may sound more like a science fiction movie than real life, but believe it or not, all these advancements are already here. And they’re changing the landscape of fertility treatments.

PNT instead begins with two fertilized eggs: one from the mother and one from the donor. Pronuclei, the nucleus of the sperm or egg during the fertilization process, are removed from the parents’ embryo and placed into the donor embryo, with the aim of eventually leading to a healthy child,  according to a 2015 article in Bioethics titled Mitochondrial Replacement: Ethics and Identity. (Note that MRT is not performed in the U.S. and hasn’t been approved by the U.S. Food and Drug Administration.)

“This allows our doctors to help couples who want to have biological children to be able to do it with their own genetic material,” Zhang says. “It is very promising.”

Genetic Testing

Predicting the future seems like a far off idea, but genetic testing gives doctors some insight on what will and won’t lead to a successful pregnancy.

Preimplantation genetic testing (PGT), previously referred to as preimplantation genetic screening (PGS) “has really helped to increase the pregnancy success rate of patients who have suffered from recurrent miscarriages” by only using embryos that have the best chance for success, says Jane Frederick, M.D., medical director of HRC Fertility in Orange County.

This type of screening allows doctors like Frederick, whose lab was one of the pioneers of this testing, to figure out which embryos may have chromosomal abnormalities before implantation through IVF. It can also help patients who are trying to “balance their families” by letting them only implant embryos of a specific gender—for example if a patient already has three sons and would like a daughter, or vice versa. Advancements in this space have also made it possible for medical professionals to build “probes” that allow them to test for over 100 diseases that could be passed down from parent to child.

Though PGT has been around for roughly 18 years, Frederick says, it has gotten more accurate over time. Now, thanks to third generation technology it can be up to 99% effective in accurately screening embryos, she says. That’s up from about a 90% success rate 10 years ago.

More accurate PGT can help drive down patients’ chance of miscarriage, while also avoiding multiples, which can be dangerous for both parent and child. “I think the most exciting advancement in recent years is really being able to transfer back just one single healthy embryo and reduce the multiples,” which can have a high cost to society or lead to premature delivery, Frederick says.

The treatment has made pregnancy possible for patients dealing with absolute uterine factor infertility, who up until recently had been told they’d never be able to be pregnant.

Currently, PGT testing can cost thousands of dollars in addition to IVF, and not every practice has the capability for it, or the track record of doing it accurately. Increasing the accessibility of PGT is one of Frederick’s hopes for the future of fertility treatments, with PGT hopefully eventually included as part of the price and process of IVF automatically. “In the coming years, I hope [the technology] can drive the cost down, more labs are successful and there will be more uniformity with the results,” she said. “That would really be the future of our industry.”

To provide even better results, genetic testing has paired well with another cutting-edge advancement: artificial intelligence (AI). According to research published in 2018, a group of doctors did a study during which AI was used to scan images of thousands of embryos, see which ones led to a successful pregnancy, and then use that information to scan new embryos. The technology was able to accurately select the best embryos roughly 70% of the time.

“Opportunities exist to leverage artificial intelligence (AI) in IVF clinics which have adopted digital imaging as part of their clinical practice, utilizing their time-lapse datasets of many thousands of labeled images,” the study, titled Robust Automated Assessment of Human Blastocyst Quality using Deep Learning, said. “Time-lapse imaging (TLI) is an emerging technology that allows continuous observation of embryo development without removing embryos from controlled and stable incubator conditions.”

Even further down the line, the CRISPR technique could be used for gene editing that may eventually allow the tweaking of DNA so certain hereditary diseases like Huntington’s disease or cystic fibrosis are no longer be passed down. CRISPR, an acronym for Clustered Regularly Interspaced Short Palindromic Repeats, is a system that can pinpoint pieces of genetic code and edit DNA, according to the Broad Institute.

“There’s a lot of research going on the field,” Frederick says. “If someday we could figure out which gene would make you have [a specific illness] and make the gene go away, that would be a wonderful concept. We are far, far away from putting that into the standard of care, but there’s a lot of research going on in the genetic engineering field and there’s a great movement forward to figure it all out.”

The takeaway? The complete story of how these scientific advancements will play out is still being written, but the latest chapters make for exciting news for hopeful parents looking to build their families in the way that’s best for them.