Thirty Years After First IVF Baby: What Will the Future Bring

In summary, here are recent developments and related social issues that REACH’s Dr. Jack Crain said are shaping reproductive medicine:

- Reduction of multiple births. The trend toward single embryo transfers particularly for younger women is to avoid the many complications associated with multiple births. Currently, physicians routinely transfer two embryos for women that are less than 35 and often 3 for women 37 or older. The future of reproductive medicine will focus on improving techniques for growing and then selecting the best quality embryo(s).

- Cryopreservation. Science may give women of the future the ability to postpone marriage and family with new approaches like oocyte vitrification. With traditional slow-freeze techniques, the egg is stored in liquid nitrogen until it is ready to be thawed and fertilized. Now, vitrification rapidly cools the egg, which prevents the formation of ice crystals in the egg. Ice formation is dangerous because it may rupture the cell membranes causing cellular destruction. Early studies have shown improved egg survival and subsequent pregnancy rates with the vitrification process.

- Embryonic disease screening. Pre-implantation genetic diagnoses (PGD) allows physicians to screen embryos for genetic diseases, such as cystic fibrosis and Tay-Sach’s disease, prior to embryo transfer. The number of diseases detectible by PGD is growing geometrically and now numbers in the hundreds. The technique can also be used to select embryos of one gender for family balancing. It may be possible to make other "social selection" choices in the future as well. “However, as genetic testing becomes more sophisticated it poses ethical issues about creating ‘designer babies.’ And as many colleagues ask, just because we can, should we?” poses Crain.

- Future laboratory changes will include microfluidic culture chambers, proteonomic assay of culture fluids, reliable chromosome count of embryos to allow selection and reduce pregnancy loss, in vitro egg maturation in 3-D systems.