“We continue to improve the effectiveness and accuracy of the diagnosis and treatment.” – Dr. Minh Ho
Children bring immense joy and newfound purpose to their parents’ lives from the moment they arrive earthside. However, for those that struggle with infertility, the journey to parenthood can feel like a painful uphill battle with no end in sight. Infertility does not discriminate; it affects White women, Asian women, Black women, Hispanic women, rich women, poor women, thin women, and heavy women. The pain of infertility is real and valid, no matter the circumstances. Research shows us that 11% of US women and 9% of US men have experienced infertility. Medicine has come a long way in diagnosing and treating infertility with IUI, IVF, egg and sperm donation, egg freezing, and surrogacy, all providing viable paths to conception. Though infertility is discussed more openly than ever before, and fertility treatments are available, we still have a long way to go.
We asked our medical partners to answer our burning questions regarding the future of fertility treatments. We spoke with Dr. Minh Ho, Medical Director, Reproductive Sciences Medical Center, Dr. Lawrence Werlin, Medical Director, Coastal Fertility Medical Center, Dr. David Harari, CMO Reproductive Sciences Medical Center, and Dr. Magarelli of CNY Fertility.
Here is what they had to say.
Are infertility rates increasing? Why or why not?*
Dr. Minh Ho, Medical Director, Reproductive Sciences Medical Center
Infertility rates have been estimated at around 15% or 1/7 couple. It was 10% about five years ago. The reasons could be: delayed childbearing, change in lifestyle, and more effective ways to diagnose infertility.
Dr. Lawrence Werlin, Medical Director, Coastal Fertility Medical Center
Infertility rates are probably not necessarily increasing per se; it’s just that people are much better educated now as to issues that could be related to infertility. There’s much more information available for couples should they think they have a problem. They can now be better educated and determine whether or not they need care.
Dr. David Harari, CMO Reproductive Sciences Medical Center
We are seeing a global increase in fertility rates such that 15% of the world’s population will experience infertility issues. That represents a surprising 0.396% rise on an annual basis.
Dr. Magarelli of CNY Fertility
Not noticeably. [It] may go down due to COVID and social distancing.
Are fertility treatments effective?
Dr. Minh Ho, Medical Director, Reproductive Sciences Medical Center
Reports show that COQ10 and DHEA may help to improve the outcome of fertility treatment. However, the effectiveness is very marginal. We can not overcome the age factor, regardless.
Dr. Lawrence Werlin, Medical Director, Coastal Fertility Medical Center
It depends. There’s no question that antioxidants are beneficial; a healthful diet is beneficial, especially a plant-based diet. Some supplements, like CO-Q10 and DHEA, may be beneficial. However, most of the data for CO-Q 10 and DHEA are anecdotal.
Dr. David Harari, CMO Reproductive Sciences Medical Center
Supplements such as COQ10 and NMN (nicotinamide mononucleotide) have been shown to potentially improve ovarian cell function in the mouse model by influencing pathways for mitochondrial functioning.
Dr. Magarelli of CNY Fertility
There are many [effective] infertility supplements: DHEA, Inositol, Vit E, and Zinc, and indeed, Folate is beneficial to fertility.
How can we improve IVF success rates?
Dr. Minh Ho, Medical Director, Reproductive Sciences Medical Center
The sooner the patient sees the doctor, the better. The chance of success is much better at age 30 or younger. We can be more effective with PGT-A ( preimplantation genetic testing) to select normal embryos for transfer. If we have one normal embryo for transfer, then the chance of live birth delivery will be 80%.
Dr. Lawrence Werlin, Medical Director, Coastal Fertility Medical Center
Well, I think we strive every day to improve IVF success rates, and part of the way that we can do that is by addressing the two critical factors that ultimately play a role in outcomes. Those two critical factors are the embryo and the uterine lining.
Theoretically, if we can put a chromosomally normal embryo back into an environment we can control, it should increase the likelihood of success.
Dr. David Harari, CMO Reproductive Sciences Medical Center
We can increase success by utilizing genetic screening of embryos in the screening processes before embryo transfer.
Dr. Magarelli of CNY Fertility
Likely yes; however, there hasn’t been much progress in over ten years if we look at pregnancy rates per IVF cycle start—a slight decline.
Where do you see fertility treatments heading in the next ten years, 20 years, or 30 years?
Dr. Minh Ho, Medical Director, Reproductive Sciences Medical Center
We continue to improve the effectiveness and accuracy of the diagnosis and treatment. We could potentially overcome the age factor or even correct the mutation and genetic diseases of the embryo in the future. We could even not need eggs or sperm to create the embryo. The embryo will be made from the stem cells of the parents!
Dr. Lawrence Werlin, Medical Director, Coastal Fertility Medical Center
The hope is that with the newer techniques, it will be possible to use less invasive procedures to sample embryos. So rather than biopsying, we may evaluate the spent media from the embryo cultures to better assess the embryo’s chromosome makeup, becoming more popular now. Another thing that is probably well into the future is that medical care will become a much more individualized approach.
Dr. David Harari, CMO Reproductive Sciences Medical Center
Research regarding stem cell therapeutics, proteomics, glycomics, and genomic engineering.
Dr. Magarelli of CNY Fertility
[In the future, we will likely see] bloodless IVF, automated embryology lab, stem cell re-creation of sperm and eggs, and no “too old” women’s eggs; see stem cells above.
What infertility advancement are you most excited about?
Dr. Minh Ho, Medical Director, Reproductive Sciences Medical Center
The discovery of CRISPR will propel the advancement discussed above into uncharted territory. The “industry of designed babies” will be inevitable, but nothing to fear.
Dr. Lawrence Werlin, Medical Director, Coastal Fertility Medical Center
Well, I think the changes that are now occurring to evaluate the embryos better genetically and potentially cure hereditary diseases. Potentially, take an embryo and perform a crisper procedure and remove a gene sequence that may be hostile to the embryo. These things are all fascinating. And of course, the genetic influence on our specialty is very much exciting for me.
Dr. David Harari, CMO Reproductive Sciences Medical Center
We are learning about signaling processes involved in early embryo development and the endometrium to improve implantation rates and be able to non-invasively quantify and identify these signals from spent culture media utilizing nest generation sequencing.
Dr. Magarelli of CNY Fertility
[I am excited about] full genome testing of embryos, not just chromosomes and genome on a chip technology, will allow cost-effective diagnoses of preconditions for diseases in embryos.
Unfortunately, many US couples struggle to conceive, and infertility rates have increased across the board. While couples may seek medical help in the form of fertility treatments, IUI, IVF, egg and sperm donation, egg freezing, and surrogacy, these treatments are costly and come with no guarantee of a successful pregnancy.
At The Gift of Parenthood organization, we look forward to a future of more affordable and successful fertility treatment options for those struggling. In the meantime, we aim to help couples and individuals struggling with infertility achieve their dreams of becoming parents through fertility assistance grants ranging from $1,000 to $16,000, available four times a year.
Will you be our next grant recipient? Apply today.
*responses have been modified for length and clarity purposes.