Future of IVF - Presentation from the RHG Congress 2018.

1. Future of IVF
Luciano G. Nardo MD MRCOG
Group Clinical Director, RHG
Consultant Gynaecologist and Reproductive Surgeon
Subspecialist in Reproductive Medicine
Visiting Professor
School of Healthcare Science, Manchester Metropolitan University

2. Where were you 30 years ago?
1988

3. 1988 2018

4. 1988 2018

5. 1988

6. Technology
1988 – What is email?
0
100
200
300
400
500
600
700
800
900
1988 2000 2002
MillionsofpeopleonInternet
840 million users

7. Technology
1984
First Cell Phone (Motorola) 2018 Cell Phone
$3,995

8. 1988 - IVF
43%
24%
0
5
10
15
20
25
30
35
40
45
50
1995 2005
 1988: Low Preg Rate,
high multiples
 1988: No ICSI (PZD,
SZI)
 1988: No blastocyst
culture
PR/cycle *
* USA CDC data, < 35 yo

9. 2028 – A glimpse of the future

10. IVF for Infertility
IVF Improvement
0
10
20
30
40
50
60
70
80
90
1985
1990
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2010
2015
2020
2025
2028
LBR /Cycle
CDC DATA – Live Birth per Cycle Start Women <35 yo

11. IVF for Infertility IVF Improvement
TODAY 2028
80% (?)35-40%
PREGNANT
90% 10%
PREGNANT
100%

13. IVF for Infertility
Embryo Selection
 Genomics
 Metabolomics
 Proteinomics

14. IVF for Infertility
Embryo Selection

15. 2028:
IVF for Reproduction

16. Life is a genetically transmitted
disease with a fatal outcome

17. IVF for Reproduction
PGD – Prevention of Disease/Selection Traits

18. IVF for Reproduction
PGD – Prevention of Disease/Selection Traits
IVF
EMBRYO
TESTING &
SELECTION
FREEZE
“BEST”
EMBRYOS
REPLACE ONE
SELECTED EMBRYO
HEALTHY BABY

19. IVF for Reproduction
The Future
Sex for fun only?
IVF/PGT
for reproduction?

20. 2028:
Egg Freezing for Preservation of Fertility

21. Egg Freezing
Fertility Preservation
EGG
FREEZING
Freeze
Eggs
+IVF
MR. RIGHT

22. 2028:
In Vitro Derived Gametes

23. 2028:
In Vitro Derived Gametes
Indications
→ Azoospermia
→ Ovarian
failure/diminished
ovarian reserve
→ Same sex couples
→ Individual can
produce both eggs
and sperm
MEIOSIS

24. 2028:
In Vitro Maturation

25. 2028:
In Vitro Maturation
BENEFITS
 Patient friendly
 No/less gonadotropin
 Less monitoring
 Less expense
 No OHSS

26. Today:
In Vitro Maturation
Jurema MW, Nogueira Fertil Steril (2006)

27. 2028:
Changes in IVF Practice

28. 2028:
Changes in IVF Practice
 Communication via internet
 CYBER-CONSULTATION
 INTERNET ACCESS TO
CLINICAL DATA
 IVF becomes simpler/cheaper
 HOME MONITORING
 MEDICATIONS – ORAL
 IVF becomes more available for
fertile couples requesting genetic
testing and women preserving
fertility

29. Concluding thoughts
IVF 2028
 The next major discovery to
revolutionise IVF will be in the
area of embryo diagnostics
 IVF will be used increasingly for
genetic testing
 Newer techniques/medications
will make IVF simpler and
hopefully less expensive

30. The Future is exciting!