For all of us in this field, and in particular patients affected by subfertility, these are really exciting times! A recent headlining feature in Time magazine demonstrates this. It appears that we could really be just around the corner of several groundbreaking breakthroughs that may have remarkable impacts on fertility treatments and the prevention of genetic conditions, as well as influencing other areas of medicine too, when it comes to disease prevention and control.
Science is working to allow women to have their own genetic children, such as those with premature ovarian failure, for example, that may otherwise not have been able to. Techniques to improve embryo diagnosis are being developed that will minimise any risk to the developing embryo and will provide highly accurate results. There may even be potential to assess egg competency and viability by analysing the surrounding cumulus cells of an egg, to predict which ones may do best following fertilization. And whereas previously abnormal embryos may have been discarded and not used to achieve pregnancy, it may be possible to perform genome editing to repair these abnormalities and allow implantation of the new embryo.
It’s now appearing possible to culture and mature follicles that contain eggs, outside of the body and preliminary models of egg-producing artificial ovaries have already been reported and it’s seeming as if it may be possible to reprogramme certain cells in animal models to create eggs and sperm. Some scientists believe they may be able to do that in humans too using, for example, bone marrow stem cells. But really importantly, what research is also demonstrating is that cells within the ovary that stop being able to produce eggs (what we call cell quiescence) may undergo internal epigenetic changes that stop them from being able to do so. And as we’re seeing, epigenetics is emerging as a red hot topic at the moment indicating that our lifestyle choices now can determine the health and possibly even fertility of our future children and their children, by being able to reprogramme certain genes. Studies in men also suggest that lifestyle choices they make can impact on sperm and subsequently the health and fertility of their offspring too. It’s also becoming clearer that it’s the ovarian microenvironment that the eggs are found in, which may influence the viability and potential of those eggs, so if this could be altered or replaced, perhaps this would restimulate the cells capable of egg production?
There is no doubt that many of these developments will expand women’s and men’s reproductive lifespans. And societal changes will follow, as we are already seeing, with the fastest rising age group having children being women over the age of 40. But, at what cost will some of these changes come at? Medical complications of pregnancies will not only be more common but, at times, also more severe, due to increasing chronological age at which women become pregnant. And preventing these complications will add more pressure on women to be as fit and healthy as possible prior to embarking on pregnancy.
But even more than this, there are serious ethical concerns that are being raised, in particular with regards to genome editing and its ability to potentially create what have been dubbed designer babies. When IVF first emerged as a technique, it was met with much scepticism, but now we face times when we stand on the cusp of potentially being able to help engineer babies that meet certain ideological criteria. And most people have an issue with this given the dangers it presents if not regulated correctly. Using these techniques to prevent serious inheritable diseases is one thing, but using the technology to enhance the child’s physical appearance and intellect is quite another. This is where science has a responsibility to itself and the public at large, to make sure it’s considered in its approach and respects the ethical principles underpinning any of this future endeavours.
There are so many new studies and innovations emerging all the time, providing us with better and better understanding of how to improve human fertility. I’ll be sharing these with you on my future blog posts, so you have direct access to this. We are living in exciting times, but as with any great human endeavour, it has to be responsible, accountable and conscientious in its approach. For now, there is plenty of research to show that lifestyle factors which we can directly impact on, can have significant effects on human fertility and their offspring, and that should be impetus enough for everyone to start investing in that from today, to make long lasting changes that your children, and their children’s children will ultimately thank you for. This is the basis of all my tips I’ll be sharing with you on my website, and I can’t wait for you to give them a go and start seeing results!