The field of reproductive medicine has seen incredible advancements over the years, transforming what’s possible for individuals and couples facing infertility. 

Here are some of the key breakthroughs that have changed the landscape of fertility treatments:

1. Intracytoplasmic Sperm Injection (ICSI):

In 1978, the first successful IVF revolutionized the treatment of infertility attributable to female conditions. However, it was ICSI, first was utilized in 1992, that shifted the paradigm for severe male factor infertility. While even IVF couldn’t work unless millions of sperm were available, with ICSI, only 1 sperm is needed for each egg.

2. Blastocyst culture:

Until the mid 2000’s, multiple embryos were routinely transferred 2-3 days after fertilization because it was difficult to consistently keep them alive in the laboratory beyond that point. Embryos transferred that early are less likely to implant for numerous reasons. With advances in laboratory techniques and equipment, environmental controls, and standardized culture media, embryos can now be kept viable until day 7 in the best labs, allowing embryologists to identify the healthiest blastocysts.

3. Vitrification:

Otherwise known as ultrarapid freezing, this technique came into routine clinical use around 2010. With a combination of biochemical methods and plunging into liquid nitrogen, vitrification results in a glass-like state within the cells and the avoids damaging ice crystals. Compared to the prior technique of “slow freezing” which had a relatively low embryo survival rates of 70-80%, vitrification results in survival rates of 95-99%. Embryos can be confidently frozen and cryopreserved indefinitely. This revolutionary technique was also responsible for…

4. Egg freezing:

Because egg survival after the legacy freezing techniques was so poor, until 2012, egg freezing was an considered an experimental procedure, limited to patients facing immediate loss of ovarian function due to treatment of cancer or other serious conditions. However, the advent of vitrification shifted the paradigm, dramatically improving of oocyte cryopreservation, making it immensely more viable, and now routinely available. Egg freezing has been a game changer for many.

5. Preimplantation genetic testing (PGT):

A technique that was first successfully performed in the early 1990’s, innovations in PGT continue to rapidly improve, allowing us to test for aneuploidy (PGT-A), chromosomal structural rearrangements (PGT-SR), and monogenic diseases (PGT-M). Emerging techniques include polygenic disease screening (PGT-P), and non-invasive PGT-A. While not without controversy, in our era of genomic medicine, the future of PGT is one of the most intriguing areas in the field.

And for honourable mention…we couldn’t leave out AI. Computer vision and “narrow AI” has already been in use for a few years, helping embryologists grade embryos, select sperm, and predict egg quality. However generative AI is penetrating our field, helping us better prognosticate, counsel, and treat patients. We can only imagine what the next few years will bring.