Here’s how technology transformed babymaking

Technology is changing the way we make babies. The pioneering work of the scientists who invented IVF led to the birth of the first “test tube baby” in 1978. We’ve come a long, long way since then. This week, I’ve been working on a piece about the cutting edge of IVF technologies and what’s coming next. Think AI and robots and, potentially, gene-edited embryos. My reporting has also made me think about just how much progress has been made in the last five decades. Clinicians have improved hormonal treatments. Embryologists have devised ways to culture embryos in the lab for longer. IVF clinics today offer multiple genetic tests for embryos. In recent years, we’ve had reports of babies born with DNA from three people, babies born following “IVF on wheels,” babies born from decades-old embryos, and even babies “conceived” with the aid of a sperm-injecting robot. The technology has also had a huge social impact. It has allowed for changes in the structure of families and provided more reproductive choices for would-be parents. So this week, let’s consider the technologies that have transformed babymaking. Alan Penzias, a reproductive endocrinologist at Boston IVF, has been working in IVF since the early 1990s. In those days, his lab at Yale would collect a person’s eggs, fertilize them, and culture any resulting embryos for two days, until the embryos had two or four cells. The embryos couldn’t survive any longer outside a body, so they’d be transferred to the uterus at that point. All of them. Even if there were, say, five embryos in total. Typical healthy patients could expect a live birth rate of 12% to 15%, he says. Then Penzias heard that other teams were managing to culture embryos for three days. “We thought, No, that’s not possible,” he recalls. He learned that scientists had achieved this by tinkering with the culture medium—the nutrient-rich fluid the embryos are grown in. Those three-day embryos, which had around six to 10 cells, seemed to have a better chance of resulting in a live birth. The teams culturing embryos for longer saw their success rates climb to 25% among similar patient groups, says Penzias. Again, he couldn’t believe it. “We thought they were making it up,” he says. In the years since, teams have made more improvements to culture medium. Today, most IVF embryos are cultured for five or six days—a point at which they have 80 to 100 cells. The culturing process can act a little like a stress test—the embryos that make it to day six are generally more likely to go all the way and develop into a healthy baby. Over the same period, advances in other technologies have opened up the options for what we can do with those embryos. Scientists learned they were able to freeze embryos and use them at a later date. A little over a decade ago, clinics shifted to a “vitrification” approach that rapidly cools the embryos to a glassy state. Vitrified embryos are more likely to survive freezing and thawing, so this approach quickly caught on. As a result, doctors no longer needed to transfer multiple embryos at once. This made it less likely that patients would have twins or triplets, which can increase the risk of pregnancy complications. Vitrification has also made IVF safer in other ways, including by affording patients a bit of time between fertility treatments. The hormonal treatments used in the first phase of IVF are designed to increase the production of mature eggs that can be collected. These treatments carry a small risk of a condition called ovarian hyperstimulation syndrome (OHSS), which in rare cases can be life-threatening. The ability to freeze all your embryos and use them at a later date is thought to give the body a chance to recover from hormonal treatment and reduces the risk of OHSS. And because clinics are now able to culture embryos for up to a week, they can take a few of the 100 or so cells and send them for genetic testing before freezing the embryos. People undergoing IVF can get genetic readouts of all the embryos before deciding which to implant. (It is worth noting, however, that these testing technologies are not perfect.) “Those are really radical changes, and we take them for granted,” says Penzias. These technologies have also changed the function of IVF. What was once a treatment for infertility is now used to preserve fertility. People who want to delay parenthood can opt to freeze their eggs or embryos and use them later. They might opt to transfer one embryo in a year’s time and a second several years later. “We’ve been able to empower women to be able to have much more reproductive choice and get more reproductive mileage from a single IVF cycle,” says Penzias. People who are about to undergo cancer treatments that might damage the testes or ovaries can opt to store their eggs or sperm ahead of time, too. Scientists have even been able to preserve pieces of ovarian and testicular tissue and reimplant them later, enabling recipients to have healthy babies. Today, more people than ever have access to safe IVF options that offer multiple paths to parenthood. Those options look set to expand. But if you want to find out more about the AI and IVF robots, you’ll have to read this week’s story, here! This article first appeared in The Checkup, MIT Technology Review’s weekly biotech newsletter. To receive it in your inbox every Thursday, and read articles like this first, sign up here.