Around 17.5% of the adult population (~ 1 in 6 worldwide) experience infertility in their lifetime (failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse due to a disease of the male or female reproductive system)1https://www.who.int/news/item/04-04-2023-1-in-6-people-globally-affected-by-infertility. Notably, a French study estimates the economic burden of infertility treatments at 70 million euros for 10.000 women2https://pubmed.ncbi.nlm.nih.gov/35428284/. In this article, Alcimed wants to give a quick overview of challenges and innovations in the field of infertility treatments and how these may reduce the risk of preterm births.
To date, there are 3 main infertility treatments available:
They are used to control hormones and stimulate ovulation. They can be used alone as first choice in cases where the cause of infertility is connected to ovulation, but they are also used combined to other treatments (IUI or IVF) to have a higher possibility of pregnancy.
A thin catheter inserts the sperm directly in the uterus to optimize fertilization. It can be used in combination with medications for ovarian stimulation. It is a first-choice treatment when the cause of infertility is unknown, it has very low risks, but the effectiveness highly depends on the cause of infertility and the woman’s age.
Mature eggs are retrieved from ovaries and fertilized by sperm in a laboratory, multiple embryos (fertilized eggs) are then implanted in the uterus. This requires two different procedures, therefore it is more invasive and has higher risks of adverse perinatal outcomes, but it is more effective. Usually, it is not the first choice of treatment, instead it is used after the failure of other methods.
There are still different unmet needs in the field of infertility treatments related to low success rate (under 50%)1https://www.sciencedirect.com/science/article/abs/pii/B9780128183090000137, especially for first treatment cycle, high risks, costs and psychological burden, which is comparable to that of a terminal disease.
Moreover, prematurity is one of the most important risks connected to infertility treatments. Preterm birth is considered such by WHO when it occurs before 37 weeks of gestation, it accounts for 10% of births worldwide and it is the leading cause of infant mortality and morbidity2https://www.who.int/news-room/fact-sheets/detail/preterm-birth.
Pregnancies happening after infertility treatments are indeed associated with a higher risk of preterm birth, due to an increase in the chances of multiple pregnancies. IVF is the one presenting higher risk, followed by IUI and then fertility drugs.
For the neonatology field, it is crucial to identify risk factors and prevent premature birth, fertility issues being one.
We have chosen to highlight 2 major innovations in the field of infertility treatments promising a lower risk of preterm birth and increased success rate.
eSET is an innovative protocol used in in vitro fertilization (IVF) where only one high-quality embryo is selected and transferred to the uterus. The process includes different steps: ovarian stimulation, egg retrieval, fertilization, embryo culture, embryo assessment, embryo selection, and finally the selected embryo transfer. Embryos selection can be done by manual inspection or paired with novel and more precise methods using artificial intelligence (AI). eSET is associated with comparable birth rate (success rate) to multiple embryos transfer whilst having lower costs and lower risk of multiple pregnancies.
Different players are positioning in AI-based algorithms for embryo selection, in particular:
Different stem cells (i.e. Mesenchymal stem cells MSCs, Ovarian stem cells OSCs and Spermatogonial stem cells SSCs) are currently under investigation.
Research groups such as Nanjing University Medical School (China), Research Institute of Obstetrics, Gynecology, and Reproductology (Saint-Petersburg, Russia), University of Pittsburgh (USA) are focused on stem-cells-based therapeutic approaches with ongoing clinical trials. These studies aim on one hand to reduce the risks and complications related to preterm birth and on the other hand to represent a valid alternative for the patients that cannot benefit from IVF, increasing success rate.
In conclusion, the development of AI-based embryo evaluating methods might make eSET the standard practice reducing preterm birth risk while maximizing success rate, overcoming the challenge of prioritizing the embryos for IVF. Also, the novel stem-cells-based therapeutic approaches might be the answer to close the gap on the unmet needs of the conventional treatments in terms of complications and low success rate. At Alcimed, we keep exploring the field of fertility and prematurity, and more globally the field of women health, to identify novel affordable solutions for the patients. Don’t hesitate to contact our team!
About the authors,
Annelisa, Healthcare Consultant in BU Milan
Giuseppe, Business Development Director in BU Milan
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