Philadelphia, October 5, 2023 – Reproductive endocrinology and infertility (REI) has finally come of age, moving beyond the "basics," limited accessibility, and thorny initial issues. A special issue of Fertility and Sterility®, published by Elsevier, explores the past, present, and future of REI, nearly five decades after the first in vitro fertilization (IVF) baby, Louise Brown, was born in 1978.
Entitled Reproduction as the Foundation for a Healthy Society, the issue presents expert perspectives on achievements, opportunities, and challenges as this rapidly growing discipline advances its contribution to medical care and the building of heathy societies around the world. The contributions are openly available so that information and insights are accessible to all practitioners and patients.
Ten million overwhelmingly healthy babies have been born since IVF was introduced. In some countries as many as 9% of births have been achieved through IVF. The 1 in 8 people who face infertility are now able to realize their dreams of having children, however, access to REI care still remains a challenge. For REI to take its place as a core specialty in medicine, ethical, societal, legal, and economic implications of the technology need to be better understood to reduce barriers to broadening care to those who need it.
Guest Editor, Kurt T. Barnhart, MD, MSCE, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, and Editor-in-Chief of Fertility and Sterility, explained, "We are now into the third decade in the 21st century, and a tension remains between societal obligations and the reproductive medicine we practice on a daily basis. This is evident by dramatically increasing media attention on REI's impact on the society. It is only right the REI returns the favor through publication of this special issue."
Guest Editor Ruben Alvero, MD, Fertility and Reproductive Health, Lucille Packard Children's Hospital, Sunnyvale, California, and Department of Obstetrics and Gynecology, Stanford University School of Medicine, elaborated, "In recent years, many for whom parenthood was previously unachievable have become beneficiaries, including individuals facing gonadotoxic therapy or other medical complications, as well as those in the LGBTQ+ community. Still, access to care remains a challenge for varying populations within societies and for currently underserved regions of the world."
The issue's content focuses on important considerations and specific aspects of the field, with many articles presenting strategies to bridge the gap between societal obligations and the practice of reproductive medicine.
Important topics and recommendations that emerge from this collection include:
- Significant collaboration among professionals, organizations, the World Health Organization, and policymakers has begun, but much more will be necessary to achieve these goals.
- The alternatives to IVF are summarized including up-to-date evidence on effectiveness, safety, and cost-effectiveness (expectant management, intrauterine insemination, tubal flushing, in vitro maturation and intravaginal culture).
- With rapidly growing demand, a supply-demand mismatch is anticipated for the REI workforce. The shortage of physicians, laboratory staff, and ancillary providers can be addressed through technology in the laboratory and the employment of advanced practice providers (APPs) in the clinic.
- Low-cost assisted reproduction will continue to develop to help those most underserved. Technical advances in the IVF laboratory will be achieved as computational, nanotechnological, microfluidic, and process advances are made. This automation will facilitate access to care, although training technicians remains a challenge.
- Better preconception care and interventions are explored as well as the value of preimplantation genetic testing to reduce the potential risk of passing on inherited medical conditions.
- The impact of reproductive endocrinology and infertility medicine on the current and future health of babies and parents and the greater population is addressed.
- Ovarian aging remains one of the most critical clinical challenges. Many would-be parents do not decide to reproduce until reaching the age when it is difficult or impossible -- without having preserved their eggs for a host of reasons.
- The destiny of possibly up to a million cryopreserved embryos worldwide is an emerging concern as their originators pass out of the reproductive stages of their lives. How these embryos could aid in research and used for reproductive purposes for third-party individuals are considered, however, mechanisms for achieving these transfers are as yet poorly developed.
Robert J. Norman, MD, Robinson Research Institute, Adelaide Medical School, University of Adelaide, concluded, "REI has matured as a field and is now poised to broadly expand in a greater number of communities. While there were many reservations in lay and even some medical communities at the onset of assisted reproduction, acceptance of the field is now widespread, save for a relatively small number with continuing ethical concerns. Communities throughout the world have embraced the benefits of reproductive medicine in helping people achieve their goals and preserve their dreams of family."
