IVF – through the looking glass

Abstract

‘Through the looking-glass’ is a metaphor often used to infer an unfamiliar or anomalous situation, an altered reality. This is perhaps a fitting representation of what human oocytes, spermatozoa and embryos experience when isolated and maintained in the artificial world that comprises an IVF laboratory. Rather than the dynamic and dark reproductive tract in vivo, the laboratory represents a strikingly foreign landscape to gametes and embryos, characterized by a polystyrene substrate, aqueous media and exposure to light. Furthermore, all culture systems employed over the past five decades have been static, in striking contrast to the continual movement experienced by gametes and embryos within the female tract. Recent developments in microfabrication, biomimetics and artificial intelligence, are, however, paving the way to replicate aspects of in-vivo physiology and anatomy that may enhance gamete preparation and selection, creating healthier embryos. Combined with potential improvements in culture conditions afforded by microperfusion, developments in new microscopies and in AI could also provide new ways both to visualize embryos and to acquire important data on their metabolic state to facilitate improved diagnosis of viability and aneuploidy. Such advancements will contribute to higher pregnancy rates, reducing time to pregnancy and reducing pregnancy loss, culminating in improved clinical outcomes.