The field of in vitro fertilisation (IVF) has seen significant progress over the past thirty years, with success rates steadily increasing. Recent research holds promise for further improvements, yet certain barriers, particularly outdated legislation, continue to hinder progress. Here, we explore the latest developments in IVF research, the challenges posed by current laws, and how individuals can enhance their chances of a successful IVF experience.

The advent of IVF in 1978 marked a pivotal moment in family planning for couples facing infertility. Since then, the birth rate from IVF procedures has risen from 8% in 1991 to 22% in 2021. As more individuals, particularly older adults, turn to IVF to build their families, there is mounting pressure on researchers to advance the technology further.

However, advancements in fertility technology are not advancing as rapidly as hoped, partly due to restrictive laws. In the UK, regulations from 1990 still govern IVF research, while the US faces a complex array of state-by-state regulations that limit research options. In this special feature, we examine how these legal constraints are impeding progress, potential solutions on the horizon, and practical steps individuals can take to improve their IVF success.

**Outdated Legislation Impeding Research**

During the 1980s and 1990s, IVF technology was new and met with significant stigma. Although much of this stigma has dissipated, the restrictive legislation from that era remains in place, slowing research and innovation. The British Fertility Society (BFS) is advocating for legislative updates to enhance research capabilities. According to Marta Jansa-Perez, PhD, Director of Embryology at Bridge Clinic London, current laws severely limit the use of embryos for research. "There are many talented researchers who lack sufficient material due to these restrictions," she explains. "Updating the laws to allow broader consent for generic research could significantly advance our understanding of embryo development."

In the US, the situation is equally challenging. A 1996 amendment restricted federal funding for embryo research, and only five states permit such research outright, with another 13 allowing it under vague regulations. Of the many unused frozen embryos, only 2.8% are available for research. Experts argue that utilizing these embryos could lead to higher IVF success rates and healthier babies. Yet, until legislative changes are made, progress will remain slow.

**Promising Directions in IVF Research**

In the absence of ample embryos for research, scientists are exploring alternative approaches. For instance, trials are investigating the impact of nutritional supplements and sound waves on sperm motility. However, the effectiveness of these methods in improving IVF success rates remains uncertain. Jansa-Perez notes that while some new technologies and lifestyle changes show promise, they often lack comprehensive evidence. "Many products are marketed with limited research backing them," she warns. "Patients desperate for better results might be led to invest in these products prematurely."

One exciting development is the use of artificial intelligence (AI) for embryo selection. AI could reduce subjectivity and increase success rates by automating and standardizing the selection process. "If we can make this process more objective and efficient, it could be a game-changer," says Jansa-Perez. However, she acknowledges that more research and trials are needed to validate these systems fully.

**The Future of Fertility: In Vitro Gametogenesis (IVG)**

Another revolutionary area of research is in vitro gametogenesis (IVG), which aims to create reproductive cells from somatic (non-reproductive) cells. This technology could potentially "revert the biological clock" and offer new options for same-sex couples and those with fertility issues. However, IVG is still in its early stages, with most research conducted on animal models. Kassie Bollig, MD, FACOG, points out that while IVG holds promise, it also faces significant regulatory and ethical challenges. "The technology is advancing rapidly, but so are the ethical and regulatory issues," she notes.

Researchers in Japan are working on IVG using mice, and Katsuhiko Hayashi, PhD, from Osaka University, anticipates the possibility of creating a human egg in the next 5-10 years. Nevertheless, many questions remain regarding the feasibility and ethical implications of this technology.

**Enhancing Your Chances of Successful IVF**

In the absence of groundbreaking scientific advancements, individuals can take proactive steps to improve their chances of a successful IVF outcome. Recent research highlights the importance of maintaining a healthy lifestyle, including:

- Keeping a moderate body mass index (BMI)
- Following a balanced diet
- Taking folic acid supplements
- Engaging in moderate exercise
- Staying up-to-date on vaccinations
- Avoiding tobacco and alcohol
- Managing stress levels
- Steering clear of harmful chemicals

Additionally, racial disparities in IVF success rates are a concern. According to the Human Fertility and Embryology Authority (HFEA), Black and Asian individuals have lower birth rates following IVF, influenced by factors such as age, health conditions, and socio-economic factors. Jansa-Perez advocates for a cultural shift to address these disparities and improve access and support for diverse populations.

Age remains a critical factor in IVF success. As women age, the likelihood of a successful IVF cycle decreases significantly. Early awareness of fertility status and options can empower individuals to make informed decisions. For example, an ovarian reserve test can provide valuable insights into a woman's remaining egg supply.

In summary, while IVF research faces challenges due to outdated legislation and ethical dilemmas, there are promising developments on the horizon. By adopting healthy lifestyle practices and staying informed about fertility options, individuals can enhance their chances of a successful IVF experience.