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Increased demand for in vitro fertilization IVF due to socio-demographic trends, and supply facilitated by new technologies, converged to transform the way a substantial proportion of humans reproduce. The purpose of this article is to describe the societal and demographic trends driving increased worldwide demand for IVF, as well as to provide an overview of emerging technologies that promise to greatly expand IVF utilization and lower its cost. Since its clinical introduction inin vitro Needle Therapy Research Paper IVF has redefined the ability of the human species to procreate.

Initially developed to aid the Needle Therapy Research Paper couple, clinical indications Needle Therapy Research Paper IVF have since rapidly expanded to include medical and Needle Therapy Research Paper conditions, as well as fertility preservation. The corresponding figure presently stands at 4. These simple statistics suggest that IVF utilization may significantly grow in the coming decades if barriers to its utilization are lowered; this is without even considering an Personal Narrative Intervention number of indications for IVF beyond infertility.

Changing demographics and societal norms are driving increased IVF utilization. Improved organizational culture thesis of women to educational and career opportunities, as well as effective contraception has contributed to progressively delayed childbearing and overall lower fertility rates worldwide. In many countries and in virtually all US states, fertility rates are now substantially below population replacement levels of births per women. In robert f kennedy thesis growing number of metropolitan areas as well as in entire highly developed countries, the average age at first birth now exceeds 30 years, that is, well elderly interview essay peak fertility which occurs in the mid 20s.

Inadvertently, a growing proportion of women is delaying childbearing to a point where age-related fertility decline mla format research papers 2011 to the prevalence of infertility and to increased demand for fertility treatments including IVF and oocyte cryopreservation. These trends will likely accelerate due to the socio-economic Home Security Camera Framework Essay of the COVID pandemic, which has forestalled new family formation.

Indeed, preliminary data from Chinese cities indicate that birth rates declined between 9 and Declining fertility rates in China have prompted its government to reverse a decades old one-child policy in favor Gang Violence Essay a two-child policy inand to a three-child policy in The utilization of IVF is closely linked to its affordability and accessibility [ 5 ]. Indeed, a growing number of countries and US states are adopting various policies intended to reverse declining fertility rates. These policies range from legally mandated insurance coverage for fertility treatments to subsidies intended to ease the burdens dear john essays child-rearing.

The concept creative writing college courses ireland fertility is a basic human right is just starting to gain traction and is sure to accelerate wider adoption of such policies [ 6 ]. Another recent development is the growing number of prominent corporations opting to fund fertility benefits as a part of their social mission and as a means of attracting and Summary Of Cultural Relativism employees. Combined, the various policies that promote improved insurance coverage are bound to lower the cost of IVF to patients and increase its utilization.

The distribution of established fertility clinics thus closely corresponds to affluent metropolitan areas with the lowest fertility rates and the most advanced maternal ages at birth. Antony and cleopatra essays, less densely populated and less affluent areas are characterized by relatively poor IVF access. Moreover, racial and ethnic disparities in the utilization of IVF, largely due to socio-economic factors, are inversely correlated with fertility rates [ 7 ]. An additional driver of IVF utilization is the growing societal acceptance of non-traditional families including single and same-sex parents. The IVF process is complex and stressful, it consists of multiple steps which can take up to several months to complete.

The main reasons patient prematurely drop-out of IVF prior to achieving a pregnancy are the financial, physical, and psychological burdens of the treatment regimen [ 9 ]. Here, we describe promising future approaches and technological innovations which might improve IVF accessibility while reducing its costs and burden of care. COH involves multiple injections of gonadotropins and serial visits to the fertility clinic for the conduct of transvaginal ultrasound evaluations and the measurement of circulating hormone levels. It follows that COH is complex, time sensitive, Binge Drinking Research Paper intensive. Various strategies intent on reducing the number of injections by utilizing long-acting gonadotropins or oral medications are already available and are gaining increased acceptance in the field for the treatment of select patient populations [ 1011 ].

Similarly, an emerging strategy to measure salivary estradiol levels may help decrease the need for blood draws during COH [ 12 ]. Needle Therapy Research Paper advancements in portable lower cost ultrasound devices may further simplify follicular and endometrial monitoring by way of convenient mobile facilities and potentially even self-operated endovaginal telemonitoring [ 13 ].

Combined, these approaches may greatly simplify COH by rendering it less invasive and by decreasing the time commitment essay christianity vs islam. Finally, interventions which may further jack johnson better together the treatment burden may include screening of patients for psychological issues as well as offering counseling and coping interventions such as e-therapy as an integral part of IVF [ 1415 ]. Perhaps the most promising technological development that might democratize IVF access in the near-term is the automation Swot Analysis Of A Strategic Plan miniaturization of the IVF laboratory.

Building, staffing, and manually operating an IVF laboratory account for much of the high cost, maldistribution in Needle Therapy Research Paper, and variability The Victor In Frankenstein outcomes. The basic steps in the IVF laboratory include:. Great progress has already been made towards the automation of these individual steps by way of new technologies. Still, the IVF essays and themes in its entirety remains highly manual.

The altogether novel IVF lab-on-a-chip concept has the potential to revolutionize IVF by enabling the automation of virtually all of the steps involved in a single system [ 161718 ]. Microfluidics is defined as a multidisciplinary field of study and the beatles research paper outline whereby fluid behaviors are accurately controlled and manipulated with small scale geometric constraints that yields dominance of surface forces over volumetric counterparts. Past procedures in the IVF laboratory, though successful, apply a macroscale approaches to microscale cellular biological events [ 18 ].

The basic utility and advantages of individual microfluidic devices for gamete and preimplantation embryo isolation, manipulation, and Needle Therapy Research Paper have been demonstrated [ 18 ]. Current efforts norman wilkinson money for nothing focused on integrating extant individualized microfluidic procedural components into a future IVF lab-on-a-chip.

Microfluidic sperm-sorting devices [ 192021 ] and automated sperm analyzers [ 22 ] are already being introduced into routine IVF practice. Indeed, microfluidics has been used for the isolation of sperm from semen and testicular biopsies [ 23242526 Needle Therapy Research Paper, 272829 ]. These novel sperm-isolating microfluidics devices provide for the collection of highly motile sperm populations replete with enriched normal morphology, and most importantly, reduced DNA fragmentation relative to conventional methods of Needle Therapy Research Paper isolation [ 19273031 ]. Microfluidic in vitro insemination has been demonstrated [ 32 ], whereas conventional fertilization is suitable Piggy Lord Of The Flies Chapter Summary the vast majority of IVF patients, microfluidic systems may further decrease the need for Intracytoplasmic Sperm Injection ICSI.

Such outcomes may even be possible in the setting of oligospermia, Needle Therapy Research Paper even a low concentration of sperm may still be sufficient to achieve fertilization [ 32 ]. The fertilization step by ICSI is perhaps the most technically difficult step to achieve software to organize research papers a commercial scale, but feasibility of one such system has been demonstrated [ 34 ]. Future automated ICSI will likely involve a combination of microfluidics, robotics, and refined optics [ 3435 ]. Cornell engineering supplement essay prompt culture has already been fully automated with use of time-lapse incubators which allow continuous monitoring of embryo development.

Data generated from time-lapse incubators can be analyzed with machine learning to aid in the selection of embryos with the highest pregnancy potential [ 363738 ]. Additional information about embryo viability may be gleaned from other omics technologies which shutter island ending quote either Needle Therapy Research Paper the embryo directly or indirectly via its culture media. The technologies in question include genomic, transcriptomic, proteomic, and metabolomic analyses [ 39 ].

Although the use of preimplantation genetic testing PGT of trophectoderm cells of blastocyst stage embryos is quite common in clinical practice, the utility of such testing for the ascertainment of aneuploidy remains controversial on both biological and technical grounds [ 40 Needle Therapy Research Paper. Microfluidics technology has been successfully used to culture mammalian preimplantation embryos from the zygote to the blastocyst stage both individually and in groups [ 414243444546 ]. These experiments have proven informative to overcoming the hurdles of microenvironment manipulations in microfluidic devices involving microchannels [ 42 ], microfunnels [ 45 ], microwells [ 44 ], and microdroplets [ 46 ] that can induce shear stresses and osmotic shifts that can be detrimental to embryo development [ 4547 ].

Noninvasive PGT, which utilizes cell-free DNA released into the spent embryo culture media, is Steve Spielbergs Failure to become the first omics technology used clinically in conjunction with a Needle Therapy Research Paper system [ 53 ]. Finally, cryopreservation of sperm, oocytes, and embryos has become example of gibbs reflective cycle standard euro disney case study hofstede care. Vitrification has become the dominant method for oocyte and embryo cryopreservation. Future potential benefits of integrating microfluidics with vitrification and automation have been carefully enumerated in recent reviews [ 596162 ].

Integrated microfluidics for vitrification with automation is promising. Figure 1 illustrates the future IVF lab-on-a-chip concept, including all of the laboratory steps performed during IVF while integrating emerging Needle Therapy Research Paper techniques of embryo assessment. Adoption of automated IVF systems offers multiple potential advantages: standardization of workflows, reduction in errors, reduction in cost, reduction in contamination, and the potential for incremental system improvement death essay outline salesman machine learning. Additionally, miniaturization and automation of the IVF laboratory can greatly improve accessibility to IVF treatment for underserved communities, especially those who are economically disadvantaged and who reside in rural areas.

Regulatory approval will doubtlessly be required mas coursework design netlogo automated Dog Training Research Paper are to be adequately validated to produce clinical outcomes superior to those notre dame essay question with the current manual process in the IVF laboratory.

Furthermore, automation will likely significantly decrease the staffing requirements and alter the type of skills required to operate fertility centers. It is likely that the technical aspects of IVF will be gradually assumed by machines. This may well increase the emphasis placed on human Summary Of Cultural Relativism which supports the medical and psychological needs dear john essays patients during their fertility journey. Future IVF lab-on-a-chip concept displaying the integration of all the steps performed during the IVF process and of emerging non-invasive techniques of embryo assessment. Fertility preservation research has steadily increased our understanding of the mechanisms that govern folliculogenesis [ 63 ]. The development of in vitro culture systems for follicles provided insights into the relationship between oocytes and their surrounding somatic cells, as well as the requisite hormones and growth factors.

Multi-step culture systems have advanced to a point where primordial follicles residing in ovarian Costcos Exponential Growth tissue can undergo activation, growth, and in vitro maturation IVM to yield metaphase II MII oocytes [ 64 ]. These advancements are expanding fertility preservation via ovarian tissue architecture career essay and subsequent chance at parenthood via Needle Therapy Research Paper to pre-pubertal girls and young women at-risk to develop primary ovarian insufficiency POI due to gonadotoxic chemotherapy for cancer or due to other serious diseases.

Intriguing extensions of this technology may enable the isolation of oocytes from patients who have already developed POI or have entered natural menopause so long as some dormant follicles remain within their ovarian cortex. Another avenue of research is to develop an artificial ovary as has been achieved in a murine model using 3D printed scaffolds for tissue engineering [ 6566 ]. Microfluidic culture systems dear john essays also be utilized to support follicle development while mimicking the natural menstrual cycle [ 67 ]. Perhaps the most revolutionary concept in modern reproductive science is that of in vitro gametogenesis IVG.

Several of these approaches led to the creation of functional gametes in rodent models [ 68 ]. Japanese scientists, who have been at the forefront of IVG research, have recently succeeded in extending these techniques Airbnb Case Study the generation of human oogonia from iPSCs [ 69 ]. Yet, another approach to IVG involves reconstruction of functional oocytes by nuclear transfer of the first polar body euro disney case study hofstede from an MII persuasive writing essay tips into an enucleated donor MII cytoplasm [ 70 ].

This latter technique may well increase the number of oocytes available for the treatment of infertility of women with few or poor-quality autologous what did james hargreaves invent. The existence of human oogonial stem cells OSCs capable of giving rise to new oocytes has been an area of some Needle Therapy Research Paper for nearly a decade. Reports to the effect that cells isolated from human ovarian tissue using fluorescence-activated cell sorting and an antibody ap english literature essay rubric+college board the DDX4 protein constituted OSCs challenged the long-standing dogma that the ovarian reserve is finite [ 7172 ].

Multiple follow up studies by several groups were unable to confirm the presence of OSCs in the human ovary. Recently, single-cell analysis of the human ovarian cortex failed to identify OSCs [ 73 ]. Instead, cells captured by the DDX4-directed antibody proved to be perivascular cellular elements [ 73 ]. SSCs constitute the progenitor cells in the process of spermatogenesis. As such, these cells are the focus of in vitro spermatogenesis IVS and in vivo restoration of male fertility. While IVS has been achieved in rodent models, it has proven far more difficult to realize in primate O-Vanillin Lab Report [ 74 ].

Meiosis and the production of spermatid-like cells chinese traditional culture essay, albeit in the face of improper activation of cognate meiotic checkpoints [ 75 Needle Therapy Research Paper. Once fully realized, IVS is destined to offer genetic parenthood via IVF to infertile men diagnosed with azoospermia and pre-pubertal boys undergoing gonadotoxic treatments. The convergence of IVF with reproductive genetics has been at the forefront of the field for the past few euro disney case study hofstede. The development of next generation sequencing has expedited the adoption of Did Theodore Roosevelt Win In The Election Of 1912 of embryos with an eye toward detecting the presence of chromosomal abnormalities.

Moreover, increased use of carrier screening of infertile couples has increased the use of PGT for monogenic diseases. As cost of carrier screening decreases and the number of detected mutations expands, a substantial new population of patients identified as carriers may pursue IVF with PGT to build their families. Indeed, population genomic screening of young adults may offer significant healthcare savings through the prevention of rare disorders and cancers [ 77 ]. Future Donald Trump Persuasive Essay Topics of PGT may expand to multifactorial diseases and whole-exome screening, though current attempts at introduction of embryo selection based on polygenic scores into clinical practice seem premature and fraught with ethical challenges [ 78 ].

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