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Future perspectives of fertility

The stresses and strains, trials and tribulations, expectations and disappointments that infertile couples must endure still need to be lessened. The adoption of ‘softer’ protocols for ovarian stimulation is becoming more widespread and the more patient-friendly GnRH antagonist protocol is taking over from the traditional long agonist protocol. Ovarian stimulating agents free from extraneous proteins are now self-injected from pen devices and slow-release preparations of FSH lessen the number of injections. The development of an oral preparation of FSH is proving more than a stern challenge but is, nevertheless, expected to materialise sometime in the future. Oral preparations of a GnRH analogue are maybe more of a pipe dream whereas an ovarian hyperstimulation (OHSS) free clinic is a distinct possibility. The widespread use of time lapse imaging is expected to considerably improve embryo selection for transfer and this will surely increase the use of elective single embryo transfer. A whimsical prediction for an IVF protocol in 2025 would include oral preparations of FSH and GnRH antagonist, an oral agonist trigger with a ‘freeze-all’ regimen and replacement of embryos, one at a time, in a subsequent natural cycle. More seriously, until infertility is recognised as a health problem by governing authorities, in these days of rising costs of medication and technology, not a small number of couples will find themselves childless and denied treatment simply because of a lack of funds. This prevention of a basic human right on these grounds, I find immoral and unacceptable. If we have the capability to treat, this should not be denied the patients.

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