10 January 2024

Professor Robert Gilchrist is a part of a bench-to-bedside research success story, innovating existing infertility treatments to offer a less invasive and cheaper alternative to in-vitro fertilisation (IVF).

Infertility affects 1 in 6 couples globally.1 According to the World Health Organization, infertility is a disease of the male or female reproductive system, defined by the failure to achieve a pregnancy after 12 months of regular unprotected sexual intercourse.

This story is part of our 10 of the Best - fourteenth edition. 10 of the Best is an annual NHMRC publication, showcasing 10 NHMRC-funded health and medical research projects. See more 10 of the Best.

Whilst assisted reproductive technologies, like IVF, are effective for some couples facing infertility, 4 out of 5 couples are unsuccessful when trying to conceive using IVF treatment.2

Professor Gilchrist, a University of New South Wales (UNSW) translational research scientist specialising in reproductive biology, says IVF is not suitable for everyone.

'Polycystic ovary syndrome, or PCOS, is the most common endocrine disorder in women and a major cause of infertility. It can be difficult to treat with IVF'.

Photo of Professor Robert Gilchrist
Professor Robert Gilchrist

A standard IVF cycle typically takes around 6 to 8 weeks. The process requires women to inject follicle-stimulating hormones for 2 weeks to stimulate egg growth before collection of mature eggs from the ovary. Women with PCOS are very sensitive to these hormones.

Professor Gilchrist, along with an international team of researchers, have improved the fertility treatment, known as in-vitro maturation (IVM).

IVM is the process of maturing eggs in a laboratory instead of inside the ovary, which removes the need for about 2 weeks of hormone injections associated with traditional IVF. IVM technology has been around since the 1960s, but there has been little progress in improving this technology.

Using funding from an NHMRC Development Grant, a scheme intended to increased rates of translation of health and medical research into commercial outcomes, Professor Gilchrist and his colleagues have improved existing IVM technology through innovation, discovering new ways to assist egg maturation outside of the body.

An international team of researchers, led by Professor Johan Smitz (Vrije Universiteit Brussel, Belgium) and Professor Gilchrist, discovered a unique way to mimic the environment inside a women’s body in the laboratory.

'This new method, called CAPA-IVM, switches off the progression of the egg for 24 hours. So [the egg] grows more slowly, and it matures more healthily. And it’s more fertile when you introduce it to the sperm. It’s giving us a longer window of time to work with the egg'.

This novel treatment is now available in the clinic at The Royal Hospital for Women in Sydney.

Professor Gilchrist says translating research from laboratory science to the clinic is incredibly challenging and rare but investing in fundamental biology research results in significant discoveries over time.

Around 15% of women who currently experience fertility issues will be eligible for the new CAPA-IVM treatment.

'The major advantage of this treatment is that it reduces the use of hormones, offering a less invasive, cheaper and quicker alternative to IVF', Professor Gilchrist says.

Whilst CAPA-IVM treatment is not suitable for everyone, it is particularly promising for women with PCOS and those diagnosed with cancer and who are seeking urgent fertility preservation.

Infertility caused by cancer treatment can have significant psychological impacts for cancer patients and survivors. While the success rates for IVM may not be as high as for IVF, it remains an important technology for women diagnosed with cancer who commonly require fertility preservation procedures.

Professor Gilchrist explains there is often not enough time for women receiving a cancer diagnosis to undergo a cycle of traditional IVF before starting their cancer treatment.

'The psychological benefit of an alternative to traditional IVF is essential to patient well-being'.

Next steps

CAPA-IVM was launched at The Royal Hospital for Women in Sydney in July 2022.

'Clinically, we are in the process of refining the procedure to improve it, identifying the suitability of certain patient groups, increasing patient and clinician awareness of the availability of the procedure, and implementing it in more hospitals in Australia and globally,' Professor Gilchrist says.

The laboratory-based research team will continue to work on improving our understanding of egg maturation both inside the body (in vivo) and inside the laboratory (in vitro) to deliver improved procedures to patients.