ART NOW: The evolving landscape of assisted reproduction
Assisted reproductive technology (ART) sits at a pivotal point in its evolution. Clinical success rates are continuing to improve, laboratory techniques are increasingly sophisticated, and new technologies are reshaping how fertility care is delivered. Yet beneath this progress lies a more complex reality: the pace of innovation often exceeds the pace of evidence, patient expectations are shifting in ways that influence clinical decision-making, and the field faces ongoing challenges in ensuring safety, quality, and transparency. IBSA ARTiculate 2025 set out to explore how scientific developments, laboratory practice, patient expectations, and regulatory constraints converge to shape the current landscape of assisted reproduction.
Finding the balance between innovation and evidence
At the centre of modern ART is a delicate balance between what new technologies make possible and what clinical evidence currently supports. In recent years, an expanding range of tests, treatments, and adjuncts has entered routine in vitro fertilisation (IVF) practice, often driven by plausible biological rationale or early observational findings. Some of these developments offer genuine clinical value; others remain unproven, highlighting the need for cautious interpretation of emerging innovations.
Add-ons are a clear illustration of this challenge.1 Despite widespread use, systematic reviews repeatedly show that many commonly offered interventions, including time-lapse selection,2 endometrial scratch,3,4 immune therapies, and various supplements,5 do not reliably improve live birth rates.
The regulatory framework has struggled to keep pace with this expanding landscape. While the Human Fertilisation and Embryology Authority (HFEA) provides guidance,6 it cannot prevent the availability of interventions despite limited evidence, especially as more patients receive treatments across multiple clinics or outside the UK and Republic of Ireland. As a result, clinicians are required to navigate emerging technologies, uncertain evidence, and regulatory limitations while maintaining a cautious, evidence-led approach.
The difficulty of generating high-quality evidence in ART contributes to this landscape. Small sample sizes, diverse patient populations, and the biological complexity of reproduction make definitive trials challenging.7 Meanwhile, innovation, including data-driven modelling and artificial intelligence (AI)-led approaches, is advancing rapidly,7 often faster than rigorous evaluation can occur. Bridging this gap remains central to ensuring that new developments genuinely improve patient outcomes.
How patient expectations influence the treatment journey
The absence of strong evidence does not lessen patient demand. Patients undergoing fertility treatment frequently describe an overwhelming desire to maximise their chances of success, particularly when they have already experienced unsuccessful cycles or are nearing the end of funding eligibility. In this context, add-ons such as time-lapse systems and endometrial scratch can feel like proactive steps – a way to ‘do everything possible’ – even when the IBSA Group - Public evidence supporting them is weak. The emotional drivers behind these decisions are powerful, strongly shaped by the fear of regret and the emotional weight of infertility.
This pressure is amplified by the sheer volume of information patients encounter, including testimonials, online forums, social media posts, and commercial messaging. Anecdotal stories can appear more relatable, and therefore more persuasive, than population-level data, making it difficult for patients to judge what is credible.
For clinicians, this creates a challenging communication landscape. Evidence-based counselling must not only explain the data but also recognise and address the emotional context behind patient choices. The goal is not to dismiss patient preferences, but to ensure choices are grounded in realistic expectations. Clear, consistent explanation of what is known, uncertain, and unlikely to help remains one of the most important responsibilities in modern ART. Transparent communication, realistic counselling, and guidance toward trusted evidence sources such as the HFEA can help patients to make decisions without unnecessary cost or false reassurance.
When strong evidence shapes practice effectively
One of the clearest examples of evidence improving safety in ART is the modern approach to preventing ovarian hyperstimulation syndrome (OHSS). OHSS is a well-recognised complication of IVF and can present in two forms: early OHSS, which may occur during or shortly after ovarian stimulation, and late OHSS, which may develop if pregnancy occurs.8 Early OHSS is clinically significant because it can occur before pregnancy is established and is associated with increased vascular permeability, leading to fluid shifts and potential thrombotic complications, reinforcing the importance of prevention.9 The 2025 British Fertility Society (BFS) guidelines consolidate the evidence into a practical framework for identifying patients at risk and applying effective preventive strategies.10
Risk stratification using markers such as anti-Müllerian hormone, antral follicle count, and follicular response allows clinicians to identify patients at higher risk of developing OHSS. To reduce the risk of early OHSS, the BFS guidelines recommends stimulation and triggering strategies that minimise exposure to human chorionic gonadotropin (hCG), the principal driver of OHSS. Using a short-acting gonadotropin-releasing hormone agonist for final oocyte maturation, rather than hCG, significantly reduces the risk of overstimulation.
To reduce the risk of late OHSS, freeze-all strategies are recommended in which all embryos are frozen and no fresh transfer is performed, avoiding the rise in endogenous hCG associated with early pregnancy that can trigger late OHSS. The guidelines also make clear that several commonly used adjuvants, including aspirin, melatonin, and calcium infusions, do not reduce OHSS risk and should not be relied upon for prevention.10
This evidence-based framework demonstrates how consistently applying robust data can meaningfully improve patient safety and strengthen the quality of ART practice.
The increasing importance of laboratory precision
The laboratory environment has also seen major evolution. Vitrification, the rapid-freeze method now widely used to preserve oocytes and embryos, is central to contemporary ART. IBSA Group - Public As the number of patients choosing to freeze eggs has risen sharply,11,12, particularly driven by fertility preservation, donor programmes, and the rise of social egg freezing, clinics are now managing high volumes of both freezing and warming cycles.
Vitrification, however, remains a sensitive process. Outcomes depend on factors such as oocyte quality, cryoprotectant exposure, temperature control, and operator skill. 13,14 As more patients return to use previously frozen oocytes, attention has shifted to optimising performance at the warming stage. Evidence from recent studies indicates that, compared with standard vitrification, ultra-fast warming improves oocyte survival, improving blastocyst formation rates, therefore resulting in a higher likelihood of clinical pregnancy.15,16 These developments highlight that progress in cryopreservation depends not only on new technologies but on continual improvement of established methods – an essential focus as more patients rely on stored oocytes for future treatment.
ART today reflects both remarkable progress and ongoing pressure. Patients are more informed yet exposed to conflicting information, clinicians must integrate new technologies without compromising transparency or safety, and laboratories face technical demands that require rigorous validation. Regulation provides guidance but cannot fully address variability across an increasingly globalised fertility landscape. Together, these dynamics raise an important question: as science, technology, and expectations evolve, what will fertility care look like for the next generation of patients?
ART IN THE FUTURE: How technology, evolving multidisciplinary roles, and elevated patient expectations will shape the next era of assisted reproduction
Rapid technological advancement, increasingly complex patient needs, and the evolving roles of clinical and scientific professionals are collectively pushing ART into a new phase. The next era of fertility care will require not only improved tools, but also new approaches to evidence generation, multidisciplinary models, and an increased focus on the patient experience.
The growing role of digital tools and data in ART
Integration of digital and data-driven technologies into routine practice will be a central feature of the next decade in ART. AI and machine learning are already being incorporated into several aspects of ART. Examples include automated consultation transcription systems, which reduce administrative burden and create more accurate clinical records, and platforms such as Alife Health, which use patient-level data to support individualised stimulation planning and predict optimal egg-collection timing. Digital image-analysis systems capable of assessing follicle counts or early embryo development offer additional support in areas previously reliant on manual interpretation. As clinics generate larger datasets, these tools may help to identify patterns in ovarian response, embryo development, and treatment outcomes that are difficult to detect through conventional assessment, supporting more tailored and efficient fertility care.
Fertility care has also begun to extend beyond the clinic through remote and home-based technologies. AI-enabled hormone monitoring and smartphone-based semen analysis allow patients to generate reliable physiological data from home, reducing clinic visits. These early IBSA Group - Public applications suggest a future in which AI enhances consistency, reduces variability, and enables personalised treatment.
As digital approaches become more integrated, the way evidence is generated will also need to evolve. Traditional randomised trials are often unable to evaluate rapidly developing technologies, making adaptive study designs, registry-based trials and real-world data analysis increasingly important.
Advances in embryo assessment for improved clinical decision-making
Embryo assessment is advancing as we learn more about what influences embryo viability. Aneuploidy remains the leading cause of embryo failure and miscarriage,17 making chromosomal assessment a key part of embryo selection to increase the chance of implantation. Traditional methods, such as morphological grading, provide valuable developmental information but their ability to predict which embryos will implant successfully is limited. This has led to increasing reliance on preimplantation genetic testing for aneuploidy (PGT-A), which can reliably identify chromosomally normal embryos and reduce the likelihood of transferring those that are non-viable.18,19
Emerging tools, including AI-driven image analysis, non-invasive metabolomic or proteomic profiling, and advanced microscopy, can capture aspects of embryo competence that morphology or PGT-A alone cannot. The field is moving toward a multimodal approach that integrates chromosomal status with metabolic activity, cytoskeletal stability, developmental kinetics, and other molecular indicators of viability. As these technologies advance, their value will depend on rigorous clinical validation and clear evidence that they improve the precision of embryo selection and ultimately benefit patient outcomes.
Evolving clinical and scientific roles in modern fertility care
The integration of digital tools into fertility care is reshaping the roles of clinicians and embryologists. As AI becomes embedded in routine practice, fertility professionals will spend less time on procedural tasks and more time interpreting algorithm outputs, recognising potential bias, and determining how data-driven insights should inform personalised treatment decisions. Human oversight remains essential; technology can support analysis, but contextual judgement, ethical reasoning, and patient communication cannot be automated. This shift will require clinicians to understand how algorithms function, where their limitations lie, and how they should be validated before influencing care.
These changes place new expectations on the multidisciplinary team. The role of the fertility nurse is expanding beyond clinical tasks, such as assessments, ultrasounds, and day-to-day support, to include navigating digital communication, helping patients interpret online information and maintaining compliance within complex regulatory frameworks. As treatment becomes more decentralised, with remote hormone monitoring, at-home testing, and virtual consultations, nurses will play a pivotal role in maintaining continuity to ensure patients remain informed and supported throughout their journey. As such, fertility nurses will require greater digital literacy, evidence appraisal skills, and stronger communication in the future.
The clinical scientist’s role is also evolving. Embryologists are facing growing procedural and regulatory demands, contributing to rising workload and burnout.20,21 AI-supported fertilisation assessment and embryo selection tools, along with early laboratory automation, have the potential to ease manual burdens and shift the embryologists’ role toward high-level analytical tasks.7 These include interpreting embryo development data, incorporating molecular and ‘omics’ insights into decision-making, and overseeing the introduction of non-invasive embryo testing technologies. As laboratories adopt more advanced digital systems, embryologists will increasingly work at the interface of biology, analytics, and clinical practice, requiring new technical and interpretive competencies.
Responding to what patients will need from the next era of ART
While new technologies will shape how treatment is delivered, the future of ART will be equally defined by what patients need from their care. Patients value communication, continuity, and emotional support as much as clinical success rates. They want clear, consistent information, realistic explanations of their likelihood of success, and coordinated treatment pathways. As aspects of care move into digital environments, maintaining a sense of connection will require an intentional multidisciplinary effort. Timely updates, inclusion in decision-making, and recognition of the psychological strain of infertility are not optional; they are central to how patients experience the quality of their care. The next era of ART will need to combine scientific advancement with care models that are transparent, supportive, and genuinely patient-centred.
Bringing future trends into a coherent vision
Taken together, these developments point toward a future in which ART becomes increasingly personalised, data-informed, and integrated across clinical, scientific, and digital domains. Ultimately, the next era of ART will be defined by how technology broadens what is possible, whilst relying on strong clinical oversight, a rigorous evidence base, and a fertility team able to interpret and apply complex information in a cohesive, patient-focused way.
THE ETHICAL SIDE OF ART: Ensuring that progress is guided ethically, transparently and fairly for every patient
As ART continues to evolve, the ethical foundations underpinning the field become increasingly critical. Rapid innovation, the pressures faced by patients, and the global expansion of fertility services heighten the need for clarity, fairness, and responsible stewardship. Ethical considerations are an integral part of clinical care, shaping how evidence is communicated, decisions are made, and treatment is accessed.
The ethics of how we talk about treatments
One of the most visible ethical challenges in contemporary ART concerns how information about treatment options is communicated. As outlined earlier, the evidence base for many commonly used add-ons remains limited, yet these treatments are frequently presented in ways that imply greater certainty or benefit than the data support. Research reviewed during IBSA ARTiculate 2025 showed that clinic websites often provide incomplete or inconsistent descriptions of add-ons, with some overstating potential advantages, others omitting known limitations or risks, and many failing to reference established evidence frameworks such as IBSA Group - Public the HFEA traffic-light system.22 Pricing information is also variable, with unclear distinctions between optional and essential costs, making it difficult for patients to assess what they are choosing or why.
These communication gaps raise ethical concerns. When shared information implies greater certainty than the evidence supports, patients may make health decisions based on overly optimistic or incomplete messages instead of clear scientific guidance. The Competition and Markets Authority (CMA) has emphasised that clinics have a legal and ethical responsibility to provide accurate, accessible, and complete information before patients commit to purchase. This includes the level of evidence supporting a treatment, its likely benefit, its risks, and its cost.23 Ethical communication requires presenting information clearly and fairly so that patients can make decisions that reflect their own values and circumstances.
The importance of patient experience in fertility care
Ethical responsibilities extend beyond clinical outcomes to the overall patient experience. The emotional and logistical journey through fertility treatment can be lengthy, uncertain, and psychologically taxing. Delays in care, difficulty reaching clinics, or inconsistent information from different members of the team can amplify the stress patients face. Ethical practice requires recognition of the emotional burden and the integration of meaningful support and clear communication as a core component of high-quality routine care.
Towards fairer access to fertility care
Funding and access to fertility treatment remains one of the most significant ethical challenges in ART. Within the UK, inequity is shaped not only by regional variation in NHS funding criteria but by delays in assessment, referral, and treatment across the fertility pathway. In the UK, thousands of patients access fertility treatment services each year, with around 52,400 people having IVF and about 2,900 undergoing donor insemination in 2023.12 However, long waits for investigations, inconsistent local commissioning policies, and referral bottlenecks mean that many patients lose valuable time before receiving treatment. For older patients or those with diminished ovarian reserve, these delays can reduce their likelihood of success. In addition, eligibility rules and ‘postcode lotteries’ in IVF funding disproportionately disadvantage people with lower incomes and those unable to self-fund treatment.24 Improving equity requires not only consistent NHS funding criteria but also redesigning the fertility pathway so that access reflects clinical need rather than geography or financial circumstances. Earlier referral, clearer treatment pathways, and the use of predictive tools to support risk stratification, particularly for older patients and those with greater clinical complexity, can help prioritise time-sensitive care and reduce delays for those unable to self-fund care.
Globally, disparities in access are even more pronounced,25 and ART remains largely unavailable, inaccessible or unaffordable for many people worldwide who need it. In many low-resource settings, barriers extend beyond cost and include limited healthcare infrastructure, restricted laboratory capacity, and inadequate political and cultural recognition of infertility as a legitimate public health issue.26
Although modern IVF has become increasingly sophisticated, this level of complexity is not always feasible in every setting. Low-cost, simplified IVF approaches, such as ‘The Walking Egg IBSA Group - Public Project’,27 demonstrate that safe and effective treatment can still be delivered where conventional laboratory systems are not available.28,29 By reducing reliance on high-cost equipment and highly specialised laboratory environments, these lower-cost models offer a scalable path toward expanded access in environments where traditional IVF is unattainable.30,31
As ART continues to globalise, the central ethical challenge is to ensure that innovation does not widen these disparities and that effective, safe fertility care is accessible regardless of geography, income, or health-system structure.
Responsible embryo stewardship
Embryo creation and long-term storage present another important ethical responsibility.32 The number of stored embryos in the UK continues to rise, with many remaining in storage long after treatment ends. Donation rates for research or for use by other patients remain low, meaning that a substantial proportion of embryos are eventually discarded.32 Recent regulatory changes extending potential storage to 55 years increase reproductive choice but also heighten the ethical and logistical challenges associated with long-term management.33 Clinics and regulators must now consider how consent should be maintained over decades, what obligations exist when embryos remain in long-term storage without consent updates, and how to plan for ongoing growth in storage volumes. Public attitudes consistently show that embryos are viewed as having moral significance, and policies must reflect this while ensuring that systems remain practical, transparent, and fair.
ENVISIONING THE NEXT ERA OF ASSISTED REPRODUCTION
As ART continues to evolve, the field stands on the threshold of significant change. Scientific discovery, digital technologies, and increasingly sophisticated laboratory systems are expanding what is possible, while new research frameworks and multidisciplinary models are reshaping how advances will be evaluated and delivered.
The next era of assisted reproduction will depend on how effectively the multidisciplinary fertility team can bring these developments together to improve patient care. Such a future depends on reliable evidence, transparent communication, and coordinated expertise across clinical, scientific, and regulatory domains. Together this offers the greatest opportunity to meet rising patient expectations and deliver more equitable, meaningful reproductive outcomes. If innovation can be aligned with integrity and equitable access, the next era of ART holds the potential not only to improve outcomes, but to deliver a more coherent, fair, and genuinely patient-centred fertility landscape.