Nobert GLEICHER (USA)
Dr. Gleicher grew up in Vienna, Austria, where he initiated his medical studies at Vienna University Medical School. After preclinical years, he switched to Tel Aviv University’s Sackler School of Medicine in Israel, where he graduated and completed a year of rotating internship. He then moved to New York City for a residency in Obstetrics and Gynecology, and a fellowship in reproductive immunology at Mount Sinai Medical Center. As Chief Resident he was awarded the Dr. Solomon Silver Award in Clinical Medicine, given annually to “that younger member of The Mount Sinai Hospital and Medical Center staff who best exemplifies the ability to apply the advance in research to the practice of clinical medicine.”
Upon graduation, Dr. Gleicher was appointed to the medical school faculty of Mount Sinai School of Medicine as Assistant Professor, in the department as Head of the Division of Reproductive Immunology and given responsibility for all student and resident education in Obstetrics and Gynecology. Two years later he moved to Chicago as Chairman of Obstetrics and Gynecology at Mount Sinai Hospital and Professor of Obstetrics and Gynecology and Immunology/Microbiology at Rush Medical College. He held these positions for 10 years until his resignation in 1990, when he started to concentrate on development of the Center for Human Reproduction (CHR), which he founded in 1981. Since 1990 Dr. Gleicher has held a variety of academic professorial appointments at Chicago Medical School and, after his move back to New York City, at New York University School of Medicine and Yale University School of Medicine. Since 1999 he is President, Medical Director and Chief Scientist of CHR-New York and President of the not-for-profit Foundation for Reproductive Medicine. He also holds an appointment as Guest Investigator at Rockefeller University and Medical University Vienna.
Dr. Gleicher has published hundreds of peer-reviewed scientific papers, abstracts and book chapters in reproductive endocrinology and infertility, relating to medical complications in pregnancy and to the immune system in reproduction. He served as founding Editor-in-Chief for the American Journal of Reproductive Immunology (AJRI), and for 30 years of the Journal of In Vitro Fertilization and Embryo Transfer, in 1992 renamed Journal of Assisted Reproduction and Genetics (JARG), now the 2nd official organ of the American Society for Reproductive Medicine (ASRM). He in addition served as editor and/or editorial board member on many other medical journals, and edited a number of major textbooks. Currently, he serves as Academic Editor for PLoS ONE, and is a member of multiple editorial boards. In 2009, Dr. Gleicher was invited to give the prestigious bi-annual Patrick Steptoe Memorial Lecture to the British Fertility Society, as recognition of his contributions to advancements in reproductive endocrinology and infertility.
He is a Fellow of the American College of Obstetricians and Gynecologists and of the American College of Surgeons, and, in addition to many other societies and professional organizations, a member of the ASRM and the European Society of Human Reproduction and Embryology (ESHRE).
In demand as a speaker, Dr. Gleicher travels extensively worldwide, while maintaining his role in clinical patient care and research at CHR-NY, and as one of the most prolific scientific writers in the specialty. While located in Chicago, Chicago Magazine repeatedly listed him amongst “best physicians” in reproductive endocrinology and infertility. Since his return to NYC, he was repeatedly one of only a handful of reproductive endocrinologists in New York City listed by the New York Times Magazine on its “Super Doctors” list, as chosen by peers.
Abstract
The Future of IVF – Can We Be Better
As we celebrate the 40th anniversary of the first IVF birth, it appears opportune to look toward the future. Predictions of the futures, of course, always are characterized by biases of authors, and this one is no exception. I, nevertheless, venture to say that it, likely, will take much less than another 40 years to accomplish many, if not most, of here made projections. One, however, cannot offer a rational for predicting the future without noticing the shortcomings of current IVF. Yes, we have come a long way since the first IVF birth; - but progress has stalled and, to some degrees, actually reverted, as live births rates around the world have declined in recent years. As will be demonstrated, these declines are, likely, the consequence of add-ons to IVF and other changes in routine IVF practice, which were accepted based upon unproven hypotheses and introductions to market of unvalidated tests and treatments, often heavily promoted by commercial interests rather than the primary interests of patients. A cleansing of IVF practice from such potentially useless and often harmful treatments, therefore, must be a first point of order if IVF outcomes are to resume the incline that characterized them for the first 30 years of IVF-practice.
In parallel, IVF must return to a clear distinction of what represents established practice vs. experimental treatments, with the latter only permitted in experimental settings, clearly identified as such to the public. Finally, the excessive influence of commercial interests that, unabashedly, increasingly have permeated and actively biased medical literature and education, must cease, to allow for an uninhibited exchange of opinions, whether they are supportive of commercial enterprises or not.
Once these essential preconditions for productive progress are met, reproductive medicine can in coming years expect unprecedented changes that are destined to radically improve IVF practice. One overwhelming paradigm shift will be a switch from protocol-driven IVF to individualization of IVF cycles (Personalized IVF), which will be all-encompassing, from preparation of ovaries, often weeks to months before start of IVF cycles, to ovarian stimulation protocols, timing of oocyte retrievals to management of gametes and embryos in the laboratory, with HIER (Highly Individualized Egg Retrieval) a forerunner of what can be expected. Though increasing automatization of the IVF laboratory appears unavoidable, at least for the foreseeable future it will remain limited because of the competing need for individualization of laboratory practice.
Scientifically, two principal developments come to mind: The ability to culture in vitro human primordial follicles to maturity, fertilize them and establish transferrable embryos, will not only facilitate significantly more efficient fertility preservation but will also potentially disrupt the current concept of ovarian hyperstimulation, with significant consequences for pharma industry but also IVF centers. Even more disruptive to current practice will be the ability to produce autologous oocytes and spermatozoa from patients’ own stem cells, a feat already accomplished in the mouse, and under intense investigation in a number of laboratories around the world.
IVF of the future will, therefore, look very different from what represents the current provider structure. The IVF center of the future, likely will primarily be a laboratory facility, equipped for long-term storage of ovarian and testicular tissue, gametes and embryos, able to mature primordial follicles and/or produce gametes from patients’ stem cells without need for ovarian stimulation. Embryo transfers will not necessarily have to take place at these IVF centers, as there produced embryos can be cryopreserved and transported to off-site providers. Age limits for female reproduction will undoubtedly expand. With it, graying of patient populations fertility centers will be treating will intensify. In short, becoming a mother at great-parental ages, will become a new norm, and society better get ready!