Pioneers of fertility innovation: in conversation with Prof David Gardner

Playing a vital role in pioneering fertility medicine, our team of world-class scientists, specialists, and nurses are truly heroes to the countless families they’ve helped create. And, with science (and these heroes) as the backbone that delivers bundles of joy to so many, we want to pay homage to where it all began this World Embryologist Day – the lab.

We sat down with our Group Director of ART, Scientific Innovation and Research,?Prof. David Gardner, a highly esteemed scientist, to discuss all things fertility science.?David is a Fellow of the Australian Academy of Science, a Member of the Order of Australia (AM), and is internationally recognised for his pivotal work in laboratory techniques to grow blastocysts to day five maturity prior to embryo transfer, as well developing the ‘Gardner Grade’ used to determine the quality of blastocysts before transfer. His work is considered gold-standard around the world, and he continues to make substantial and meaningful contributions to the field.

Q: What inspired you to pursue this career path?

A: Forty years ago this October, I walked into a laboratory at the University of York in the UK. My supervisor (Henry Leese) wanted me to work on embryo development, whereas I actually wanted to work on uterine physiology. So, I went about having never really studied the embryo to immersing myself in it, to isolating them and trying to grow them. And immediately, one couldn’t be anything but captivated by the concept of this cell. This beautiful, big cell that has the potential to be all the tissues in the body. It kind of just hit me like a lightning bolt. This is the very origins of life. So, it “had me at hello”.

I was very fortunate that within a few weeks of that experience, of meeting my first embryos at work, I met the father of IVF, Robert Edwards. I had a dinner where I was with him and he was just so inspiring about the journey that led to Louise Brown and everything else that I immediately thought, ‘you know, this is an area of science that I could really fall in love with and hopefully excel at, but also maybe, just maybe, there's a chance I can help people directly through this’. The realisation that science could help society really gelled and I was very fortunate because the year was 1983 and there were not many IVF babies in the world. So, I kind of feel I was very lucky that I got in at the ground floor, right at the start. Even though I was, you know, five years behind Louise and decades of work behind Edwards and other pioneers.

Q: Has there been a standout moment in your career around developments in the field?

A: I guess I'm famous for one major thing, although I'd like to think in 40 years, I've done quite a lot of different things. The standout that I would get the claim for is developing a system to grow the human embryo to the blastocyst stage.

We couldn’t grow the embryo for more than 24 to 48 hours and that meant we were putting the embryo back too early into the uterus. That’s when it would normally be in the fallopian tube. The fallopian tube and uterus differ in their environment, so if you do an asynchronous transfer, it doesn’t work too well and that’s why implantation rates were much lower than they should have been.

In the 90s it was like an overnight success, 10 years in the making of the story. It was a decade of basic research and clinical research that led me to create what we call sequential media, called G1 G2, and that facilitated the growth of blastocysts in a laboratory environment. That, almost overnight, doubled implantation rates by going from day two or day three to day five, and much higher implantation rates. What it meant was we could go to single embryo transfer so that got rid of all the problems with twins, triplets and quads that we were having.

I guess the icing on the cake was that if you’re the first to be able to do something, in this case grow the blastocyst, you get to create a system to quantitate that development. So back in ‘99, after we’d been doing it a few years, I came up with a grading system that I thought would last 12 to 24 months called the ‘Gardner Grade’.?25 years later, the work that we published is one of the highest cited papers in the history of reproductive medicine.

Q: What excites you most about innovations in fertility science?

A: I always get excited if it's anything that's going to help us increase our pregnancy rates and take-home baby rates so that that's an obvious answer. I think you'd expect most people to say, ‘well, obviously we're going to help more people’ but, what I'm particularly excited about is making IVF more efficient and effective so that the people who work in IVF actually have a less stressful occupation.

A lot of what we do in an IVF laboratory is so hands on, this is almost as if everybody's an artisan. Everyone's a craftsman, they work with their hands, they've got fantastic hand-eye coordination, but it's very hard to do it all the time. It's the attention to detail. If you're performing several ICSIs or a biopsy, you're literally bound to an inverted microscope for hours, and it pays a toll on the body. So, part of what I'm hoping is that the new innovations will make some of the more laborious processes more streamlined. And, if we can reduce the time that someone sits at a microscope to do an ICSI by half, that's amazing. It's less stress and it means that we get less burnout. Looking after an embryologist is as important as looking after an embryo! You know, you’ve got to look after both. It's a win-win, I get happier patients because more patients get pregnant, and I've got a happier team because their job is now physically less stressful.

Q: Why do you think it's so important that research is prioritised in fertility science?

A: It's essential. If you look at the pool of public funding and look at it as a pie chart, about a third goes to cancer, a third goes to neurology and a third goes to cardiac research. And then there's a little slice of the pie left, which is for everything else and in that little slice of the pie, if you look really carefully, you'll see women's health. You won't even see men's health which is the other side of it. So, it's essential that we do research into fertility because it's quintessentially the thing that drives most people.

For people who aren't infertile, it's hard to understand what a devastating effect infertility has on a on a person, on a couple, on their whole extended family. It's as real as any disease in its impact and the more work and the more funding we can find for this kind of research, the more couples we can help. Infertility isn't going away, it's getting worse, and human fertility is seeing quite a large drop.

We’re in a desperate need for the sake of our population both here in Australia and every developed country to understand what it is that makes us fertile. There's never been a greater need for men to go to their GP, get a referral and have their sperm analysed. Over the last 50 years, sperm counts have dropped 50%. That is a staggering. And it's not just sperm counts that have dropped, but sperm quality has significantly dropped. This is not a good scenario, and we also know that fertility somewhat reflects your health in some cases. So, it's in everyone's interest to understand at an early age what their fertility potential is.

Q: What are your hopes or predictions for the field in 10 years’ time?

A: I truly hope, but I also predict, that we will see a lot more technology come into the IVF laboratory. What I mean by that is really towards automation of a lot of the processes that we do, or the manufacturing of devices specifically for the things we do. Obviously, everyone's talking about artificial intelligence right now and we as Virtus are the world's first creators of AI for selecting embryos. We published the first paper on that in 2018 together with?Simon Cooke,?Peter Illingworth, Angus Tran. We created a deep learning algorithm that could be used to analyse human embryo development from the time lapse video of the incubator.

Since then, AI in reproduction is growing and growing. One of my predictions for the field in 10 years is of course the increasing utilisation of artificial intelligence. IVF is such a complex process involving so many variables that artificial intelligence is a phenomenal way of actually helping us interpret all of the things that are happening. And I predict that physicians are going to be able to use it to help optimise stimulation regimens within IVF cycles, and in the lab we will get real time feedback on all our KPIs. It’s going to benefit our clinical works and of course our patients’ journeys.