Small advances, huge difference

Professor Sarah Robertson is on a personal mission as well as a professional one.

As one of the world’s foremost experts in reproductive biology, and Director of the University’s Robinson Research Institute – leading 400 researchers working on pregnancy and infant health – she is keenly aware of the huge responsibility such work carries with it and its ability to transform people’s lives.

At a time when she was transitioning from the field of immunology to reproduction in the late 1980s, a close friend had delivered a baby boy at only 28 weeks of gestation. He weighed 850 grams.

“He was so tiny; plus he was underweight for his gestational age because my friend had pre-eclampsia. It was a life-threatening situation and a shattering experience for the family,” Professor Robertson says.

Each year, 15 million families around the world experience a pre-term birth (at less than 37 weeks’ gestation), and one million of those babies die. Pre-term birth is now the world’s biggest killer of children under the age of five, and prevents many more reaching their full life potential.

“Pre-term birth results in major issues for the infant and the family, with health and developmental consequences that can stay with the child for life. It is very motivating when you can see in your own family and friends the distress that illnesses of pregnancy cause,” she says.

It’s two years into Professor Robertson’s directorship and the Robinson Research Institute is having continued success across each of its research themes. Many members of the Institute are now preparing to move down North Terrace to the University’s new Adelaide Health and Medical Sciences building in the city’s West End. The move to new, state-of-the-art laboratories will be crucial to the future of the Institute’s work, and will accelerate capacity to make significant inroads into the causes of preterm birth and other conditions that affect infant and child health, such as a recent finding about the biological factors that influence the timing of birth.

“For us, it’s not just about providing better treatment and care for children who are born too soon, but also finding ways of predicting risk, and ultimately preventing pre-term birth. This is one area where even small advances would make a huge difference, in Australia and globally,” she says.

Another key focus of the Institute’s work is unravelling the complex biology that results in parents – both mothers and fathers – transmitting information to their offspring at the time of conception, effectively setting their child up for a lifetime of good, or poor, health.

Professor Robertson says she’s positive that future research developments will impact not only people’s ability to have a child, but to help ensure their child has optimal health.

“There will be some very exciting advances in the near future,” she says. “We will have amazing technologies for assessing and responding to health conditions before they can be transmitted to the child, with much better preventative health measures.

“For example, we’re going to see remarkable capacity to assess and improve people’s reproductive competence, particularly the status and quality of eggs and sperm. In the past, tests for male fertility have been relatively simple – they’ve been based around measuring sperm counts and sperm mobility. But in the future we’re going to be measuring the role of tiny molecules, such as non-coding RNAs (ribonucleic acids), and we’ll be looking at the molecular composition of seminal fluid.

“We will also assess the egg mitochondria (the critical energy-producing ‘organs’ within living cells), which play an important role in transmitting metabolic information from the mother to the child. There’s also the potential for stem cell technology to be used to develop healthy eggs and sperm,” she says.

She says IVF technology will improve to better replicate the real environment of conception and maturation of an embryo. “We’ll be looking to develop nanoscale, microfluidic systems for a real-time adjustment of the IVF culture to match the individual embryo’s needs. This is within our reach, and it’s part of what we’re working on in the Institute.”

Professor Robertson says improvements in real-time sensing will also have a major impact. “Being able to monitor the status of a pregnancy, particularly when we talk about the threat of pre-term birth, and to measure the development of the fetus over the course of pregnancy will give us the opportunity to intervene much earlier.”

However, Professor Robertson cautions that technological changes are only a part of the story. “There will be fantastic developments emerging from reproductive medicine in the decades to come, but we also have to change people’s mindset around the solution not always being a magic pill. The solution is often in your own reach. If you care for your health and maintain it, that will have the greatest impact on your fertility and the long-term health of your child.

“I would really like to see a future in which all aspiring parents have a greater sense of ownership of their own reproductive capacity and their reproductive ‘careers’, if you like. I’d like to see school students educated to understand the incredible privilege and value of their capacity to reproduce, even many years before the time when they might want to start a family.

“And it’s not just about the biology and our genes, it’s what I describe as ‘from cells to cities’. Better nutrition, exercise, better workplace and cleaner built environments, these all play a role in creating a healthier society for future populations.”