Fertility treatment has seen a great deal of progress over the last few years.
As a result, a growing number of couples are actively exploring the different options available nowadays and are commonly faced with questions, such as, “do I need such testing”, “will I benefit by having that treatment” and so on.
Reproductive medicine has enjoyed the results of excellent research in various fields of practice.
However, not all breakthroughs may be beneficial to infertile couples. The aim of current practice infertility investigation and treatment is to select appropriate screening methods, while at the same time applying tailor-made fertility treatments, based on specific data and individualized information for each couple. This approach will provide the benefits of current progress in fertility treatment, while moving away from the “one-fits-all” concept.
In particular, we can now customize ovarian stimulation protocols in IVF, based on anti-Mullerian hormone (AMH), a marker of ovarian reserve in women.
This is measured and helps to decide the type of protocol and the dose of medicine used. In this way, IVF protocols have now been able to be adapted to individual needs, yielding higher pregnancy rates, whilst keeping rates of ovarian hyper-stimulation syndrome very low.
Another example of personalized medicine in fertility treatment is the application of highly sophisticated time lapse technology, that allows closer monitoring of the embryos while in culture.
Not all women need such close control, however, women of advanced age, with a history of unsuccessful IVF treatments, or with severe male factor infertility will benefit from the information provided. Pre-implantation genetic screening is another relatively recent technique available, that provides useful diagnostic information about the chromosomal structure of embryos.
Again, while younger couples may not find the extra information provided useful, it is couples with advanced maternal age that will benefit from having an embryo transfer of a chromosomally normal embryo. In this way, miscarriages are less likely to happen and women will be spared the psychological burden of such a situation.
The endometrium is another area of intense research recently.
Diagnostic tests and examinations may be applied in cases of repeated unexplained failed IVF cycles, usually in an outpatient setup.
Hysteroscopy, along with a biopsy of endometrial tissue may provide useful information when there may be a question of polyps, fibroids, or issues of implantation, such as inflammation, or, even, a change in the window of implantation.
Again, careful judgment of the prior history and fertility treatment will allow more accurate application of the available options.
If health professionals are to achieve the highest pregnancy rates, with the lowest intervention and cost, they will need to provide customized, personalized medical treatments to all interested couples seeking fertility treatment. In this way, not only will they improve the chance of pregnancy, but will truly take care of all the individuals undergoing assisted reproduction treatments.
Dr Nicholas Christoforidis, MD, MRCOG, DFFP
Reproductive Gynaecologist, Clinical Director
Embryolab Fertility Clinic
Nicholas Christoforidis is an Obstetrician and Gynaecologist, sub-specialised in infertility and assisted reproduction techniques. After graduating from the Medical School in Aristotle University of Thessaloniki, Dr Christoforidis subsequently trained in Obstetrics and Gynaecology in the UK. He has been a member of the Royal College of Obstetricians and Gynaecologists since 2002.
In 2001, he was appointed as research fellow in human reproduction, at Imperial College and Hammersmith Hospital in London, where he trained extensively in IVF and assisted reproduction techniques.
He has been the clinical director of Embryolab Fertility Clinic since 2004. He is also a co-founder of the Embryolab-Academy, a non-profit foundation, focused on education, training and research in assisted reproduction.