Personalized Medicine in Fertility
by Dr Elias Tsakos * MD, FRCOG
Scientific Manager of EmbryoClinic Assisted Reproduction Unit, Thessaloniki
Dr. Elias Tsakos’ article on personalized medicine in fertility was selected for publication by:
Personalized Medicine opens a new chapter in fertility, increasing the probability of success of treatments, but also their safety. In fact, with this approach, the couple actively participates, is trained and empowered through a scientifically sound and at the same time human contact with the specialized fertility team.
But what exactly does personalized Medicine mean and how is it applied? Individualized or personalized or absolutely precision Medicine is applied in a specialized way for each patient individually, taking into account his absolute personal characteristics and recognizing his uniqueness. This term first appeared in the early 2000s and was originally related to the study of drug metabolism in the context of Pharmacogenomics.
What does individualized treatment mean in fertility?
Fertility is one of the fields of Medicine that in recent years has applied the personalized approach, aimed at improving safety and the success of treatment. The individualized treatment of fertility focuses on the unique characteristics of each couple separately – such as genetic, biological, anatomical, functional, psychological, moral and mental – but also on its particularities and adapts the diagnostic and therapeutic protocols accordingly.
The combination of the personalized medical approach with the advancement of Assisted Reproduction and Genetics, the accumulated scientific experience, the high technology and the evolution of the diagnostic means and the Pharmacology is a guarantee for the highest levels of safety and success.
Thorough recording of the couple’s medical history is the field from which the individualized approach to the diagnostic stage of fertility begins, as data from individual and family history can provide information on possible factors that require further investigation. For example, a history of infertility, miscarriage, cancer, thrombosis or diabetes and thyroid disease is a valuable source of information for further personalized investigation and prevention.
Also, data from the individual history of the woman, such as dysmenorrhea (painful period), menorrhagia (bleeding during the period), short menstrual cycles, atypical abdominal pain, etc., form a clearer picture. Respectively, the individual and family history of the man is especially important.
What are fertility tests?
The control of the hormone AMH, the control of the microbial flora, the assurance of the health of the cervix with a Pap test and the control of the breasts are some of the necessary examinations for the woman before the Infertility treatment. Additional tests, such as hysteroscopy, genetic testing for cystic fibrosis, karyotype testing and thrombophilia testing, provide additional valuable information about a woman’s specific characteristics and guide us to the appropriate medical protocols that are appropriate in each case. Of course, the fertility tests also include those prescribed and defined by law, such as hysterosalpingography, genetic and infectious disease testing, hormonal testing, and ultrasound.
In the case of the man, his general health, but also the condition of his genetic material, are evaluated with examinations -beyond the classic sperm diagram- such as the microbial examination of the sperm, the control of the fragmentation of the sperm DNA (DFI test), the hormonal control and karyotype and cystic fibrosis control. In fact, in special cases, the assistance of a specialized urologist-andrologist is necessary, so that the evaluation is complete and the conditions before the IVF treatment have been optimized. Personalized diagnosis addresses all those factors that lead to increased safety and effectiveness of treatment.
What does fertility treatment include?
Fertility treatment can include a wide range of interventions, for example drug treatment of ovulation, correction of hypothyroidism, removal of endometrial polyps, etc., which either alone or in combination can offer maximum success with maximum safety.
With the individualized approach, the correct choice of the type of treatment is made, e.g. insemination, in vitro fertilization, etc., the ideal medication protocol for each case, the appropriate ancillary support (medical, pharmaceutical, psychological, etc.) and the overall strategy and schedule are planned.
Also, with the appropriate diagnosis and correction of infertility factors, natural fertility is increased, with the result that in some cases there is no need to apply assisted reproduction and IVF methods.
The personalized approach to fertility is also suitable for unmarried women, from 18 to 49 years old, who want to know, explore, maintain and improve their fertility, as well as for unmarried women who want to have children, as provided by Greek legislation and is supported by the State and the Scientific community.
* Dr Elias Tsakos MD, FRCOG
Dr. Tsakos has 30 years of medical experience, is an internationally recognized doctor and is one of the pioneers in Hysteroscopic, Laparoscopic and Robotic Surgery in Greece. He is:
- Member of the Board of Representatives of the Royal British College for Greece and Cyprus.
- Member of the Board of the Hellenic Society of Assisted Reproduction Physicians (ELEYA).
- Member of the British, European and American Fertility Society (BFS, ESHRE, ASRM).