By Dr Debbie Blake, Scientific Director
Those who have gone through fertility treatment over the past decade, may have been offered an ‘add-on’, or optional extra, by their fertility specialist. These include a range of procedures that aim to increase the chance of an embryo implanting into the uterus and leading to a live birth. Some of these additional extras involve genetic screening of biopsied embryos (PGT-A) or stimulating beneficial receptors in the uterus with a variety of solutions – all of which come at additional costs.
Recently the practice of offering add-ons has come under fire, for the potential they can be indiscriminately used for clients who may be desperate to try anything to have a baby, regardless of the level of evidence to support its use.
The counter argument is if fertility clinics fail to offer some select add-ons, then they may well be disadvantaging their clients who do indeed fit the specific criteria for those who will benefit.
Providers of fertility treatments must therefore strike a calculated balance between staying abreast of the most current promising technology and offering proven, ethical and safe treatments. After 30 years of involvement in research and clinical and embryology, I believe this balance can be successfully achieved through a series of judicious practices.
The three key pillars of introducing emerging technologies are 1) performing due diligence by critically assessing published data, 2) ensuring clients are offered them only when indicated followed by Informed Consent and 3) the results are closely monitored and continuously reviewed.
If you are experiencing the heartache and challenge of infertility, the chances are you will seek the assistance of a clinic that offers you a range of innovative treatments that can provide you with the greatest success rate, for your individual needs. In this age of social media, hot off the press research gains rapid worldwide attention, and clinics are finding clients themselves are requesting novel add-ons that they have heard about. It is however important that fertility practitioners resist market pressure and adhere to their routine systematic approach of expert evaluation when introducing new practices.
All well-established clinical treatments have originated from a foundation of good, basic biology, chemistry and physics, stemming from sound research. So, it is important that the decision makers within the clinic have a sound understanding of the science behind each innovation, which ultimately is a CREI (Reproductive Endocrinology and Infertility) qualified Medical Director and a PhD Scientific Director.
The most highly respected and reliable resource in the field of evidence-based medicine is the Cochrane Collaboration, consisting of a worldwide network of experts who assess all the available data for hundreds of different innovative medical treatment options. They perform what is called a meta-analysis of all relevant randomised control trials and provide excellent guidance as to the strength of benefit (or not) of the innovation.
However, one of the major draw-backs of most fertility trials is the small number of participants that are included, due to the fact that fertility issues are unique to each individual and heavily impacted by the client’s age. This inevitably reduces the power of the evidence and is one of the biggest challenges in providing absolute proof that an add-on is beneficial or not.
Once the new procedure has passed the clinic’s internal due diligence, it is added to the list of available add-ons so that clients are aware – but it is only offered with informed consent to clients with consideration to their cause of infertility, age and reproductive history.
Responsible use of add-ons means they should not be promoted carte blanche to all clients nor should it result in a significant financial gain to the clinic. At Repromed, we believe if there is enough convincing evidence that the add-on will benefit all clients, it will be included within the standard treatment cost and no longer be classified as an add-on.
One such example is EmbryoGlu which after decades of use, has been demonstrated to significantly facilitate embryo implantation and pregnancy, and as such, is included with no added cost to every embryo transfer cycle at Repromed. Similarly, if after continuous review of an add-on’s performance and safety, both internally and internationally, there is evidence of no benefit, then the add-on must be discontinued, as has been the case with some sperm selection techniques.
Our team continuously assesses the scientific merits, safety, value and clinical evidence of the latest medical advances, to ensure clients have access to a comprehensive range of options. Clients put their trust and faith in us to help them achieve their dream of having a baby. It is our responsibility to recommend a treatment plan either with or without add-ons, that hand on heart, we believe will enhance their chances of having a baby.
Dr Debbie Blake is Scientific Director here at Repromed. Debbie has been leading fertility laboratories in Aotearoa New Zealand for more than 20 years and an author/reviewer for the Evidence Based Medicine Cochrane Collaboration since 1999. She has extensive academic and commercial research experience with University of Auckland and Auckland University of Technology.