A systems medicine approach could improve fertility medicine, creating opportunities for personalised IVF treatment, Dr Thanos Papathanasiou, Medical Director at Bourn Hall Clinic, argues at the Fertility 2020 conference 9-11 January 2020.
A large component of fertility is hormonal and this is influenced by physiological and psychological factors that can vary within the same individual on a monthly basis.
Creating a computational model, which could be fed with an individual’s data, would allow recommendations for personalised treatment to be based on a strong evidence base.
Personalised IVF treatment
Dr Papathanasiou has access to over forty-years of patient data from the earliest treatments at Bourn Hall. The clinic was set up by the pioneers of IVF Patrick Steptoe, Robert Edwards and Jean Purdy after ten years of experimentation resulted in the birth of Louise Brown.
The tireless record keeping used to identify the right combination of procedures required to provide a robust, repeatable, treatment has continued to the present day; creating a unique archive of data.
Dr Papathanasiou comments: “Twenty per cent of the women that are referred by their GP to us for NHS fertility diagnosis can be treated effectively with lifestyle modification, a further thirty per cent can be helped to become pregnant naturally with monitored ovulation induction. For the remainder IVF is the best treatment.
“However, beyond the obvious reasons for infertility such as blocked fallopian tubes and lack of sperm, trying to identify cause-and-effect is not trivial, which substantially hampers both diagnosis and therapeutic intervention.
“Hence there is a need to take an holistic approach to fertility medicine and study all aspects of the network at once. A ‘systems’ approach offers opportunity to gain insight into the underlying mechanisms of infertility not accessible by conventional, reductionist, research approaches.”
Many of the studies in fertility medicine use small data sets and inconsistencies in their approach make it difficult to consolidate the information in a meaningful way. This issue is made more acute as the results are often reported without the necessary caveats about type of study and sample size.
A more holistic approach to IVF
Dr Papathanasiou argues that a computational model would improve as more data sets were added. He is presenting three posters at Fertility 2020, which illustrate the type of data that could help inform the model.
- Use of AMH to indicate ovarian response
- Optimising egg retrieval in woman at risk of OHSS
- Improving outcomes in egg collection
Dr Papathanasiou comments that some of the fundamental information about IVF treatment is not readily available.
“It is very clear from our studies that fertility fluctuates from one month to another. Early detection of this would enable clinicians to decide when to progress with egg collection and this would improve success rates in treatment. Additionally, women of different body weights and AMH levels require personalised dosage appropriate for the protocol to be used.
“Collating data for all patients in a consistent way and using this anonymised data to create a computational model has the potential to provide the basis for a personalised diagnosis and treatment strategy for each individual.
“There is much debate about use of adjuvants for particular patients, but no one really knows how these can help particular patients. A systems medicine approach would enable these questions to be answered with science rather than conjecture.”
Fertility 2020 is a joint Conference of the Association of Clinical Embryologists, British Fertility Society and the Society for Reproduction & Fertility. The event has become the largest UK educational forum focusing on fertility and reproductive medicine. The theme for the joint annual conference is
‘Reproduction in a changing world‘ featuring an exciting, cutting edge programme of high profile, scientific international and UK speakers, with a wide range of concurrent sessions focussing on specialist areas in fertility and reproductive biology.
The event is being held in Edinburgh from 9-11 January and will also feature over 200 scientific poster presentations, a large trade exhibition and a packed networking programme.