Highlights and Trends in The Field Of Fertility Treatment
Dr Tony Rodrigues at Fertility Show Africa 2022
In an insightful talk at this year’s Fertility Show Africa 2022, Dr Antonio Rodrigues – a reproductive medicine specialist and a founder and director of Medfem Fertility Clinic in Sandton, Johannesburg, South Africa – spoke about what is happening in the field of fertility treatment and fertility medicine, spotlighting the highlights and trends that are shaping it.
Dr Rodrigues, during his talk at Fertility Show Africa this year, noted that since Medfem Fertility Clinic was started 30 years ago, there have been isolated breakthroughs in fertility treatment, and many potential enhancements to existing treatments.
What is more remarkable, however, is the fact that not much has changed over so many years! The truth is that the core fertility treatments offered, such as In Vitro Fertilisation (IVF), in uterine insemination (IUI) and hormone treatments, remain tried-and-trusted solutions, continuing to deliver great success rates in treating a variety of fertility challenges in both men and women.
In this article, we revisit the most important breakthroughs in fertility treatments over the last few decades; briefly summarise Dr Rodrigues’ overview of the trends and issues that continue to gain momentum and shape the field of fertility treatments today, including the shift towards patient-centred care, greater consensus that fertility treatment costs should be covered by public and private healthcare, the impact of age on fertility a growing concern and the importance of fertility preservation, and the challenge of multiple pregnancies. We also look at some of the more futuristic scientific developments that Dr Rodrigues mentioned that may become viable treatments in the not-so-near future.
There have been only a few but very important breakthroughs in fertility treatment over the last decades, and certainly worth noting is Intracytoplasmic Sperm Injection (ICSI) and preimplantation genetic diagnosis (PGD).
ICSI is an assisted reproduction procedure that was first used in Belgium in 1992, and is still considered one of the major breakthroughs in treatment of male infertility. Since ICSI involves the injection of only a single sperm into each egg to create embryos, even the most severe of male factor abnormalities can be overcome with this advanced fertility treatment.
Another big breakthrough in fertility treatment was preimplantation genetic diagnosis (PGD). It is used for the testing of early-stage embryos (up to 5 days old) for genetic abnormalities that will reduce the changes of a pregnancy. Essentially, PGD involves performing a biopsy on 5-day old blastocysts, removing a few cells from the outside layer of the embryos. At Medfem Fertility Clinic, an expert team of lab scientists prepare this sample for genetic testing at a specialist facility. The report generated will help fertility specialists to ensure only normal embryos are transferred to the uterus during IVF (in vitro fertilisation) treatment.
By preventing chromosomally abnormal embryos being transferred during IVF, PGD significantly improves the chances of success of an IVF cycle and also ensures a quicker time to pregnancy.
PGD also helps to prevent recurrent IVF failures, which can leave patients very despondent and feeling that they did something wrong. Knowing for certain that the embryos transferred are normal, other possible causes of IVF failure can be investigated.
This allows for a more patient-centred approach – a very clear and growing trend in the world of fertility treatment.
Maximising patient-centred care
There is a clear and positive trend in the fertility industry towards what can be referred to as “formalised patient-centered care”.
Patient-centred care acknowledges that the patient is the most crucial factor in any treatment and that any treatment enhancements or add-ons must be considered only in light of a couple’s unique and specific fertility treatment needs. For this reason, psychology and specialist psychological care plays a big part in patient-centred care.
Dr Rodrigues stressed that this is a great advancement, because there is no one-size-fits-all fertility treatment: every couple is unique and will therefore require a unique combination of treatments and solutions, and in some cases, more than one cycle of treatment.
What is crucial is that the treatments recommended are specific to the patient – in other words, truly personalized treatment.
Dr Rodrigues shared a number of ways in which his team has maximized patient-centred care at Medfem Fertility Clinic over the last three decades, including:
* Access to care
* Patient engagement
* Information systems
* Integrated and comprehensive team care
* Care coordination
* Patient centred care surveys
* Publicly available information.
“At Medfem, it is our joy when a couple, who was facing infertility, holds a healthy, normal baby in their arms!” said Dr Rodrigues in his expert talk. “That’s what we do this for. That’s what we’ve done it for all these years! Since the 1980’s, Medfem Fertility Clinic’s team has helped to bring more than 18,000 babies into the world, assisting thousands of couples struggling with infertility to experience the joy of parenthood.”
Funding fertility treatment costs
Fertility treatment costs is another topic that continues to headline in the fertility industry year after year, and this is mainly because fertility treatments must often be funded by patients themselves, placing many infertile couples under immense financial pressure during an already-difficult time, and excluding many others from receiving the treatment they are entitled to.
Fertility is a basic human right. It is also a disease recognised by the World Health Organization (WHO) that should be funded by both public and private healthcare providers.
In the USA, there are efforts to legally oblige medical funds in certain states to fund fertility treatment such as IVF. In South Africa, very few medical aids over cover for all fertility treatments, even though infertility is a prescribed minimum benefit that should be covered by law. However, even South Africa’s biggest medical scheme provides only limited cover and only on certain plans. While some public hospitals in South Africa offer fertility treatments, the cost thereof will for the most part still have to be covered by the patients themselves. Much more work remains to be done to ensure every couple facing infertility can receive the treatment required in South Africa.
In the meantime, one of the most effective ways to manage the costs of fertility treatment is to ensure that the treatments included in your treatment package is exactly the right treatments for your fertility challenges as a couple.
In other words, patient-centred care is crucial to making fertility treatment affordable. And this is becoming ever-more important as growing numbers of couples world-wide experience fertility challenges, due to a number of well-documented reasons, including age-related fertility problems and poor lifestyle choices.
The impact of age on fertility remains a growing concern
Another prominent development in fertility is certainly not a new factor, but one that is becoming an increasingly important: the age of the mom-to-be.
If one looks at the statistics, it is obvious that the pregnancy rate is correlated to age. The reality is that as women age, their fertility rates drop, decreasing faster and faster each year.
This is simply because a woman’s supply egg not only dwindles rapidly with age, but the quality if her eggs also drop significantly as each year passes. Because there are fewer and fewer egg cells left, and more and more of these are also abnormal, the chance of a healthy pregnancy is significantly reduced. There is no treatment that can reverse this decline in egg numbers or egg quality.
This is an important message that the team at Medfem Fertility Clinic believe should be spread as far and wide as possible: as women get older, their fertility rates go down! If you want to have a baby, be mindful of the fact that the longer you wait, the less likely your chances of achieving a pregnancy unassisted.
Women who are 27 and older should be aware that from this age, their fertility rates will begin to decline, and by their mid-30s, it will drop much more rapidly. By the age of 40, the pregnancy rate is very low.
However, it must also be noted that with the right kind of fertility treatment, such as IVF for example, many women over the age of 38 can still have a baby. Even if a woman no longer has a healthy egg supply, IVF with donor eggs is an alternative to consider.
Nevertheless, if more women can be reached with the knowledge that their ability to have a baby reduces drastically with age, they will be able to take proactive decisions to, for example, start a family sooner, or consider other options such as fertility preservation.
Younger women under 27 can check their egg reserves with an anti mullerian hormone or AMH test that will give them an idea of what the medical fraternity calls ‘longevity’ of their egg supply, or the length of time they still have to fall pregnant naturally.
Given the growing number of women who are advancing in maternal age – in other words, they are around 27 years and older – are not yet ready to start a family. One solution to this challenge – fertility preservation – has gained prominence in the field of fertility treatment over the last few years.
This option allows women to freeze some of their healthy eggs for use in the future when they are ready to start their families. This should obviously be done while a woman is young and still has a good egg reserve.
Fertility preservation is also an option for increasing numbers of people who are diagnosed with cancer and face treatments such as chemotherapy and radiation that can completely destroy fertility in both men and women.
Emphasis on lifestyle
Dr Rodrigues also notes a growing emphasis on an important aspect of fertility: the lifestyle choices of both the male and female partner in a couple with fertility challenges. This is because well-documented lifestyle choices and diseases are known to have an adverse effect on fertility in both men and women.
Healthy eggs and healthy sperm cells are absolute requirements for a healthy normal embryo, although a healthy egg plays a bigger role. A healthy egg fertilised with healthy sperm, also called a euploid embryo, is the only kind of embryo that is able to successfully implant in the lining of the uterus where it will hopefully grow become a full-term pregnancy. Where the egg cell is abnormal, the embryo will not implant in the uterus successfully, and will likely miscarry – most often without the woman even knowing.
The lifestyle choices and diseases known to have an adverse effect on fertility in both men and women include, for example, obesity, poor nutrition, smoking, alcohol and drugs, as well as high levels of insulin (hyperinsulinemia) and/or prolactin (hyperprolactinemia), thyroid disease (hypothyroidism) and cancer.
Lifestyle choices play a critical role in how we get disease and when we get it. When a couple controls their lifestyle choices, with the right diet and by managing stress effectively, they will not only reduce their chances of getting lifestyle diseases, but will also postpone getting such diseases to age 90 or 100 instead of age 40.
Certainly, the bottom line in respect of the impact of lifestyle choices is this: the time to pregnancy is definitely reduced if both partners are taking good care of their health.
The problem of multiple pregnancies
Also high on the list of current and persistent issues in the world of fertility treatments is the challenge of preventing multiple pregnancies following procedures such as IVF.
While for many couples who are unable to conceive having two or three babies at once may seem like a dream come true, the reality is that multiple pregnancies are high risk to both the mother and the babies.
No matter her age, a mother carrying two or more babies are at risk of a high incidence of blood pressure problems and diabetes related to the pregnancy. In respect of the babies, the risks include prematurity, growth retardation and early delivery, all of which can result in long stays in ICU, which could result in further long-term problems.
At Medfem Fertility Clinic, the team follows strict protocols that meet stringent international standards to minimise the possibility of twins or triplets.
There are also some futuristic developments in the field of fertility that still sound like science fiction and, indeed, are many years away from being practically and widely used in fertility treatments.
One such an example is Artificial Intelligence or AI. Dr Rodrigues explains that AI will enable medical professionals to input a range of data and profile information pertaining to a couple’s unique treatment requirements, and through the AI capabilities, calculate the best treatment combinations based on this information. This is a development that is gaining momentum in developed countries such as Australia, New Zealand and the UK, as its implications for better patient care is evident.
Another case in point is an advancement that allows, for example, a sperm cell to be created from a skin cell. Because they are rapidly dividing cells, human skin cells have the ability to become any cell.
Skin cells can now go through a process that turns them into sperm cells – this is already working in mice. Although exciting, such procedures are five to 10 years away from being routine procedures in the field of fertility treatments.
There are also advancements in terms of genetics and what is possible: for example, predicting genetic makeup and even altering family histories by, for example, eliminating diseases such as diabetes, hypertension, high cholesterol and cancer on a genetic level. Much of these advancements are still experimental and many questions remain to be answered in this regard, particularly from an ethical perspective. As such, these developments too are a long way off from being routine.
Beyond these futuristic advances, much of the development in fertility treatment these days centre around the crucial work being done in laboratory and changes in the way treatments are offered.
Where to find the latest in advanced fertility treatments
At Medfem Fertility Clinic, you will find a world-class team of fertility experts working in purpose-built, state-of-the-art facilities to provide couples with cutting-edge fertility treatments that continues to deliver superior results.
At Medfem Fertility Clinic, you will also find the largest staff-to-patient ratio of any fertility clinic in South Africa, ensuring you receive the best in patient-centres care possible.
If you would like to meet one of our fertility specialists, simply click here to book an initial consultation or contact us telephonically on +27 (11) 463 2244.
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