What is the gold standard of care for infertility treatment?

What is the gold standard of care for infertility treatment?

An interview with Dr. Marcos Meseguer, Scientific Supervisor and Senior Embryologist at the IVI (Instituto Valenciano de Infertilidad) Valencia IVF unit


Infertility is a global issue affecting millions of people. As the access to assisted reproductive technologies (ART) continues to grow worldwide, IVF clinics are still highly varied in their procedures and protocols – from country to country and even clinic to clinic. We spoke with Dr. Meseguer about the challenges IVF clinics face when trying to adopt a ‘gold standard’ and why fertility industry involvement is a great first step in supporting clinics in changing the standards of fertility care.

With over twenty years of experience in the field of embryology, Dr. Marcos Meseguer is a Scientific Supervisor and Senior Embryologist at the IVI Valencia IVF unit, part of IVI, a world-leading reproductive medical group. Dr. Meseguer continues to be involved in research and clinical work in the lab and also teaches Biotechnology at the University of Valencia. Together with his group of students, their research is mainly on embryo selection using time-lapse imaging and AI technology.

Tell us about your collaboration with Dr. Schoolcraft for the review: ‘Paving the way for a gold standard of care for infertility treatment: improving outcomes through standardization of laboratory procedures? *

Dr. Schoolcraft is a highly respected reproductive endocrinologist whom I have known for many years. Between 2016 and 2017, we met for a series of meetings to address the variations between clinics, the introduction of new IVF technologies and the importance of clinic standardization. During this process, the urgency for standardization became very clear as did our ideas for how it could be achieved. We were very proud to have the opportunity to write this opinion paper.

What is the gold standard of fertility care?

That is a very difficult question to answer. I think that the clinics reporting the best trustable rates is one place we can start – that could be our gold standard. Then other clinics could start to standardize their procedures accordingly. But that also requires teaching and knowledge-sharing. This is where participation in national and international congresses becomes crucial ­– being open to sharing knowledge with anyone interested.

“I think that the clinics reporting the best trustable rates is one place we can start – that could be our gold standard.”

How is the current approach to IVF fragmented?

I consider myself a very lucky embryologist. I have had the opportunity to travel all over the world and visit more than 200 laboratories on six continents. And what is interesting to me is that we all have the same goal, but the procedures change between places, clinics and countries – there is no standard way to do certain procedures or to analyze them. This is strange to me because there should be the best way to do it. Why are we doing it differently? We need to standardize because of the variation between clinics. By analyzing the fertility outcomes, we can see why some procedures give poorer results and others better.

“Why are we doing it differently?”

How important are fertility success rates to look at?

Our number one goal always is a high take-home baby rate. That is the success we strive for every day, so we should always look at the live birth rates. But we must keep in mind that when clinics report their data, it is affected by the type of patients. So, we need to find some type of reference for patients that may help us identify the results even more specifically.

“Combining the success rates with the type of patient will make those data points even stronger.”

For example, if I talk about the success rates of my clinic, IVI Valencia IVF, with 40% oocyte donation, of course, we are going to have very good results. Then we should compare against other clinics doing oocyte donation. Therefore, success rates should be compared to the same data groups. Combining the success rates with the type of patient will make those data points even stronger..

marcoLabImage

What are the challenges to changing the standards of fertility care?

One thing to always consider when discussing a global issue is that resources will vary, affected by the economic situation and regulations of each country. It is difficult to address standardization if clinics are not up to date with the best and newest technology. Not just the technology related to automation, but the tools and equipment needed for procedures: good incubators, a good source of culture mediapipettescatheters, etc.

Globally speaking, finding well-trained and skilled embryologists with real-world training is a challenge as the levels of accreditation also vary from country to country. The role of the embryologist is changing as we move towards more technology and data analysis. We need different types of embryologists now, those interested in research and statistics as well as skill-trained for the IVF lab.

“It is difficult to address standardization if clinics are not up to date with the best and newest technology.”

What are the first steps in paving the way to a gold standard of fertility care?

I believe this comes down to training, the standardization of lab procedures and getting technology into clinics. Increasing the level of education for embryologists will go a long way to creating universal standards of lab practices. Companies in the fertility industry, like CooperSurgical who continue to promote knowledge, train and educate, especially in those countries with fewer resources, will help expand knowledge. If we are able to reach those places, incorporating the knowledge we have gathered in the last ten to twenty years, it will allow them to grow and provide better options for their patients.

It would be great to standardize each of the procedures, and at the same time provide different procedure options for patients. This adaptability will give patients access to a gold standard procedure that is tailored specifically for their fertility journey.

“It would be great to standardize each of the procedures, and at the same time provide different procedure options for patients.”

What is your outlook for the future of fertility care?

Emerging technology such as image analysis and time-lapse are relatively new, but I think every patient can benefit to some degree. For example, it is extremely helpful especially for patients generating a decent number of embryos and we need to choose the right one.

In the next few years, the algorithms that are being designed through AI, some of which are already happening, will continue to grow. This is a relatively easy process that can have a big impact on our decision-making processes. Not taking the decision away from us but really helping us make the best informed decisions for the health of our pregnant women and the health of future babies.

If we continue to be grounded in research and science, we can solve these challenges in our industry together. We are in the process, and I think we can get there.

References

*Schoolcraft, W. and M. Meseguer, Paving the way for a gold standard of care for infertility treatment: improving outcomes through standardization of laboratory procedures. Reprod Biomed Online, 2017. 35(4): p. 391-399.

About the author

Dr. Marcos Meseguer received his B.Sc. degree in Biological Sciences from the University of Valencia in Spain. He then performed a pre-doctoral fellowship in St Mary´s Hospital, Manchester University, United Kingdom, and received his Ph.D. Degree in Obstetrics and Gynecology and the European Doctor Degree in 2002 from the University of Valencia, Spain. He has also a master’s degree in Research Methods; Design and Statistics from Universidad Autónoma de Barcelona, Spain.

Dr. Meseguer is currently the Scientific Supervisor and Senior Embryologist at the IVI Valencia IVF unit. Previously, he was co-Director of the Andrology Laboratory at the Instituto Valenciano de Infertilidad (IVI).

Marcos Meseguer

Scientific Supervisor and Senior Embryologist at the IVI (Instituto Valenciano de Infertilidad) Valencia IVF unit

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