When it comes to conceiving a healthy baby, there are many factors involved: personal health history, environmental exposures and even genetics, where our fertility potential is actually encoded in our DNA.
Patients have so many options today that they may not know what route is best for them or if they should follow the same journey as other friends and family. We sat down with TopLine MD Infertility Specialist Dr. Sinem Karipcin from Conceptions Florida to discuss the future of fertility testing and treatment and how we are heading towards personalized medicine.
TopLine MD: Where do you see fertility care heading in the near future?
Karipcin: Personalized medicine is becoming more important than ever. Infertility treatments are not one size fits all – if we know more about the processes of infertility we can customize a couple’s fertility care. Current testing does not give us enough information to customize the care at this point.
TLMD: What are the current tests for assessing the fertility potential of a women?
K: After collecting a detailed history and conducting a physical exam and pelvic ultrasound to assess the anatomy and antral follicle count in the ovaries, we utilize blood tests, such as cycle day 3 estradiol, FSH and AMH, as the standard assessments for ovarian reserve.
TLMD: What are the limitations of the current testing? Do these tests provide personalized information?
K: Well, these tests only tell us a part of the story and are just a snapshot of the patient’s current status. We can use them to estimate the response to an infertility treatment but only in the near future. They are even limited in predicting a successful pregnancy. What these tests don’t tell us are genetic markers and predispositions that a person may carry.
TLMD: What are the next steps in personalizing fertility care?
K: Genetics have changed the landscape of medicine in general. For example, BRCA testing is used to determine if a patient has a genetic pre-disposition for breast cancer and we are able to offer these patients preventative measures to avoid complications later in life. We are soon going to be able to assess the genes involved in reproductive processes routinely, which will help us prevent, diagnose and treat infertility problems, like ovarian failure or pregnancy loss, properly.
TLMD: Have you started using genetic testing to assess a woman’s fertility potential in your practice?
K: Yes. I have started to use it for some of my patients.
TLMD: Have you seen any patients that have benefitted from this personalized form of medicine?
K: Definitely. I had a patient with initial excellent ovarian reserve results, whose first IVF transfer resulted in a miscarriage. We decided to repeat the IVF transfer along with additional genetic testing to find out more on why this may have happened. Her genetic testing results showed premature ovarian insufficiency genes, which can lead to a loss of normal functions of her ovaries and over time, I witnessed her healthy ovarian reserve decline. I would have never had an explanation of why she could not produce healthy egg cells that are capable of fertilization if I hadn’t tested her fertility genes. Obviously, repeat IVF with genetic testing was the best plan for this patient.
When trying to get pregnant, it’s frustrating for both the patient and the physician when we don’t have the tools to completely understand where the problems are coming from. Soon, there will be no unexplained infertility diagnosis.
Dr. Karipcin is a double board certified fertility specialist with extensive expertise in egg freezing, IVF and fertility surgery. She manages several conditions causing infertility including endometriosis, recurrent pregnancy loss, diminished ovarian reserve, polycystic ovarian syndrome, as well as performs fertility preservation in women who have had cancer without compromising their treatment.