“Tailor-made” treatments, a truth or a mistake in reproductive medicine?
One of the two keynote lectures at this annual meeting explored the promise of personalization in reproductive medicine. Unless based on evidence of “published knowledge” and without input of genotype information, a personalized approach may be nothing more than intuition.
With over 10,000 registered for this 38th ESHRE Annual Meeting and approximately 80% in-person attendance, it was like the good old days for another session of two keynotes, with a full house once again. more and a renewed atmosphere of anticipation.
Endocrinologist Stratis Kolibianakis, in an age now embellished by “tailored treatment” and “individualized” approaches, has led many to reflect with his own personalized view on the truths and fallacies of personalization in medicine. of breeding. The gist of his argument – his version of the truth – was that personalized treatment is only possible through the application of “hard knowledge” from relevant published literature. Without it, customization is nothing more than a best guess – or at worst “pure hunch”.
Kolibianakis had started his presentation by proposing that the medical model of personalized medicine lies at the interface of the individual phenotype and genotype, but these, he said, were still lacking in reproductive medicine. Examples of studies looking for a genetic basis for female infertility – in endometriosis or early menopause – were still largely inconclusive. The complex etiology of infertility, population bias and standardization, and the difficulty of applying genetic biomarkers with so many candidate predictors complicate these studies anyway.
So it seems easier to tell what isn’t personalization in reproductive medicine than what really is — no matter how it’s presented. So setting treatment goals with respect to patient wishes is not personalization, Kolibianakis said, or even decisions about type of treatment, type of stimulation, or progress after egg retrieval.
The personalized treatment will therefore depend on the extent of the doctor’s expectations. “Whether or not we expect a treatment to work,” Kolibianakis explained, “we expect a specific dose of the drug to be the right one.” And the basis of these expectations remains the published knowledge literature, ranging from systematic reviews and RCTs to isolated expert opinion expressed in an editorial. Without this knowledge, he said, we are left with “cognitive biases”, intuition and “mistakes”. Thus, personalization of treatment is “simply the way of applying science in clinical practice”, exemplified by the development of carefully curated guidelines with evidence from replicated and validated studies.