Written by James Coker | Reporter, European Medical Journal | @EMJJamesCoker
The field of reproductive health is currently seeing rapid advancements. This was very much on display at the recent European Society of Human Reproduction and Embryology (ESHRE) congress, which took place from 1st–4th July 2018, fittingly in the same month as the 40th birthday of Louise Brown, the first baby born following conception by in vitro fertilisation (IVF). During the event, the European Medical Group spoke with a leading expert in fertility treatments, Dr Elena Labarta, a gynaecologist at the IVI Clinic Valencia, Spain. The discussion centred around her passion for individualising fertility care for women who are unable to conceive naturally, thereby improving success rates. New data were presented during the event which support the use of anti-Müllerian hormone (AMH) levels to predict the number of oocytes a woman can produce following ovarian stimulation and Dr Labarta spoke to us about the importance of this study in depth. We also touched upon exciting developments that are taking place in this area of medicine.
Importance of Individualised Treatment
“Individualising is important because everyone is different so we have to adapt treatments according to the needs of each individual patients,” emphasised Dr Labarta. “For example, treating a patient of 30 years and a patient of 43 years is not the same, so we have to evaluate the patient before deciding what the best strategy is for her; this is individualisation.”
Predicting Ovarian Response
To be able to accurately predict a woman’s ovarian response to ovarian stimulation is one way of improving personalisation of fertility treatment. A new study presented at the ESHRE Congress reinforced the accuracy of using AMH levels to decide upon the correct dosage of Rekovelle® (follitropin delta, Ferring Pharmaceuticals, Saint-Prex, Switzerland), a human recombinant follicle stimulating hormone. It showed that natural variations in AMH levels during and between a woman’s menstrual cycle had no clinically relevant impact on ovarian response in 95% of patients included in the Phase III ESTHER-1 trial.1
“I think one of the steps of the whole IVF procedure that can be more individualised is ovarian stimulation,” explained Dr Labarta. “In this regard it serves that different biomarkers of the ovaries reserve of the patients can give us information about how to treat the patient by stimulating her ovaries. Therefore, in recent years we have analysed the value of measuring the serum levels of AMH, reflecting their ovarian reserve, to help choose the best protocol of ovarian stimulation.”
She believes the new findings will serve to assuage any doubts that clinicians have regarding the use AMH levels to predict ovarian stimulation; they have proved decisively that although AMH can vary depending on the day, this does not affect the number of oocytes that are ultimately produced. Dr Labarta added that the type of tests used to measure AMH is instead the main issue that needs addressing. Previous research has shown that AMH levels can vary depending on the type of platform used, which has led to calls for international standards for the different AMH tests to be brought in to ensure that results from different tests are interpreted correctly.2
Patient centricity can also be enhanced by being able to predict response to treatment. It can help clinicians and patients decide together what particular course of therapy is pursued and plan future strategies based on this information. This links into Dr Labarta’s clinical role at the IVI Clinic Valencia, where she is seeing an increasing number of patients who require fertility treatment. She wears many hats at the clinic, ranging from advising and treating patients to helping develop new methods to enhance IVF. “The most important thing is I help patients from a medical and psychological point of view and I feel very lucky because working in this unit allows me to not only do clinical practice but also lots of research,” she said.
Advancements and Emerging Areas
Dr Labarta also described some of the innovative developments that have been introduced at the IVI Clinic Valencia in recent times. One of the biggest of these is the vitrification of oocytes, a technique which enables women to postpone having children and reach middle age without experiencing any significant decrease in their ability to conceive a child in the future.3 It is advancements such as these which have helped continually enhance the IVF procedure, providing options for different people and increasing success rates.
In addition to well-documented emerging areas such as artificial intelligence and big data, Dr Labarta views gene-editing as playing an increasingly important role in fertility care in the future, including the CRISP-Cas9 genome editing tool. Another field that she expects will start getting greater attention at events such as the annual ESHRE Congress relating to endometrial receptivity: “The uterus is growing in importance and there is much to study in this field,” she added.
EMJ Reproductive Health
It was very interesting to gain the perspectives of Dr Labarta on this increasingly significant area of medicine. For further insights in the field of reproductive health, you can check out the latest edition of the EMJ Reproductive Health eJournal, which is available to read here on our website. The journal includes a review of the recent ESHRE Congress in addition to abstract and symposium reviews presented at the event, interviews with leading experts in the field, and a range of peer-reviewed articles.
- Ferring Pharmaceuticals. New analysis of Rekovelle® data further supports use of AMH to personalise fertility treatment. 2018. Available at: https://www.ferring.com/en/media/press-releases/new-analysis-of-rekovelle-data-further-supports-use-of-amh-to-personalise-fertility-treatment/. Last accessed: 30 August 2018.
- Magnusson Å et al. The correlation between AMH assays differs depending on actual AMH levels. Human Reproduction Open. 2017;4.
- IVI-Fertility. Vitrification of oocytes. Available at: https://ivi-fertility.com/assisted-reproduction-treatments/vitrification-of-oocytes/. Last accessed: 30 August 2018.