All over Instagram I am seeing lists about what things people think are in and out for 2024. Most of them seem a bit like virtue signalling. Like, when people say “in: donating to charity” and “out: caring what people think of me.”
Anyway, if I was to say what things I think will be “in” in fertility care for 2024:
Keep getting more personalized. For example, a study would show no value of, say, antibiotics given to 1000 infertile women who share only “infertility” or their age in common. This is helpful to know that giving antibiotics for just the diagnosis of infertility is useless, but is there a group of people in that 1000 that did benefit? In this example, if you pulled out the 100-ish people who have endometritis (uterine infection) causing infertility then you would see a benefit. If you are those 100 people, as it stands now, antibiotic treatment might be missed unless the study is designed to pick out that group of 100 (often studies are not properly “powered” to pick up small subgroup variations in outcomes).
More available, more accurate diagnostics. When I started practice we could test for a handful of genetic conditions, florid endometritis, and endometriosis only by laparoscopic surgery. Now we can test for hundreds of genes, and soon the whole genome, easily. Now we can test for endometriosis with a simple uterine biopsy. Now we can test for not just the presence of florid endometriosis but for minor alterations in the microbiome of the uterus. These are just a few examples of how diagnostics are helping us target treatment better than ever. This year we will see this trend continue. Unfortunately many of these tests are not covered by our public health care system (https://www2.gov.bc.ca/gov/content/health/health-drug-coverage/msp) as adding new items to be covered takes years - which our patients do not have.
Going sooner to IVF (https://www.olivefertility.com/fertility-services/treatments?fertility-treatments=ivf). I’ve noticed this over the years and it’s a good trend. Treatments like IUI (https://www.olivefertility.com/fertility-services/treatments?fertility-treatments=iui) or surgery or pills like letrozole or clomid can help a person conceive but their success rates are much less than IVF. It is often, and usually, good to start with this less aggressive treatments, but some people and their doctors will waste precious time on treatments with a 10% per month pregnancy rate when IVF has a 50%+ pregnancy rate, depending on the situation. As more companies have benefit plans that cover IVF we will see people spend less and less time on less effective treatments and move sooner to IVF.
AI. It feels painful to type “ai" for some reason. I think it’s because the application of AI so far has felt like a private club that has been meeting for months that the majority of us didn’t know about. We are made to feel like losers relegated to interfacing with AI only through ChatGPT to help snazz up our text output until someone develops something better that will show us all this buzz will actually help and not just take our jobs. Rant over. Ok that’s unnecessarily negative. Hahaha. AI has already helped us with egg freezing. For the past couple of years images of eggs prior to the freeze have been captured and using AI we are getting better and better (machine learning!) at predicting whether a given egg will make a baby. Given how data driven IVF outcomes are, AI makes sense in this space. I think we’ll see more and more use of AI to optimize treatment and laboratory protocols.
The world of infertility is the most scientifically exciting and clinically meaningful area of medicine. Prove me wrong! Hahahaha! What’s exciting is the speed of change. We have newer and better tools all the time. I admit that for some patients the tools are imperfect or aren’t being developed fast enough, but for most people there is reason to be optimistic. When I am speaking to patients I try to give them a sense of my optimism or pessimism. I’ll always be honest and I’ll always do my best to personalize their treatment and prognosis. At 2024 begins I am more optimistic than ever for patients.
Dr. Beth Taylor
