Personalized approach in IVF increases success rate

Becoming pregnant can be a lengthy and stressful process for one in every six couples. As fertility treatment protocols are based on the "average woman", approximately 30 per cent of patients need a personalized approach in IVF. In January, the first babies were born in Estonia after the use of genetic testing prior to IVF treatment.

The pilot program for using personalized medicine in fertility treatment started in 2019 at two major fertility treatment centers in Estonia - East Tallinn Central Hospital (ETCH) and West Tallinn Central Hospital (WTCH). Patients were chosen to the program after they had gone through repeated unsuccessful IVF treatments and the cause for infertility had remained unclear. In a year, a total of 50 patients participated in the program, 17 patients managed to get pregnant and 3 babies have already been born.

The patients were tested with novel beREADY test that reflects the readiness of uterine lining prior embryo transferring. The day of testing has been chosen according to the standard treatment plan. To measure the readiness, a tiny tissue sample is taken and a set of 67 biomarker genes are analyzed by DNA sequencing technology. The outcome of beREADY testing shows that one in three patient requires personalized treatment plan and the standard timing is out of optimal. The test has been developed by the researchers of Competence Centre on Health Technologies (CCHT).

A total of 26 patients have been tested at the ETCH, there are already 9 pregnancies and 2 live births. The head of the fertility treatment centre at ETCH, Dr Tiina Loog, considers using personalized medicine an important step towards more accurate and patient­friendly medicine.

We have been offering endometrial receptivity tests at our fertility treatment center since 2016, first in collaboration with the IVI laboratory in Spain. However, since April 2019, we switched to the test developed by CCHT, which is equally accurate as well as more affordable for the patient.

Of course, the test does not guarantee a pregnancy, but it definitely helps to choose the most suitable day for the endometrium to be ready for the embryo. Especially in cases where repeated IVF treatments have been unsuccessful."

Dr. Tiina Loog

The implementation of personalized medicine also had a positive beginning in another IVF clinic - WTCH. At WTCH 34 patients have been tested, eight are pregnant and one has delivered her baby. For most patients, the embryo transfer is yet to come.

"We recommend the endometrial receptivity test to patients, who have had several unsuccessful rounds of IVF treatment. On several occasions we have altered the embryo transfer timing based on the test results. As patients become more aware of the possibilities of modern medicine and going through multiple IVF treatments is both emotionally and financially difficult, the test has also been requested by patients who want increase their chances of getting pregnant during the first cycles," explained the head of the center, Dr Katrin Kask.

The manager of the Precision Medicine Laboratory at CCHT, Kaarel Krjutškov, noted that it is critical to contribute to the start of the fertility treatment and use personalized medicine for increasing the chances of a successful pregnancy.

"The endometrial receptivity test is like an insurance, so that the valuable embryos are transferred back to uterus just at the right time - not too soon nor too late. As fertility treatment is time-consuming and the age of the women increases with each additional cycle, becoming pregnant can be increasingly difficult. Thus, the test should not be the last resort for patients, but a prerequisite for continuing the fertility treatment after pregnancy has not been achieved with the first or second cycle," said Krjutškov.