Factors that are related to IVF outcome can be grouped as laboratory factors, human factors and genetic recombination
IVF clinics are organized, wish and work, to have positive results and healthy live births. This is a pursuit in which most times result in stress, anxiety and obsession for both the clinics and patients. Everyone involved in the IVF process is constantly thinking of what to do more in order to have the desirable result. In the case of a positive result nobody asks why, but in the case of a negative result, cascade of questions surface: why did that occur? Are more tests necessary? Can we modify the treatment so that might not happen again? Patients desire 100% success, but this is “unnatural” for human reproduction
To begin with, IVF is a multifactorial, multistep process that involves humans, nature, laboratory and equipment. We try to mimic natural human reproduction in the IVF lab. Yet, how can we control, affect, reproduce and explain every outcome?
In running an IVF clinic, all technical, laboratory factors and procedures must be flawlessly executed
Paradoxically, IVF is also a chain event. One mistake in a point of the process negatively affects the whole procedure, even if all other steps executed correctly. Lets take an example: all steps have gone well, but a misstep during the embryo transfer compromises the results significantly. In another, all steps are executed correctly, but the embryos are genetically abnormal, and thus destined to negative results. Choosing a protocol for ovarian stimulation might increase the chances for premature luteinization, yet may compromise endometrial receptivity, even though all other steps are optimally executed.
Factors that are related to IVF outcome can be grouped as laboratory factors, human factors and genetic recombination. Regarding the laboratory factors, quality control procedures have been broadly employed aiming to significantly reduce any missteps and glitches during IVF. Most IVF clinics are operated under extensive and strict ISO certified procedures. The goal is to reach near zero mistakes and minimize variability in these steps, and I believe there is success in that.
Human factors, as related to clinicians and embryologists, can contribute to a significant variability. Education, training and strict protocols can eliminate much of this variability. But it is very difficult to standardize human performances. Each case of IVF could be monitored and executed by the same IVF specialist and the same embryologist. However, these logistics are difficult to be implemented in busy units.
Each case of IVF could be monitored and executed by the same IVF specialist and the same embryologist.
Genetic recombination is characterized by variability and randomness, which is entirely out of our ability to be controlled. We know that both these elements increase as a woman’s age increases. Yet, we have no treatments to decrease genetic mistakes at the time of oocyte meiosis, fertilization and early embryo development. The only means we have is to consider maternal age quite seriously and consistently communicate this to society, and planning infertility treatments without time delay.
It seems that in running an IVF clinic, all technical, laboratory factors and procedures must be executed flawlessly. In addition, any new methods that by evidence–based criteria improve outcomes must be implemented thoroughly. Efforts must be focused on decreasing human induced variability. These include encouraging moderate sized IVF units or segmentation of larger IVF units into separate working areas so that a single physician, a single embryologist and standardized equipment is involved in each case. These ideas however, must be tested thoroughly in a randomized way. Strict monitoring of all possible factors involved in IVF, including human staff performance, digitized in a model of multiple regression analysis, can be helpful in early detection of biases. Patients and clinicians must also properly acknowledge and respect the limitations of genetic recombination. A failure therefore could be expected and an IVF retrial thus will be emotionally manageable.
Hopefully, in the future we will be able to develop methods and logistics to decrease human induced variability in the IVF procedures. Also, it will be revolutionary if we could device treatments and methods to safely decrease the genetic errors around the period of egg fertilization. These are necessary future steps that will increase significantly IVF success.