The gold standard in IVF

One of the world’s leading IVF specialists, Markus NITZSCHKE, shares his assessment of the Ecomed clinic network.

Markus is a highly experienced specialist who practices and teaches around the world. He has repeatedly conducted training for Kazakhstani doctors, shared his expertise, and even consulted our patients. For many years, he has demonstrated in practice that the latest reproductive technologies can and should be accessible to more people — something that can only be achieved by reducing their cost.

A specialist of his caliber does not compromise on quality. Markus advocates the rational use of resources and, importantly, trust in physicians. In an exclusive interview for readers of the journal Reproductology, Markus discussed global trends in infertility treatment. He also explained the difference between an expensive IVF protocol and a more affordable one, and in which cases a lower-cost approach may be the better option.

— Over the past few years, I have observed a consistent trend worldwide, — Markus explains. — Reproductive medicine specialists increasingly prefer to freeze reproductive material and separate the ovarian stimulation cycle from the embryo transfer cycle. In addition, whenever possible, they try to use lower doses of medication. Both approaches help minimize the risk of ovarian hyperstimulation syndrome (OHSS) and its potential impact on treatment outcomes. The chances of achieving pregnancy increase while the risks decrease.

I am very pleased to see that the Ecomed clinic network, whose work I have been following for many years, actively applies some of the most advanced approaches to infertility treatment. Mild stimulation protocols have also been successfully adopted in your clinics.

Kazakhstan faces the same challenge as many other developing countries: patients’ financial resources are often limited.

Today, approximately eighty million couples worldwide would like to undergo IVF but cannot afford it because of the high cost of treatment. IVF was originally developed in highly industrialized countries and was initially accessible mainly to patients who could afford expensive treatment.

However, the situation is changing. There is what we call a “gold standard,” based on expensive medications produced by leading pharmaceutical companies. If a patient can afford this approach, then of course it makes sense to maximize the opportunity it provides.

At the same time, we should not forget that less expensive approaches are also available. For example, an alternative to an expensive medication may also produce good results while reducing the overall cost of an IVF protocol several times over.

The Ecomed clinic network has been using this approach for eight years, and your physicians have accumulated considerable practical experience. Several years ago, Ecomed presented its experience with lower-cost IVF at a European congress on reproductive medicine, and the presentation was very well received.

That is why I believe that, within a few years, Kazakhstan may be in a position to teach other countries how to use this approach effectively.

— That is difficult to imagine, because we are accustomed to thinking that we need to travel to Europe or the United States to access the latest medical technologies…

— There is absolutely no reason to think that way. I can say with confidence that the Ecomed clinic network has world-class physicians. Everything depends on education, equipment, and opportunities to gain practical experience at leading IVF centers around the world. Here, I see all three conditions being met.

Moreover, Saltanat Baikoshkarova, your head, not only organizes international training opportunities for Ecomed staff but also brings leading specialists to Kazakhstan and arranges training for reproductive medicine specialists and related healthcare professionals throughout the country.

I would compare the path your IVF sector has taken with Japan’s experience. As you know, Japan initially imported the world’s most advanced technologies and later became a leader in innovation itself. You are moving in the same direction.

— Is there a direct relationship between the cost of an IVF protocol and its outcome? Does a more expensive treatment always mean a greater chance of success?

— There is a relationship between cost and time. Let me give you another comparison. Imagine a prestigious new car. You can still reach the same destination in a simpler and less expensive vehicle.

It is good that we now have this choice. In the past, a physician could offer a patient only the “premium-class” option — an expensive protocol. Today, we have alternatives, and we should make greater use of them.

Often, the main difference is simply the amount of time separating a couple from a successful outcome. With the gold-standard approach, we may achieve a result in approximately two to three months. Alternative approaches may extend this period to four or five months, but the patient may pay 60–70% less.

At the same time, we should remember that there is a large group of patients for whom the gold-standard protocol is simply not medically appropriate.

— So, in some cases, a standard, expensive protocol may be unsuccessful while a less expensive alternative may work?

— If a patient has an adequate ovarian reserve, stimulation using a gold-standard protocol can produce very good results. You may obtain a large number of oocytes that can subsequently be used in treatment. This is particularly useful when infertility is associated with fallopian tube problems or male-factor infertility.

However, when ovarian reserve is low, the outcome may be approximately the same regardless of whether expensive stimulation is used.

So, is it reasonable to spend additional resources?

Patients with low ovarian reserve are considered one of the most challenging groups in reproductive medicine and are often regarded as having a poor prognosis. Unfortunately, this group also receives relatively little attention at scientific congresses.

There is another group of patients — women with polycystic ovaries. According to reproductive medicine specialists, this condition affects approximately 10–20% of patients worldwide. For these women, intensive ovarian stimulation may be contraindicated.

In such cases, lower-cost alternative approaches not only reduce treatment expenses but may also provide an appropriate solution for these patients.

— As I understand it, many clinics in the United States and Europe immediately recommend donor eggs to patients considered to have a poor prognosis in order to protect their success-rate statistics.

— That is indeed the case. Ecomed, however, has been working for eight years with patients even when their chances of success are minimal.

This is another reason why I am so confident that physicians from other countries will soon come to Kazakhstan to learn from your unique experience.

I have noticed that the more educated women are, the more often they want to have a child using their own oocytes and prefer not to use donor eggs.

At the same time, I can say with certainty that I have never seen a family in which the parents regretted having their child, regardless of the reproductive technology used or the genetic origin of the biological material.

When a woman carries a pregnancy, feels her baby moving inside her, and gives birth, she has no doubt that this is her child.

With a spontaneous pregnancy, people may sometimes take the arrival of a child more for granted. But when achieving pregnancy requires a long and difficult journey, the child is, in every case, deeply wanted and immensely precious.