There is a lot of hype about how genomics is going to revolutionse IVF . Using all the basic biological information which our genes provide, along with all the insights which big data analytics provides , powered with artificial intelligence , IVF doctors will be able to take better care of infertile patients. They will be able to provide "personalised precision medicine" and this kind of tailoring is supposed to help improve IVF pregnancy rates.
While some of this maybe true , I think there is just too much hype as well. The idea of analysing genomic data for providing predictive analytics to help you remain well is seductive and logical, but the truth is that the actionable advice which you can give by analyzing the patient's genome is very limited. In fact, the advice which you give the patient after a genomic analysis is pretty much the same advice your IVF doctor would give you without even doing the test !
While genomic analysis looks very impressive ( for example, the ERA, or endometrial receptivity assay has become very popular to analyse "failed implantation" in many IVF clinics ) the fact is that most IVF specialists do not understand the results; and these really don't change the treatment which the doctor can offer.
However, the advice looks a lot more impressive when it comes on a computer print out, which uses a lot of esoteric and exotic names . And perhaps you are more likely to take it more seriously when you have spent a lot of bucks to get this fancy report. Forget about the poor patient, most doctors don't understand this either - it's all gobbledygook to them as well !
We need to cut through all the clutter and ask ourselves, "What real life difference is this genetic analysis going to make to patients and doctors?" While it can be profitable ( for the doctor , who orders the tests, and the company which markets these tools) to do the analysis , let's not forget that it comes with a down side as well. While the genomic companies are happy to market their new toys by highlighting success stories, most of these are anecdotal and isolated. No one has been able to prove that they provide a worth while return on investment.
I think it's important to understand that, yes, we can input all this data in and we will get an output in the form of glossy, colorful reports , but how useful are these results? We forget to do a cost benefit analysis, and think about what the costs would be if we applied these tests across the board to everyone ( which is what the genomics companies want us to do !)
The impact for the patient can actually be negative , because she wastes a lot of money on these expensive tests, which she really didn't need to do the test in the first place.
All data needs to be interpreted in the clinical context , and the role of the doctor remains extremely important. After all, it's the doctor who's going to tell the patient - this is what you need to do with the information . The problem will all these tests is they promise to provide a crystal ball , but the fact is that it's a very cloudy crystal ball , and the signal to noise ratio is poor.
While it's great to have this data on a research basis I don't think it's really fair to ask patients to pay for this, because the impact it will have on their health is still unproven. Part of the problem is we all suffer from shiny object syndrome. It's great to talk about the future and how it's going to become a lot better with genomic analysis and smarter computers. We all want to play around with gee-whiz technology , and so do physicians.
I am not a Luddite, but it's the doctor's job to convert this data into wisdom for the patient who is sitting in front of him. Translating this research data into clinically useful decisions for the individual patient is going to take time. Until we get there , the companies should acquire this information on a research basis , but it's unfair to charge patients for a clinically unproven service . The danger is that once patients realise that the information they get is of limited value, everyone will get disillusioned, and digital health startups will lose their credibility, without being able to accomplish what they set out to do .
Fed up of all the expensive tests your doctor is ordering for you ? Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !