Modern medicine has benefitted hugely from clinical trials that have provided us with realistic outcomes expected from a wide range of treatments. As numbers are generally large, they can help to determine baselines for treatment protocols and they can give a good idea of side effects. However, such information cannot be the only basis for ‘best’ treatment.
Large trials give information on specific questions that may not apply to an individual, and entry criteria for trials are usually very limiting (eg. Patients of a particular age, or excluding other medical conditions). It must always be remembered that a statistical ‘benefit’ of treatment is a very long way from assuming that everyone trying the treatment will have that benefit. For example, 40% could benefit, 50% have no effect, and 10% could be worse off. Such a trial would still be considered ‘beneficial’ on average. Thus the art of medicine to try to determine how to get the most out of a particular intervention. It is a reality of medicine that accounting for individual differences can lead to markedly different treatments.
It must be emphasised again that mainstream medical practice is often the best that there is, and entirely appropriate for the vast majority of patients. But attention to detail at every stage of treatment may uncover problems, and sometimes it is necessary to think ‘outside the box’. This is an important and courageous aspect of all the best treatment. It is only possible to do this effectively and safely with a strong research background.
Dr Sacks has initiated numerous research projects at many different levels of intervention for couples trying to conceive. Each has its aim of optimising a particular factor, as the complexity of reproduction means that standard protocols will deliver an ‘average’ rather than ‘best’ outcome. Taking account of as many factors as possible is likely to produce the ‘best possible’ outcome. In addition, at IVFAustralia, patients undergoing IVF can have their treatment optimised and individualised having access to everything currently available. This includes:
- digital high magnification selection of sperm
- polarising microscope for egg quality assessment
- long, short, or flare protocols using all available stimulatory drugs
- best available culture media for blastocyst culture
- time lapse embryo culture systems
- expertise in the best and safest protocols for women with polycystic ovaries
- expertise in the most appropriate and realistic approach in women with poor ovarian reserve (low egg numbers)
- ultrasound guided embryo transfer (as appropriate)
- egg collections done under general anaesthetic, sedation or even local anaesthetic
- embryo biopsy and chromosome analysis
Dr Sacks is passionate in ensuring that couples trying to conceive undergo as effective treatment as is possible for them. There should be no stone left unturned. But it is also sadly true that some do not succeed. It is equally important that those couples feel that they have tried everything that they could, or at least are aware of all the choices that are available, as they make other life choices. The reproductive path is a journey rather than a destination, and Dr Sacks sees his role as a partner along that journey. A feeling of support, encouragement and empowerment comes from knowing that research is being done, that everything is being scrutinised, that personal circumstances and beliefs are very much part of the treatment plan, and that someone else is looking out for you.
Additional cultural readings
Fearfully and Wonderfully Made by Dr. Megan Best
A comprehensive, accurate, biblically-based ethical handbook on reproductive medicine for Christians.
Toward a Meaningful Life by Simon Jacobson
A fresh Jewish perspective on every aspect of life, including birth.
Treatment of Infertility with Chinese Medicine by Jane Lyttleton
A systematic look at what Chinese medicine offers in the way of treatment for functional infertility in men and women.