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Opinion

Trends and expectations for the fertility sector in 2023

By Eran Eshed, CEO and co-founder of Fairtility

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Eran Eshed

2022 featured some pivotal moments whose impacts will reverberate into the new year. Eran Eshed, CEO and co-founder of Fairtility, reflects on the developments poised to shape fertility care in 2023.

This year, we saw the US Supreme Court overturn Roe v Wade in a decision with passionate responses from both sides of the political aisle. Through 2022, we have started to learn to live alongside Covid.

From a technological perspective, AI has clearly entered the Zeitgeist with endless social media posts featuring AI-generated art and text, stoking both excitement and fear of how AI will impact our future lives. And, we are facing a global economic downturn that is impacting people around the world with spiking rates of inflation and rising cost of living globally.

With these new realities in play, the field of fertility care will feel the effects of all of these trends in different, but significant ways. Let’s take a look at how some of 2022’s pivotal developments are poised to shape fertility care in 2023.

Roe v Wade and IVF Clinics in 2023

The overturning of Roe v Wade by the US Supreme may have a significant impact on IVF in 2023, specifically in states that do not explicitly allow for IVF or IVF embryo selection as part of their anti-abortion laws.

With state-by-state laws forming in the coming year, prospective parents will need to remain informed of their local legislation, as reproductive medical procedures may be restricted or entirely banned in certain states.

Consequently, prospective parents may need to travel out of state to receive IVF treatment. IVF clinics will have an uncertain year ahead as patient demand remains unpredictable in the wake of Roe v Wade.

Additionally, clinical IVF teams will need to remain vigilant as “foetal personhood” legislation, which suggests that foetuses and embryos have the same legal standing as a born child, may expose routine assisted reproductive technology procedures such as IVF to risk, and potential liability for providers.

IVF in the post-pandemic world requires innovation

We are seeing the impact today of healthcare treatment delays that occurred as a result of Covid. For prospective parents who are up against a biological clock, fertility treatment delays were agonizing. During the pandemic, many IVF clinics had to temporarily close the doors to patients.

As the world resettles into new routines alongside peeks and dips of Covid cases, patient demand for IVF is higher than ever.

However, filling this need is not simple as we face a global shortage of embryologists. Meeting this need requires the advancement of IVF technology to automate routine processes for clinicians, freeing up their time to service additional patients.

Digital transformation in this field will gain further momentum in 2023, as the introduction of new technologies into IVF clinics, such as AI-guided decision support tools, will help increase capacity, reduce costs, and improve access to reproductive health treatments.

The new generation of fertility patients are tech savvy

AI has entered our daily lives. This couldn’t be clearer as our social feeds are filled with ChatGPT and AI-generated portraits.

These new technological opportunities, combined with a younger generation that has grown up with endless access to information means today’s fertility patients are looking for greater automation, transparency and explainability in their care journey. This tech savvy generation wants to feel engaged and in control of their journey and choices.

Opportunity comes up against reality when prospective patients are sitting with their fertility specialists. The worst thing for prospective parents undergoing IVF to hear – other than the simple fact of an embryo transfer not implanting – is that there is no explanation for the failed attempt.

This can make patients feel they are sitting in the back seat of their treatments rather than in the driver’s seat.

Herein lies the opening where new AI solutions will have an impact. Digital technologies such as transparent AI tools, electronic witnessing and automated cryo storage are becoming more commonplace and widely deployed in the reproductive health space. These can enable greater transparency and increased clinician-patient collaboration.

Harnessing the power of AI to augment IVF decisions

AI is going to impact more than just the patient experience. Fertility care is moving toward new areas of sophistication, which is being driven by data.

New tools and technologies in health in general and IVF specifically enable collection of vast amounts of data that either could not be collected before or was not good enough quality.

New transparent AI tools can take advantage of this data, with the ability to manage, interpret and truly make sense of it all. This is enabling standardisation of clinical protocols and improving accuracy and consistency in clinical decision making, regardless of the experience level of the embryologist.

The image-based nature of IVF has made it ripe for AI transformation. Collecting vast amounts of aggregated data, and training AI algorithms to identify specific biomarkers as an embryo develops, is giving embryologists a new level of insights into the quality of developing embryos that is not possible with human analysis alone.

With millions of data points collected and analysed during an IVF cycle, embryologists are being armed with rich AI-driven biological data and quality assessments to help them determine the most viable embryos.

AI-powered embryo quality selection tools are being deployed into clinics around the world. Utilising these tools to support clinical decisions along the IVF treatment journey, we may expect to see an overall improvement of IVF care outcomes, with patients requiring fewer IVF rounds to achieve a live birth.

The pandemic economy – what’s in store for IVF?

One of the biggest challenges the world is grappling with as we close 2022 is the post-pandemic economic crisis. However, it is unlikely the economic downturn will affect the fertility care market in the way it has other fields.

Since peoples’ desire to become parents is a fundamental need for many, prospective parents will prioritise IVF over anything else. These single-minded patients will be doing their homework on which fertility care provider is most likely to help them fulfil their dreams.

Fertility clinics will need to up their offerings to prove to their potential patients that they can get the job done. This is going to position clinics utilising advancing AI decision support tools ahead of the rest, since prospective parents who are tight on funds will want to make sure they are given the best chance of success.

Advancements in technology can provide hope to those who are invested in the IVF process. It will facilitate a lot of the changes that we need to see, including improved access, lower costs, improved patient experiences and more consistent and objective clinical decision making.

Based on patient demand, IVF professional need, and the new technologies entering the IVF lab, 2023 is poised to be a year in which we see the bar raised on the standard of care in this field.

For more info, visit fairtility.com.

Opinion

The continued struggle for female representation in drug trials  

Dr Janet Choi, chief medical officer at Progyny

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Dr Janet Choi, chief medical officer at Progyny

The exclusion of women from drug trials undermines efforts to ensure equitable and effective healthcare for all individuals.

In 2002, the Women’s Health Initiative (WHI) was forced to pause its study on hormone therapy’s effect on menopause symptoms due to results showing it increased the risk for breast cancer, stroke and heart disease, and thrombotic events like pulmonary emboli.

Over 20 years later, in May of this year, JAMA published a review of this study and determined that, given current available hormone therapy formulations as well as risk/benefit analysis, younger menopausal women may actually derive significant benefits from menopausal symptom relief with appropriately prescribed hormone therapies.

The initial study had looked at women who were older and typically years post-menopause – the average age of the study participants was 63.3 years – and the age-related changing of blood vessels, among other things, may be the key to shifting from greater risk to greater benefit with hormone therapy.

I wish this more measured summary of the study’s findings and recommendations had been headlined back in 2002 – and I imagine thousands of my OB/GYN colleagues and billions of menopausal women over the years feel the same.

Yet, due to these 2002 over-generalised published findings, doctors and patients shied away from hormone therapy, which led to unnecessary suffering for many symptomatic menopausal women.

The irony of the WHI study is that after decades of women being excluded from clinical research, Congress finally passed an act in 1993 requiring that the National Institute of Health (NIH) enrol women and persons of colour in clinical trials.

On the heels of this landmark decision, the intentions of the WHI study were excellent – a first of its kind for women – but may have unintentionally set back women’s health innovation.

The reality

If you’re wondering why we are just now reevaluating and reinterpreting findings made in a 2002 women’s health study you may (or may not) be shocked to learn that while there is growing inclusion of women into research trials, they are still underrepresented in key therapeutic research areas, such as cancer and cardiovascular disease.

Excluding women from drug trials can have several harmful consequences. First, it can lead to a lack of understanding about how medications affect women differently than men, as their physiological responses may vary due to hormonal and metabolic differences, among other factors.

This can result in ineffective or potentially harmful treatments for women. It can also hinder progress in medical research by preventing the development of sex-specific treatment approaches.

Additionally, while the amount of research conducted on the behalf of women has grown in the past two decades, research involving pregnant women has been restricted.

This leads to a limited understanding of how best to medically care for pregnant women: for example, less than 10 per cent  of prescription medications have been studied enough to understand the impact in pregnancy on both the woman and her foetus.

While the NIH and American College of Obstetricians and Gynecologists (ACOG) both acknowledge pregnancy as a “medically complex” state that can alter metabolism of medications, and the course of various diseases, increased pregnancy-specific data needs to be collected to optimise the care of women in pregnancy.

Another recent, glaring case study: initial COVID vaccination trials did not include pregnant women, which led to restrictions on the availability of the vaccines as well as restrictions of the use in pregnant women with dire consequences – as unvaccinated pregnant women are more likely to develop severe COVID infections requiring ICU admissions and are more likely to develop other pregnancy-related complications like preeclampsia and preterm birth.

How do we move forward?

The exclusion of women from drug trials undermines efforts to ensure equitable and effective healthcare for all individuals.

It’s crucial for the government and pharmaceutical companies to put more resources and funding into women’s health so we can have a deeper understanding of how to treat diseases that impact over half of the population, for more female and diverse talent to enter the medical field – either as doctors, researchers, healthcare executives – and to incorporate how biological sex can affect medical treatment into provider education.

And, for pregnant women, the answer was proposed by ACOG back in 2015: “A more careful examination…points to the need for evidence-based consideration of pregnancy exposure in research rather than broad exclusion of all pregnant women”.

If evidence demonstrates minimal risk to the foetus as well as potential benefit to the pregnant woman, why should she be denied the right to give informed consent to enrol in a clinical trial?

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Opinion

‘Women are left in limbo’: how telemedicine can cut down NHS gynaecology waiting times

By Kat James, director of new projects at Consultant Connect

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Almost 600,000 people in England are waiting for gynaecology treatment. It is clear the current system is not fit for purpose.

The NHS, across the board, is struggling to reduce waiting lists, but gynaecology health, in particular, has been sent to the back of the queue.

Referral numbers are about 60 per cent higher than pre-pandemic, which represents one of the three highest specialties in terms of volume increase since pre-COVID.

Not only are women left feeling neglected, but longer wait times also result in them needing more complex treatment or even emergency admissions to hospital.

Then, there is also the impact on family life, work, and women’s mental health. A survey of the Royal College of Obstetricians and Gynaecologists found that four-fifths (80 per cent) of women said their mental health has worsened due to the wait and that one in four of those whose mental health had deteriorated, pain was given as a reason.

More than three-quarters (77 per cent) of women said their ability to work or participate in social activities had been negatively impacted.

One of the main stumbling blocks impacting patient waiting times is the disconnect between primary and secondary care. Often, patients who have faced long waits for their appointment are discharged after their first hospital appointment and told that their care is best taken care of by their GPs.

The good news is that new ways of working better connect primary and secondary care and ensure patients receive the right treatment first time. If applied at scale, these solutions considerably reduce waiting lists.

For example, giving GPs immediate access to speak to a consultant on the phone for specialist advice and guidance for their patient. In ordinary circumstances, a GP would have to call the hospital switchboard or send a written advice request which might take days to be answered.

Often, these queries would go unanswered or aren’t transferred to the correct department, resulting in patients being referred sometimes unnecessarily or presenting at a busy A&E department.

Technology like Consultant Connect allows GPs to directly “hunt down” a specialist consultant from a pre-defined rota for expert advice via a phone call, ensuring GPs can direct their patients to the right care first time. This service is available for gynaecology in almost 50 NHS areas across the country.

In Coventry, for example, a 54-year-old patient presented with obvious advanced gynaecological cancer. While the two-week wait referral had already been made, the GP couldn’t move the appointment sooner than 14 days later.

Meanwhile, the patient started deteriorating, and the GP considered an urgent admission. The GP used Consultant Connect and, within seconds, was connected to a gynaecologist, who then arranged for the patient to be scanned that day. The patient got the care they needed and avoided an acute admission.

In June 2023, the service expanded to cover a menopause advice and guidance line as referral data in one local area showed increased referrals relating to menopause-specific questions, many of which did not require to be seen in a hospital setting.

This meant that trusts weren’t seeing patients who needed to be seen, and patients with menopause symptoms were on waiting lists for a prolonged duration without management plans.

With the new Consultant Connect Menopause line, GPs can get through to a consultant with special interest in menopause matters within 26 seconds.

Data shows that 87 per cent of calls resulted in the GP receiving “enough” advice for their patient to benefit from an immediate treatment plan via their GP rather than waiting for a hospital appointment with a specialist unnecessarily.

Another way to tackle the wait problem is to leverage remote ways of working, which opens access to a new pool of workforce that otherwise wouldn’t exist.

Consultant Connect runs a network of NHS consultants who review gynaecology referrals remotely, with no need to travel to local hospitals and with consultants choosing their own working hours. This is often attractive to consultants who work part-time in hospital or are on parental leave, for example.

For patients, it means they get access to treatment plans faster: the remote working consultant determines the urgency of a referral and writes up a management plan, which means that treatment can start immediately.

Often, the health problem can be resolved through this plan, and for those still needing to be seen, it means they come to their first appointment on a more informed basis.

At the same time, it ensures patients are on the correct pathway, and any diagnostic test needed for a diagnosis are initiated in a timely manner.

Last year, Consultant Connect’s team triaged over 5,000 gynaecology referrals across the UK, resulting in 43 per cent of referrals being safely removed from the waiting list.

Many of these patients were returned to their GP with a treatment plan devised by the consultant. By fast-tracking urgent cases, women are not put through unnecessary stress and pain while waiting to be referred to a gynaecologist. Among these referrals, one in ten cases were upgraded to the urgent and suspected cancer pathways.

By reviewing current systems to make them more joined up and to allow for efficient ways of working, we can speed up care for women and make sure that clinicians have the right tools to help the NHS deal with the mounting gynaecology backlog.

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Opinion

‘We are not allowed to talk about our bodies’: why we need to address social media censorship

By Clio Wood, women’s health advocate and founder of &Breathe

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Social media censorship is just another example of women’s issues being sidelined and women being made, yet again, to feel small.

The gender data gap is huge and, if you’ve ever read the great Caroline Criado Perez’s book, Invisible Women, you’ll know what I mean. It touches every day of a female life.

That impact includes social media too. Because while the social media platforms are notoriously secretive about their internal workings, it’s a pretty safe bet that social media algorithms, like most of the rest of life, are built on male data and trained on male behaviours.

This means that as long as women have different behaviours and priorities of what they want to see on these platforms, we’re going to find it a struggle.

Meta and Tiktok are silencing women’s health and sexual wellbeing content. Censorship harms women’s health: it increases women’s pain, and disempowers women, which in turn means the gender health gap cannot close. What annoys you when you’re on your phone scrolling has long-lasting impact for us and our children.

I’ve experienced this censorship first hand on Instagram, with my reach being restricted for simply posting a body confidence reel of me dancing in a bikini.

That in itself – one example of many – is infuriating, but what’s especially galling is that everyday men’s health topics are left uncensored, and hyper sexualised women’s bodies, unsolicited “dick pics” and fake accounts using nearly naked female profile pictures are making their way into social media feeds and inboxes unchecked. The hypocrisy of the situation is clear.

All the while charities are being forced to use male nipples instead of female ones, and female-led period brands are losing hundreds of thousands of pounds when their ad accounts get deleted.

Creators, charities, medical practitioners and brands are being censored constantly through algorithms picking up words like sex, vagina, vulva, or period. Which are all normal human functions or body parts and integral to these creators’ missions. You can’t be a period care brand without talking about periods.

CensHERship aims to alter the trajectory of the current algorithms and end the routine censorship of women’s health content online

Creators end up using written symbols and numbers to disguise these words and bleep them out in speech to try to get around this censorship.

It’s examples like this that finally led me – after many years of finding this situation ridiculous – to do something about it.

Together with Anna O’Sullivan, we’ve created CensHERship, a campaign which aims to alter the trajectory of the current algorithms and hopefully restore some balance to what is allowed on social media. Our ultimate aim is to bring the platforms to the table for discussion by this time next year.

We launched a survey in late January 2024 to try to collect as much information as we can about the incidences of muting and censorship that female creators are experiencing, whether they are educators, charities, brands or medical professionals. The results emphasised that this is a widespread issue taking in all of women’s health and sexual wellbeing.

In tandem we hosted an intimate roundtable to launch the CensHERship campaign and found, to our astonishment, that the problem goes much deeper than social media. Women’s health and sexual wellbeing brands are being refused bank accounts, insurance and being kicked off payment platforms without warning.

Social media censorship is just the tip of the iceberg. It’s just one more example of women’s issues being sidelined and women being made, yet again, to feel small.

We’re not being allowed the freedom to talk about our own bodies and health, because speaking up goes against the male-gaze archetype of the female role and body. Let’s end CensHERship once and for all.

Clio Wood is a women’s health advocate, journalist, author and Founder of &Breathe.

Anna O’Sullivan is a communications and marketing professional and writes FutureFemHealth 

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