World Monitor Magazine June #3 - Page 49

EXPERT OPINION approach is introduced. First of all, in oncology, when dealing with a particular oncological disease, doctors look for a specific drug or treatment method, to which the tumor is most sensitive. We can see the same in reproductive medicine. This variety of methods and pharmacological tools give us opportunities to choose a specific treatment method for each patient. There is no limit to perfection in personification. I believe that soon we will determine the genotype characteristics of patients with different forms of infertility, a certain polymorphism of genes – this is a future. But today there is an opportunity to personalize our approaches. First, we work with each patient individually. Depending on his/her status and reasons of infertility, we determine a treatment method, and drugs are selected considering a large number of factors. The specific patient’s protocol is taken into account and selected; the stimulation schemes are maximally personalized. The most personalized method is the opportunity to use the gene diagnostics. Despite the fact that we operate only once year, the ‘Persona’ was the first in Kazakhstan to open a laboratory able to determine all 46 chromosomes in an embryo prior to transfer. Pre-implantation diagnosis existed in Kazakhstan already, but we have implemented the ICGH method that allows the determination of all 24 pairs of chromosomes. We transfer a proven healthy embryo and guarantee 99 percent lack of chromosomal pathology. This increased effectiveness by up to 50- 70-80 percent for patients who have had a history of failed IVF, especially for older women, in cases when the pregnancy did not occur previously. Some patients cannot undergo a transfer, because all embryos are changed, especially for women after 40 years of age. This method, in my opinion, is the height of that personified approach, which is possible in reproductive medicine. In the future, we will be able to identify monogenic diseases. Then, we will be able to say with 100 percent probability that we transfer a healthy embryo. It will be possible to avoid many diseases that are not diagnosed today during pregnancy, to give to the opportunity for a child to be born healthy. Speaking about genetics in Kazakhstan and new opportunities of IVF, how do you assess the problem of infertility in Kazakhstan? This problem concerns me, as I am a specialist in fertility treatment and president of the Kazakhstan’s Association of Reproductive Medicine. In Kazakhstan, like all over the world, the infertility occurrence is about 15 percent, there is no downward trend. Moreover, we see that the number of fertility-challenged couples is even increasing. When we say that in Kazakhstan about 150-160 thousands of marriages are effected every year, and 20 thousand patients among them have problems with the birth of children. And this army is being replenished all the time. Today, there are about seven thousand programs of in-vitro fertilization in Kazakhstan, and approximately 400-420 programs per million people is absolutely not enough. If we look at European countries, the standard there is one thousand programs per one million people. This suggests that many people today cannot attend a doctor because for financial reasons, lack of knowledge, or useless doctor methods. This is why the reproductive medicine in Kazakhstan possesses great potential. Approximately 40 percent of couples need a supportive treatment by means of reproductive technologies. Speaking about the couples having problems with the birth of children: how do they understand that they need to consult a reproductive health professional? If the spouse, in particular a woman under 45 years of age, maintains a normal sex life without using any protection and there is no pregnancy within one year, it means that we can diagnose infertility. The spouses after 38 must come to a doctor even earlier. If you notice that pregnancy does not occur in six months, you can contact a reproductive health professional to find the causes of infertility. What is the situation with quotas in Kazakhstan, including your center? Since the 2000s, by our initiative, the Ministry of Health has begun supporting patients with infertility. In 2010, 250 quotas have been given. Now their number has increased to almost 900 quotas in this year. From the next year we plan to work in the insurance system, and I believe that due to this the number of quotas will increase further. Currently about five clinics that have been established long ago provide treatment by quotas. How is the situation with donation in Kazakhstan? The situation with sperm donorship is not good, as there are not s )ݥѼ̸Qɕեɕ)ɔЁͼѕ聄͡ձ)ɕ䁡ٔչȀԸ)%ӊéхЁѼѡ䁝ѥ)ͥ䁅ɅݥѠ)ٕٔɅՍѥɕɅ)ȁՍѥєѡЁѡ)ݔȁ̰ѡ́ɽ)͡хѥ̸)QͥՅѥݥѠє́)ѕȸ5剔Ս́ɔ)ѕȁȁٕ䁽ѕ̸]ٔ)ȁݡݔ͔)ѕUI= ,(