Evidence Based Medicine & Infertility Treatment
Evidence based medicine is exactly what it sounds like: physicians making medical care decisions based on the best evidence of effectiveness. Such evidence comes from expertly-designed research studies that are meticulously conducted under the strictest guidelines, then thoroughly analyzed and reviewed along with other similar studies.
Being part of a research hospital, Advanced Reproductive Medicine (ARM) is grounded in evidence based medicine (EBM). All our board-certified reproductive endocrinology and infertility doctors (REIs) are highly qualified and respected researchers. They are in constant communication – and often collaboration – with the top experts in the world of infertility medicine and research.
Our physicians’ professional lives are a balance of conducting research and caring for patients with infertility. They are at the forefront of discovering in their research new aspects of infertility treatments to help the very people who are depending on them daily in the clinic. We are evidence based medicine specialists in the field of infertility, continually immersing ourselves in the all-important details in an attempt to cure any cause of infertility.
Infertility medicine researchers have their specialized areas, as do we.
- We maintain a focus on the effects of weight on infertility.
- Our work with Duke University last year resulted in the impressive finding that performing an IVF transfer with one embryo greatly increases the chance of a healthy baby.
- Our award-winning research linked omega-3 fatty acids with improved fertility.
- We proved that smoking harms male fertility.
- Our research on using an existing drug for PCOS (polycystic ovary syndrome) patients showed a 45 percent increase in fertility.
Fertility physicians in private practice and those in academic practices follow the treatment guidelines and nuances we help develop through our research. And of course, we put our research-based medicine to work for our own patients. It’s why many patients chose us as their infertility physicians.
Origins and development of evidence based medicine
While it may seem like EBM should be a given since the days of the ancient Greek Hippocrates, sometimes known as the father of medicine, it has only gained ascendancy as a standard for medical care in the last few decades. EBM has roots in 19th century Parisian medicine and earlier, but more recently came to the forefront with Archie Cochrane’s 1972 book Effectiveness and Efficiencies: Random Reflections on Health Service.
In 1979 Cochrane awarded the field of obstetrics and gynecology a “wooden spoon” for being the least evaluative and scientific of medical specialties. Most of ARM’s physician researchers are also certified OB/GYNs, and we are happy to note that this challenge was taken up by the field and has been properly turned around.
When you consider that the first IVF (in vitro fertilization) baby was born in 1978, fertility medicine and EBM have blossomed in parallel fashion. Certainly, we haven’t perfected IVF yet, nor has a world of physicians and researchers perfected EBM.
One arrives at medical evidence through well-conceived, often very narrowly focused studies in a particular area of medicine that often include randomized trials. The results of many similar studies are compiled, carefully analyzed and reviewed.
But it can seem like EBM and the world of patient care are not always in alignment. Measuring study findings often results in evidence based on the average effect of a treatment on a large group of patients studied. It could be that some are effected more than others, some not at all. As we well know in fertility medicine, we have to take the individual patient’s particulars into account.
So does the proper practice of EBM. David L. Sackett and other experts on the discipline wrote in 1996 that EBM is more than blind application of the results of a clinical trial. Practicing EBM means doctors combine what they’ve learned in their one-on-one clinical patient experiences with the best available external evidence from rigorous research. And that’s what we do at Advanced Reproductive Medicine.
Medical research + EBM = fewer infertility patients in the future
2018 marks the 40th year of IVF births. In large part due to the proper application of evidence based medicine, we are much better at IVF now. And we continue to get better, meaning more babies for previously infertile men and women.
Advances apply to other aspects of infertility as well, from egg freezing, which was still classified as experimental until 2012, to equally important egg thawing techniques, preimplantation genetic testing, ovulation induction and many other aspects of infertility treatment.
Across the board, we are getting better at treating our fellow human beings who cannot conceive without medical help. That can even mean gaining a better understanding of how to predict ovulation, so couples have a better chance of getting pregnant without our help.
But what we really need is more evidence to base our medicine on. Consider that we can’t pinpoint the cause of infertility in 15 percent of cases, resulting in a diagnosis of unexplained infertility that simply means we don’t know. Even there, as our Dr. Edward Illions explains in his blog, we’re getting much better at treating it.
While we’ve made great strides in IVF, we all want to do much better in that regard. And we can, with the proper evidence based medicine. That means more research, more analyzing, more review. And so forth.
But the gaps in what we know and what we need to know in EBM are still fairly wide. For instance, why so many women have problems with embryo implantation in IVF needs much more study to arrive at evidence. We also need to better understand why some women are poor responders to ovulation stimulation. There are so many aspects to even these relatively narrow areas of treatments, from dosages to techniques to instruments.
As the field of infertility medicine gets better at chasing down the hard evidence in those and many other areas, we’ll be right there conducting more studies, doing more research to add to the growing library of EBM solutions.
Infertility patients in Colorado and worldwide will benefit. And as we apply that EBM to our treatments for patients, we will always factor in their particular medical situations, their preferences and their concerns, along with the pearls of wisdom all of the ARM physicians glean from working with and observing the people they care for.