Patient-tailored infertility care is the way forward

Abstract

As in any other healthcare discipline, the debate around standardization of practice versus individualized care is also present in the field of infertility. While the former looks for the efficiency of diagnostic and therapeutic processes in the average population supported by evidence-based medicine (EBM), the later looks for patient-centred care, integrating individual clinical expertise and patients’ rights and preferences. Both approaches have been compared in a few randomized controlled trials (RCT) having as end-points live birth rates and incidences of adverse effects. However, the available evidence is arguable and too weak to clearly proclaim that one is better than the other. Indeed, it has been suggested that RCT, the keystone of EBM, are not the best tools to evaluate the efficacy of personalized care. A different design, named ‘N-of-1’ trials, has been proposed as the most appropriate methodology to this end. Infertile patients are still undertreated worldwide. Poor outcomes, fear of adverse events and financial reasons are behind this. In this context, a more personalized approach, aimed at optimizing the outcome while fulfilling the patient's preferences, is necessary to overcome these barriers.