Medical student’s sneak peek at Kindbody's fertility clinics.
I had the huge pleasure of spending a part of my elective at Kindbody ’s fertility clinics in New York.?
First things first, what’s an elective, why fertility clinic and why Kindbody?
An elective is a clinical placement, undertaken as part of a medical degree, during which medics organise a rotation/(s) of choice, often in a different setting than what the university has provided them with so far.??
I’ve been interested in reproductive endocrinology for quite a while and considered it a speciality to potentially specialise in one day. I’ve always found this field of medicine cutting edge, with a lot of opportunity for research, impact and proactive care. However, I haven’t had much exposure to it during medical school. As with most things, without direct exposure, it can be challenging to understand if it’s the right thing for you and how to get involved.?
As a medic interested in women’s health, innovation and holistic approaches to medicine, I’ve been following Kindbody for quite a while. The company was founded in 2018 with a vision to make fertility care more accessible. Today, they are a unicorn and offer gynaecology and fertility care in over 20+ tech-enabled clinics (1).?
To make the most out of my time with Kindbody, I defined the goals for the elective to be:?
A typical day with Kindbody?
Surprise number one: fertility clinics are really busy. I am shadowing Dr Rachel Danis who is an American board-certified OB/GYN who specializes in Reproductive Endocrinology & Infertility. Dr Danis has back-to-back patient appointments, procedures and follow-up calls with nurses and patients. We see a variety of patients, from those just proactively thinking about their fertility to those with more complex needs, eg. due to cancer, endometriosis, PCOS.?
Between fertility assessments, we chat about the cases and discuss common presentations. What are the benefits of surgical treatment of endometriosis? What is ovarian hyperstimulation syndrome (OHSS) and who is at risk? What do we know about premature ovarian failure? How to induce ovulation for patients with ovulatory dysfunction? I’m learning as Dr Danis explains things in detail to patients. For example, during consultations, she shows them slides explaining hormonal changes during the menstrual cycle and ovarian stimulation. We also counsel patients’ hormone levels, ovarian reserve, age, transvaginal ultrasound scan results and important statistics so they can make an informed decision about their fertility treatment.
There’s no one day when we don’t look up scientific literature. There are new research articles and guidelines published frequently which have a direct impact on the current clinical practice. For example, we read an RCT to adjust the progesterone regime for a patient’s programmed embryo transfer to maximise the chances of live birth (Devine et al. 2021) (2).
Another day, we change to scrubs and head to the OR. There, I get to see the collaboration between embryologists and clinicians. While the OB/GYN is retrieving the follicles, embryologists are ready in the lab to receive the samples and look closely for the eggs. Sometimes we get 20+ eggs, sometimes only a few. Not all of these will be mature and suitable for freezing. In between the cases, the embryologists are working on other tasks, such as genetic testing of embryos. The atmosphere in the lab is fascinating – high tech equipment, precision and focus. Other procedures done at Kindbody include intrauterine insemination, IVF, embryo freezing and transfers.?
In the afternoon, we review the lab results with nurses and follow up with patients. Dr Danis checks hormone levels and scan results and adjusts medications and doses daily. On the first day, it sounded like they were talking in a secret hormone language. I’m very impressed with the individual approach, and how much precision (and operational effort!) is needed to adjust the medications and doses for each patient every day. Then, we need to communicate with patients – are we changing the doses of medications? How many eggs did we manage to freeze? Was the transfer successful? How many embryos were genetically euploid and “high grade” (high quality)? The stakes, hopes and expectations are usually high and there’s a fair mix of delivering good news and bad news. “What’s the best thing about your job?” I ask Dr Danis.
“Fixing problems for patients and helping them improve physically and mentally”.
Let’s zoom out now and look at fertility as an industry and field of research.
Progress and innovation
The progress and research in fertility over the last few years has been rather rapid. The development of the new freezing technique for human eggs called vitrification meant that fertility clinics can now freeze eggs quickly and at scale. Previously, human eggs (which hold a lot of water as the largest cells in the human body), were challenging to freeze due to the formation of damaging ice crystals. The speed of vitrification eliminates crystal formation and limits cell damage (3).?
Advances in pre-implantation genetic testing (PGT) have also been revolutionising the field. PGT allows screening of embryos for genetic abnormalities and selecting the ones with the best morphology and quality for implantation. An embryo that has better morphological traits is more likely to lead to live birth, while a chromosomally abnormal embryo (“aneuploid”) is a common cause of miscarriage and pregnancy loss. PGT allows fertility specialists to increase the chances of live birth as well as transfer just one embryo into the womb, reducing the risk of twins and pregnancy complications. The advances in genetic testing and increasing access to personal genetic information bring new responsibilities onto patients and medical professionals. At Kindbody, patients can decide whether they’d like genetic screening of their embryos (at an additional cost) and they are also offered expert genetic counselling.?
领英推荐
We’ve also progressed in understanding how lifestyle factors affect fertility. A?2018 review found that folic acid, vitamin B-12, omega-3 fatty acids and a Mediterranean diet were linked with improved fertility outcomes (4). Research like this enables clinicians to take a more holistic approach to treat their patients. At Kindbody, patients are offered consultations with nutritionists to discuss their diet and make potential evidence-based adjustments.?
There are also many other startups innovating in the field. Start-ups in the fertility space are introducing digital solutions, remote monitoring, holistic support and AI algorithms that can improve precision and outcomes. For example, Ava created a wearable device that monitors a woman's fertility and menstrual cycle. A start-up called Future Fertility is using AI to create egg assessment software to detect features of human eggs that are invisible to the human eye and give more precise information about egg quality (5).?
Challenges?
Knowledge Gap
“What’s the most challenging about your job?”
I ask Dr Danis further. “Feeling powerless… Often we don’t know why someone is infertile. We don’t know why they didn’t respond well to ovarian stimulation. We don’t know why the embryo transfer did not work … Not being able to fix the problems is difficult.” Dr Danis admits. Difficult questions from patients range from “Should I go through another egg freezing cycle?” to “Should we try to transfer a mosaic embryo?”. As the field is relatively new (the first IVF baby was born in 1978) there’s still quite a large knowledge gap. Around 30% of couples experience “unexplained infertility” – which means that according to the tests we use now, there’s no specific reason that could explain why they are not getting pregnant. This could be multifactorial (eg. lifestyle factors, microscopic endometriosis, male factor, immune mediated etc). Other examples of knowledge gaps include a lack of accurate biomarkers for egg quality (apart from age) and a poor understanding of how to preserve/promote ovarian longevity. It can be exciting from a research perspective to have such a huge opportunity for discovery, however, on a clinical level, it’s rather challenging to truly personalise the care for patients, provide counselling and explain what “went wrong”.?
Costs (the US vs the UK)
Going through the assisted reproduction process can be emotionally and physically taxing for patients, as well as expensive for those whose insurance does not cover fertility treatments. Despite advancements in technology and research, the costs remain very high. The demand for family-planning services is dramatically underserved due to prohibitive costs, disparities in insurance coverage, and lack of inclusive care. In the US, 75% of private insurance policies lack adequate coverage of fertility services (6). In the UK, the provision of IVF varies across the country. Although NICE recommend up to 3 cycles of IVF should be offered on the NHS, some CCGs only offer 1 cycle, or only offer NHS-funded IVF in exceptional circumstances. Egg-freezing is not currently available on the NHS unless women are having medical treatment for conditions which could affect their fertility, such as chemotherapy or radiotherapy for cancer.
Advice for medical students?
Fertility is an exciting field of medicine. New diagnostics, biomarkers and therapeutic options are developing rapidly. So how do we get involved? “What would your advice be for medics interested in fertility?” I asked Dr Danis. “You have to be interested in fine detail, be keen to get involved in research and closely follow new papers and guidelines… You also need to think about the day to day – would you enjoy counselling patients about their reproductive health? Do you like short surgical procedures?” she explains.
Finally, how can one organise an elective in a fertility clinic??
Here, a huge shoutout to the lovely Catherine Hendy who introduced me to Dr Lynn Westphal from Kindbody. Catherine is a co-founder of ELANZA Wellness . Ally Jaffee (whom I met on the NHS Clinical Entrepreneur Programme) connected us some time ago as we were both working on female health startups. So I guess the answer is: networking, connecting with people working in the space that interests you and asking!
Conclusions
To sum it all up, I had an incredible time at Kindbody. From meeting patients to spending time in a lab and discussing the newest research articles with Dr Danis, I learned a lot about reproductive endocrinology and how clinics operate. I also had the opportunity to learn more about the macro environment - innovations and challenges in the field of fertility. I’m excited to keep following the company and care models that make fertility care more personalised, accessible and holistic.?
Any cool companies and research I should check out? :)
References:
Founder and Director at HQ Science | Clinical Oncologist, Bioinformatician, Entrepreneur
8 个月Paulina, thanks for sharing!
Physician | Digital | Innovation | Lean | Social Media
2 年Wow Paulina Cecula, I enjoyed reading that!! Sounded like a good elective and you summed it up really well. Interesting to read how much detail the fertility doctors go into with patients and how important the latest research/papers are to the clinical work. ????
NHS England Clinical Entrepreneur | FemTech Advisor | Women’s Health Podcaster
2 年Interesting read - thanks for sharing!
Co-founder at ELANZA Wellness | Author 'Everything Egg Freezing' book | Techstars NYC '21
2 年Thank you for sharing this Paulina Cecula - just the start of amazing things for you ??
PhD Candidate at Imperial College London | CTO at Kitt Medical
2 年Thanks for sharing your insights Paulina Cecula !