How far is too far on new IVF techniques?
On last week’s post Milly Sunsbury asked an important question which I decided I needed to ponder on more before I answered. She asked “Are you at all concerned by the lack of research and regulation around MST in the places where it is being practiced?.” MST is a great example of what I think the general consensus would be is a very fringe IVF treatment at the moment, mainly due to its lack of approval and access within primary treatment countries such as the US.
But the question Milly asks is very valid. How do we, as individuals, decide ultimately whether we will accept a lower standard of evidence applied to our own care in order to pursue gains that may not otherwise be possible?
Here’s an important first thing to point out. We are not public or IVF policy specialists. We do not have to require something to reach the highest levels of evidence before considering the treatment, because our window of opportunity for the treatment is usually limited to a far lesser timeframe than would be required to achieve that.
Secondly, we do not need to have something show efficacy at statistically significant levels or at all age cohorts, we can dive in and determine whether our specific age cohort benefited and whether, even if not statistically significant, it was positively trended.
So how far should we go? What standard of evidence should we decide is good enough for us? While I can’t answer for each one of you (and I encourage you to interrogate the studies that I personally chose to represent my own reasoning to doctors in adding certain items to my protocol with the stated goal of improving euploidy), I can at least share my own thoughts on this.
I’ll say upfront that I’m a business owner. I am comfortable making big decisions without always having a lot of data, and I am comfortable taking risks. My risk profile, in general, is probably higher than the average person. Your risk profile may be different to mine and this is ok. In some ways, I have taken the risk and spent money on this so that you at least take some degree of comfort from my case study.
But the standard of evidence that I looked for considered the following:
How big was the potential pay off? How many people benefited even if it was a small retrospective or prospective study?
What was the study set up? Was it randomised controlled, blinded or double blinded, prospective of retrospective
Were the results statistically significant for my age bracket? If not, were they positively trended? If not, how bad was the decrease (was it equal to the increase or was the potential decrease quite small)?
How similar were my cycle characteristics and demographics to that of the study’s participants. I would always prioritise the exact methods or dosages of studies where it had focussed in on a participant who was MOST like me.
Was there meta analysis that might further support its use. If one meta analysis was done and it wasn’t statistically significant, was it still positively trended?