- Why is it essential to thoroughly explore each couple’s unique situation when treating infertility, rather than applying generic solutions?
- What are the key factors determining why one treatment plan works for one couple, while a completely different one is required for another?
- How is the assessment of both the female and male partner’s health incorporated into the treatment plan?
- How is the patient profile changing – are younger couples presenting more frequently, or do older patients still predominate?
- What are currently the most advanced treatment technologies applied in the field of fertility?
- Are all the latest assisted conception techniques used globally also available in Lithuania?
No two people in the world are identical, not even identical twins. Therefore, nowadays, highly important is individualised fertility treatment.
We adhere to 3 essential principles:
1) a thorough assessment of both partners’ health status and lifestyle, identifying the underlying causes of fertility issues,
2) open communication regarding the realistic chances of success,
3) an effective and safe, time-bound treatment plan, developed with consideration of the couple’s values and priorities, based on the latest medical research and clinical evidence, and delivered using state-of-the-art technologies.
Since there are numerous causes of fertility issues, the treatment plan developed for each couple is entirely individualised. During the initial consultation, we aim to understand the couple’s preferences, expectations, and motivation for treatment, as the journey to having a baby can be a long and challenging ordeal for both partners. It is incredibly important to evaluate whether the couple trusts their chosen doctor – a fertility specialist – as a successful outcome heavily depends on this. Our credo is to reassure patients that the doctor is “in the same boat” as the couple, working towards the ultimate goal of treatment – a healthy baby. Only then, after assessing the health of both the woman and the man, the likely causes of their fertility issues, and the couple’s preferences for the recommended treatment, is an individualised treatment plan established. If, for example, the cause of infertility is a lack of ovulation, treatment involves medical ovarian stimulation and ovulation induction; if conception fails due to blocked fallopian tubes, reconstructive tubal surgery is recommended, or the removal of one or both irreversibly damaged fallopian tubes, followed by treatment via in vitro fertilisation (IVF); if the couple is unable to conceive due to low sperm count or poor sperm quality, further male investigations are carried out; if the cause of this disorder cannot be identified, or if there is currently no known effective treatment for it, IVF is recommended. Women diagnosed with ovarian or uterine endometriosis often face difficulties conceiving. In such cases, infertility treatment is complex, combining surgical and medical therapies with assisted reproductive technologies. In short, treatment is planned according to the suspected cause of infertility. If it is possible to help the couple conceive using simpler treatment methods, that is where we begin. Only if medical and/or surgical treatments fail, or if the cause of infertility cannot be resolved by other means, is IVF recommended to the couple. From what we hear from couples attending their first consultation, there is still a fairly widespread public perception that IVF is a standard procedure performed in the same way for all women, where after ovarian stimulation with medication, eggs are “retrieved” during surgical intervention, fertilised in vitro, and the embryo is transferred into the womb. In reality, the IVF treatment process is complex, tailored individually to each couple, and selected based on the underlying causes of their infertility. For example, if a 40-year-old woman with a low ovarian reserve and uterine endometriosis seeks assisted conception, her treatment with specific hormones to improve ovarian function would start several months before ovarian stimulation. The stimulation itself would follow specific protocols designed for women in this age group, using different medications compared to the treatment recommended for a 30-year-old woman with blocked fallopian tubes and a normal ovarian reserve. Furthermore, IVF can be performed using several different techniques and supplementary specialised bioactive culture media, depending on the quality of the male partner’s sperm and the cause of infertility. Nowadays, women with diagnosed endometriosis and no other identifiable causes of infertility are increasingly seeking help for fertility issues. For these women, following IVF, the embryo would not be transferred immediately into the womb. Instead, it would be frozen and stored until the woman completes a several-month course of anti-inflammatory treatment for endometriosis. Consequently, this type of treatment cycle – from the start to the frozen embryo transfer (FET) – can take up to six months. This is why we strive to explain to couples that this journey requires high levels of motivation, patience, and trust. In summary, each couple receives a specific, individually tailored, and comprehensive course of treatment.
When a couple attends a consultation for fertility issues, both the woman and the man are investigated simultaneously. We still occasionally hear the misconception that the woman should be investigated and treated first, with the man potentially joining in at some later date. We must emphasise that abnormal semen analysis results are found in every second couple who consults us, and in about 80% of these cases, conceiving is only possible through assisted reproductive technology. Why is this? Poor semen parameters are often detected in young men who have no lifestyle risk factors and lead a healthy life. It is thought that the cause of impaired sperm quality in these men could be environmental pollution – various chemicals entering our bodies through air, water, and food while the future boy and man is still developing in the womb… Currently, there is no effective treatment available to correct impaired sperm production to enable natural conception…
Delayed childbearing is becoming increasingly common in both developed and developing countries, and this trend is projected to grow, including in Lithuania. A woman’s age remains the single most important factor determining fertility. It is well established that both natural fertility and pregnancy rates following IVF procedures decline significantly in women aged 35 and older. The primary cause of this decline is the age-related reduction in egg quality, which negatively affects embryo quality and the likelihood of implantation in the womb. Therefore, substantial focus is currently placed on strategies that can compensate for age-related fertility decline. Out of curiosity, we have calculated that the average age of women presenting to our fertility clinic with fertility issues in recent years is 36. Colleagues we recently spoke with at a fertility clinic in Rome (Italy) mentioned that the average age of their female patients is 39.
Currently, many advanced technologies are applied in the field of fertility treatment globally, and these are continually improving. Regarding genetic and molecular technologies, pre-implantation genetic testing (PGT) is available in many countries to select genetically healthy (euploid) embryos; biomarkers of egg and sperm genetic quality are being investigated; and intensive research is ongoing into embryo genome editing (CRISPR), though this is not yet applied in clinical practice. Embryo development monitoring is being refined using incubators with integrated time-lapse imaging, and artificial intelligence (AI) is being introduced for embryo selection. The highly effective rapid freezing method for eggs and embryos, known as vitrification, is increasingly widely used, making egg freezing and the “freeze-all” embryo strategy highly popular. As women nowadays increasingly delay family planning, egg freezing has become a viable option for fertility preservation, utilised by a growing number of women worldwide. Furthermore, as previously mentioned, medical ovarian stimulation is being individualised to ensure that each woman receives the optimal dose and protocol. New stimulation protocols, novel hormone formulations, and methods for preparing the endometrium (uterine lining) for embryo implantation are also being introduced, among others.
The latest technologies related to fertility treatment are available in Lithuania, but there are legal restrictions. For example, pre-implantation genetic diagnosis is only permitted in cases where there is a proven risk of transmitting a genetic disease. For this reason, a significant number of Lithuanian couples, particularly those where the woman is over 35, travel abroad for fertility treatment to Latvia, the Czech Republic, Spain, or elsewhere, where pre-implantation genetic testing for aneuploidies (PGT-A) is performed for couples who request it, without restrictions. In addition, a persistent issue in Lithuania is not the availability of the latest technologies, but rather that cohabiting couples in a civil partnership cannot access fertility treatment in Lithuania. This is because civil partnership legislation has not been enacted; without a legally recognised partnership, these couples are ineligible for any assisted conception procedures in Lithuania, forcing them to seek treatment in other European countries. There are many such couples, and they feel discriminated against, being unable to access treatment in their home country where they pay taxes.
