Getting precise

Precision medicine is a new method to assist in women's reproductive health

A sperm sample on a microscope slide with a syringe being used to extract an embryology specimen for analysis.

Medical technologies to treat infertility have evolved quickly in response to modern people's difficulties having babies. In the past, an assisted reproductive technology like in vitro fertilisation would only suggest trial procedures, meaning the chance of success can vary and is never guaranteed. But the latest science to help with pregnancy has developed to the point that it leaves almost no room for failure.

This technology is called precision medicine.

"Precision medicine is [among] the latest medical technology. In the field of reproductive health, it is a model of treatment that focuses on genetic, environmental and lifestyle-related factors," said gynaecologist and obstetrician Dr Boonsaeng Wutthiphan in a recent press briefing at Samitivej Sukhumvit Hospital. Dr Boonsaeng also specialises in infertility technology.

According to the specialist, the origin of precision medicine traces back to the Human Genome Project, an international scientific research project funded by the US government to study complete sets of DNA. Officially launched in 1990, the Human Genome Project aims for a complete mapping and understanding of all human genes. The US National Human Genome Research Institute considers this "a complete genetic blueprint for building a human being".

From this project, reproductive and medical technology specialists have used data to further thoroughly study human chromosomes and detect diseases at the chromosome level, and therefore prevent such disease-causing chromosomes from being passed from a pregnant mother to her baby. Specialists apply precision medicine with the mother.

"We know, for example, that smoking damages the nucleus of human sperm and eggs. Therefore, we suggest people who want to have a baby to stop smoking. They have to change their lifestyle. Or if you want to have a healthy pregnancy, you have to control your weight to cut the risk of diabetes and high blood pressure," he explained. One of the most unhealthy habits among modern people, added Dr Boonsaeng, is being night owls.

"The brain is entering a sleep mode after sunset and is back on active mode when the Sun rises. If a mother-to-be stays up and also wakes up late, the foetus gets stressed out all the time and is likely to develop and become a small, unhealthy baby."

Apart from lifestyle, precision medicine also focuses on examining genetic factors -- recessive genes that can be passed from parent to child. In Southeast Asian countries, said Dr Boonsaeng, there are 12 genetic diseases considered a point of concern, especially thalassaemia. In Thailand, one in four is found to be thalassaemia carrier. Precision medicine assists specialists in screening genes that carry diseases, cutting the chance of passing illnesses to the foetus. Screening can be carried out both before and after pregnancy.

"The technology allows specialists to examine and analyse the cells taken from a five-day-old blastocyst [a structure formed in the early development of a foetus] to see if it carries thalassaemia genes before transferring it to the womb," said Dr Boonsaeng, adding that this is the case with in vitro fertilisation, where embryos are cultured in the laboratory incubator to the blastocyst stage before being transferred to the womb. Or specialists can examine placental cells in the 12th week of pregnancy, or amniotic fluid at the 16th-17th week of pregnancy to check the foetus chromosomes. This will be especially useful for couples with a family history of disease. And for in vitro fertilisation, precision-medicine technology enables specialists to check the best time to transfer an embryo to the womb, particularly helpful for older patients.

Dr Boonsaeng is of the opinion that these technologies are actually not for everyone.

"If you are a healthy 29-year-old who plans to get pregnant, these tests might not be necessary," he said. "Precision medicine for reproductive health is ideal for older couples or patients with limited chances of pregnancy. These people require highly accurate tests and treatments."


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