ASRM Today: Genetics - Episode Five

Personalized Medicine and Genetic Testing: Imagine a world where your doctor doesn't just prescribe a one-size-fits-all treatment, but instead tailors your medication and therapy based on your own unique genetic make-up. That future is already becoming a reality.

Welcome to ASRM Today, a podcast that takes a deeper dive into the current topics in reproductive medicine. This is ASRM Today, I'm your host, Jeffrey Hayes, and today we're diving into one of the most exciting frontiers in modern healthcare, personalized medicine. Imagine a world where your doctor doesn't just prescribe one-size-fits-all treatment, but instead tailors your medication and therapy based on your unique genetic makeup.

That future is already becoming a reality. However, questions arise such as, how does your DNA influence the way you respond to drugs? Can genetic testing predict diseases before they happen? And what does this mean for the future of reproductive medicine? Let's explore some possible answers together. Traditionally, medicine has relied on broad treatments designed for the quote, average patient.

But the truth is, there is no average patient. We all have genetic differences that affect how we respond to medications and therapies. Personalized medicine, also called precision medicine, uses genetic information to customize treatments ensuring they are more effective and come with fewer side effects.

So, how is personalized medicine changing things? It plays an increasingly significant role in reproductive medicine by tailoring medical care to the individual characteristics of each patient. This approach can improve the diagnosis, treatment, and outcomes of reproductive health issues. Here's a breakdown of its role.

There is fertility treatment optimization, such as genetic testing or ovarian stimulation protocols, which is individualizing hormone stimulation based on genetic markers or hormonal profiles can improve IVF success rates and reduce side effects like ovarian hyperstimulation syndrome or OHSS. There is pre-implantation genetic testing, or PGT, which allows for the selection of embryos free from specific genetic conditions or chromosomal abnormalities, increasing the chances of a successful pregnancy and a healthy baby. Stay tuned because later this season we will talk more about PGT with ASRM President Dr. Elizabeth Ginsburg.

Also, endometrial receptivity analysis. Personalized assessment of endometrial receptivity helps determine the optimal window for embryo transfer, improving implantation rates and IVF. There's management of recurrent pregnancy loss or IVF failure, risk assessment and prevention such as carrier screening or pharmacogenomics, which helps select medications and dosages that are most effective and safe based on an individual's genetic makeup.

And we must also consider male factor infertility. Genetic testing can guide diagnosis and treatment, planning for male infertility. Personalized medicine and reproductive medicine bring powerful tools for diagnosis and treatment, but it also raises several ethical and privacy concerns that must be carefully managed.

Some of the key issues are genetic privacy and data security. Thinking about sensitive data exposure, genetic testing generates highly sensitive personal data. If improperly stored or shared, it could lead to breaches of privacy.

There's third-party access, which concerns arise about insurers, employers, or even governments accessing genetic data without informed consent. There's anonymity risks. Even anonymized genetic data can sometimes be re-identified, especially when cross-referenced with public genetic databases.

Thinking also about informed consent. Patients may not fully understand the implications of genetic testing and analysis, making truly informed consent challenging. And tests may reveal unrelated genetic risks for things such as cancer or neurological diseases, creating ethical dilemmas about disclosure.

There's the area of genetic discrimination, where there is concern that individuals or their children may face discrimination based on genetic predispositions, such as being denied insurance or employment opportunities. There's reproductive autonomy and decision-making. Pre-implantation genetic testing may lead to ethical concerns around selecting embryos based on non-medical traits, such as intelligence or appearance, which can lead to feelings of parental guilt and responsibility, meaning that knowing genetic risk can create emotional burdens for parents, especially when making decisions about embryo selection or pregnancy continuation.

There is equity in access issues, cost and availability, and the digital divide, meaning limited access to advanced care and genetic counseling that can widen existing health care disparities. We must also consider embryo and future child rights. These are ethical questions that arise about the rights of embryos and the future children born as a result of genetic selection or modification.

There's also the right not to know. Future children may object to knowing certain inherited risks identified during pre-implantation or prenatal testing. Finally, the use of AI in algorithms.

Think about bias in algorithms. AI-driven personalization could reflect or amplify societal biases if not properly designed and regulated. Or even opaque decision-making.

A lack of transparency in algorithmic processes can challenge accountability and trust. As genetic technology advances, it's crucial that we balance innovation with ethical responsibility. So where do we go from here? The future of medicine is looking more precise, proactive, and preventative.

With advances in genetics, AI, and biotechnology, we may soon see custom-tailored drugs for every individual, CRISPR-based gene therapies for inherited diseases, routine genome sequencing as part of every doctor's visit. Imagine a world where you know your genetic risks from birth and have a personalized health plan designed to keep you healthy for life. That's the promise of personalized medicine.

That's it for today's episode. If you've enjoyed this episode, please subscribe, leave us a review, and share it with your friends. Until next time, I'm Jeffrey Hayes and this is ASRM Today.

This concludes this episode of ASRM Today. For show notes, author information, and discussions, go to asrmtoday.org. This material is copyrighted by the American Society for Reproductive Medicine and may not be reproduced or used without express consent from ASRM. ASRM Today series podcasts are supported in part by the ASRM Corporate Member Council.

The information and opinions expressed in this podcast do not necessarily reflect those of ASRM and its affiliates. These are provided as a source of general information and are not a substitute for consultation with a physician.