Nicolas Vulliemoz, the doctor in charge of Fertility Medicine, heads a team of 20 professionals who work closely together and offer their expertise to achieve a single objective: to make the wish for a child come true. Interview.
The fertility medicine consultancy at the CHUV has been a leading centre for medically assisted reproduction for more than 30 years and has contributed to the birth of 5,000 babies. How do you maintain this high level of expertise?
It is the men and women who make up our team who ensure such longevity and excellent results. For a medically assisted reproduction treatment (MAR) to have a chance of success, it must be undertaken by highly qualified professionals who keep up to date with modern methods in reproductive medicine, notably through periods spent overseas in leading centres.
In my case, I trained in reproductive medicine for almost three years at the University of Oxford. The aim of that stay was notably to acquire the techniques which the changes to the Reproductive Medicine Act (RMA) made available to us: embryo culture and preimplantation genetic diagnosis (PGD)*. Dr Marie-Pierre Primi, head of the Andrology and Reproductive Biology Laboratory (ARBL), has also trained in England to prepare herself for the changes in the RMA. Our aim is to allow couples to maximise their chances of becoming parents by using the most modern techniques, which we have mastered.
*From 1 September 2017, important changes allow couples to maximise their chances of becoming parents.These changes relate to the possibility of culturing up to a dozen impregnated egg cells, with authorisation to freeze the embryos, and to perform preimplantation genetic diagnosis and screening (PGD/PGS).
In addition to this technique, we offer specific consultation for men, as well as psychological support for all couples. Is personalised care guaranteed?
Absolutely! Each couple arrives with their own history and their own clinical situation. We provide particular attention to each of them and offer rapid nursing, medical and psychosocial care that is not only personalised but also comprehensive. We are not here to do business but to offer the most suitable treatment. Our obsession is to respond to the wish for a child by couples who encounter an obstacle in achieving their plan for a family, and we do this by giving the necessary time, setting and support.
Fertility Medicine is at the heart of the hospital complex. One stress less for couples?
We are in permanent contact with the various specialists at the CHUV, whether in genetics, endocrinology, haematology, or even visceral surgery. Our patients have the good fortune to have all the specialists together in one place, which ensures good sharing of information and certainly reduces the stress for couples in following their treatment, which can sometimes involve a range of different actors.
Having a child is priceless. But making one is quite different… Why are MAR treatments so costly?
Ovarian stimulations and three inseminations are most often reimbursed up to the age of 40 years. Unfortunately, IVF treatments (between 8,000 and 10,000 francs) are not covered, which means a not insignificant burden for couples, especially if the treatments have to be repeated. The techniques used demand a high level of resources in terms of qualified staff, infrastructure and medical equipment. All that has a cost. We are aware that difficulty in conceiving a child can come on top of financial difficulties. This is why we also ask our patients to discuss various financial solutions with us.
Some may decide to obtain treatment abroad. The same IVF but cheaper, then?
The temptation to go abroad is justifiable, but I do not recommend this option. A medically assisted reproduction treatment remains a challenge for the couple, both physically and mentally. Being able to count on a team who know you, who look after you and support you throughout your care is a key element in the treatment. Here, we can rely on a certificated unit, an accredited laboratory and staff who are highly qualified in the most modern techniques. And we should not ignore the stress created by travelling abroad, the additional expenses, the anxiety felt, etc.
As a university centre, you place significant importance on research. What areas are you investigating?
Our current research projects are aimed at gaining a better understanding of infertility problems, in both men and women. The aim is to be able to offer less onerous and less costly treatments. In collaboration with Prof. David Baud (Head of the Department of Obstetrics), financial support has been obtained from the Fonds national suisse (FNS) (Swiss National Science Foundation) for the study of infectious causes responsible for male infertility. With their agreement, we use our patients' data for this purpose. They thus help to advance our knowledge, and some are delighted to make their contribution in this way. We also have a research project in collaboration with the HUG, which is trying to determine the risk of thrombosis associated with different IVF protocols.
What are your next challenges?
With the changes to the RMA, we have to respond to the new requirements, both technological and ethical. PGD consists of analysing the genetic make-up of an embryo obtained by in vitro fertilisation, before its transfer into the uterus. This procedure is authorised in two cases: only couples bearing a severe hereditary disease (preimplantation diagnosis) and couples who cannot conceive by natural means can decide to have this examination (preimplantation screening). The revision of the RMA increases the number of embryos which may be developed during a treatment cycle from three to 12, and unused embryos can be frozen with a view to later treatment. The criteria for applying the law are strict, and the qualifications required to practise PGD are similarly stringent. The impact on our work will be very significant, but the most important thing is to be able to offer an additional chance for our couples to be able to realise their dream of having a family.
Photo: ©Lauriane Aeby, SAM - CHUV
Text: Gabriella Sconfitti, Communications department - CHUV