Angela Spang, CEO of JUNE Medical
In vitro fertilization (IVF) is a relatively common treatment for individuals who suffer from infertility problems and have trouble conceiving naturally. This amazing technique has helped huge numbers of couples have children, but it’s not without its complications.
The effects on the patient
I myself have been through IVF, so this topic is incredibly close to my heart. I know how difficult the IVF journey is; the process is very personal and, despite knowing others are going through the same, everyone will have their own struggles. Not only do you have to consider the physical side – which is complex and challenging even if it is theoretically straightforward – but there’s also an emotional rollercoaster along the way. So now, when I look at products that could potentially help to improve the IVF journey, I can see both sides of the story, firstly as a medical device owner but, more importantly, as a woman, a partner and a patient. There are many aspects of IVF that already have nothing short of miraculous solutions, but there are some areas where we can still do more.
A new light on intrauterine adhesions
The formation of intrauterine adhesions are just one complication that can affect the IVF process. They are bands of scar tissue that develop between the inner walls of the uterus as a result of trauma. As with all types of scarring, there is a huge amount of variation between individuals; adhesions can be anything from very fine and thin layers of tissue, with a film-like texture, all the way through to far thicker and vascular structures. Intrauterine adhesions are commonly formed following dilation and curettage (D&C) – as well as any other intrauterine surgical procedures – and terminations. They can cause significant problems, including:
· Infertility
· Pain and discomfort
· Menstrual cycle abnormalities
· Dysmenorrhoea
· Recurrent pregnancy loss
But who gets adhesions?
Any surgery within the uterine cavity can potentially create localised adhesions. This is often significant for people going through IVF where, for instance, an intrauterine septum may be found that requires a procedure that can potentially increase the risk adhesion formation and consequently reduce chances of becoming pregnant even further. Overall, the more procedures a patient undergoes, the higher the likelihood of her developing adhesions and, perversely, the less chance of her getting pregnant! If a person is susceptible, then adhesions can occur even when surgeons use the best techniques.
The problem is that adhesions are complex and not fully understood; some clinicians believe that if you perform any surgical procedure on any patient, then they’re going to get adhesions, no matter what you do. Others think it’s more to do with the individual patient – some will get them and some won’t – and there’s no way of telling. The challenge is that it’s very difficult to study adhesion formation in IVF patients. If somebody undergoes a procedure for an unrelated reason and adhesions just happen to be found, that’s fair enough, but it’s neither ethical nor practical tooperate on somebody just to see if there are any, or even, from a research perspective, to investigate how many women conceive successfully despite having them. On top of this, adhesions occur in different places and to a different degree, so each pregnancy is going to be affected in quite a unique way.
What can be done to reduce the risk of intrauterine adhesions?
Adhesion prevention is vital in IVF patients, and I’ve been interested in this for a very long time, both as a patient focused on improving IVF, and from the technical perspective of trying to find products that will support women’s health and surgery. There have been several developments over the years since my days of working at JNJ with Interceed and Intergel. The most successful solutions are mechanical barriers, which can be used to separate damaged tissue during the healing process and reduce postoperative adhesions. These originated in orthopaedics and spinal surgery, but the technology has since expanded into different areas, including intra-abdominal and now intrauterine procedures. Success, however, has been variable, with methods either not having the desired effect or being tricky to apply.
That’s why I was so impressed when I found Oxiplex (FzioMed, Inc), a clear, flowable gel that serves as a temporary, absorbable mechanical barrier that prevents adhesions following intrauterine or peritoneal surgery.This gel has been successfully used in the surgical field for a long time, based on the simple principle of stopping two surfaces from sticking together in the first place. It lasts for 28 days – the amount of time over which adhesions are likely to form – and, after this, it is absorbed by the body without leaving any lasting residue. Most importantly, it has clinical data that supports its efficacy; this is a solution that is both safe and effective.
How could Oxiplex help IVF patients?
Obviously, clinicians want to do everything possible to optimise the chance of pregnancy for an IVF patient, and Oxiplex can contribute to this across a whole number of applications, including:
- Adhesiolysis
- Asherman’s syndrome
- D&C
- Myomectomy
- Polypectomy
- Retained products of conception
- Uterine septum surgery
Not only is Oxiplex a potential benefit to patients, but it also has exceptional safety and comes in an easy-to-use, prepacked syringe, simplifying its application.
The future of IVF
I would love for IVF clinics to carry out further studies on pregnancy rates in patients using products such as Oxiplex. However, huge numbers of patient recruits would be needed for results to be significant because there are so many variables to consider. That said, I think this is an avenue that will certainly see more attention in the future; to me, it’s really a no brainer. I know the sacrifices made – financially, emotionally and physically – when undergoing IVF, and so surely everything possible should be done to improve the chances of a positive outcome and reduce the risk of complications.
If Oxiplex could help even one woman fulfil her wish to get pregnant and have a healthy baby, that would be the biggest win in my eyes.