Pharmacogenomics in IVF: A New Era in the Concept of Personalized Medicine
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Pharmacogenomics in IVF: A New Era in the Concept of Personalized Medicine
Reproductive Sciences 1-13 ª The Author(s) 2018 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1933719118765970 journals.sagepub.com/home/rsx
Kallirhoe Kalinderi, BSc, MD, MSc, PhD1,2, Byron Asimakopoulos, BSc, PhD3, Nikos Nikolettos, MD, PhD4, and Vangelis G. Manolopoulos, BSc, PhD5
Abstract Pharmacogenomics is a promising approach in the field of individualized medicine in in vitro fertilization (IVF) treatment that aims to develop optimized pharmacotherapy depending on the genetic background of each infertile woman, thus to ensure maximum effectiveness of the medication used, with minimal side effects. The unique genetic information of each infertile woman, in combination with already known, as well as new predictors of ovarian response and the progress of pharmacoepigenomics, is anticipated to greatly benefit the process of controlled ovarian stimulation. This review analyses current data on IVF pharmacogenomics, a new approach that is gradually moving to the frontline of modern IVF treatment. Keywords pharmacogenomics, gene, FSHR Asn680Ser, polymorphism, IVF
Introduction Pharmacogenomics is a promising scientific field that studies the impact of individual genetic variability on drug response and toxicity, thus paving the path to personalized medicine. Currently, controlled ovarian stimulation (COS) protocols are designed according to a number of parameters including woman’s age, body mass index, ovarian reserve, and hormonal profile.1 Pharmacogenomics aims to provide additional information in an attempt to choose the right drug for each woman, as each individual can react differently in the same medication, which is greatly depended on the genetic code.2 For instance, some individuals, with specific genotypes in certain genes, are able to metabolize more rapidly a drug, thus they need increased doses of it in order to achieve therapeutic levels, whereas some others metabolize the same drug very slowly, thus they need smaller doses in order not to be exposed to the adverse effects of the medication used. Accordingly, in in vitro fertilization (IVF) treatment, all women do not respond the same way to gonadotrophin stimulation; some are normal responders, some are poor responders, and some others overrespond being at risk of developing ovarian hyperstimulation syndrome (OHSS).3 The a priori knowledge of each woman’s genetic profile before initiating COS is of crucial importance, as the proper protocol can be chosen, using the appropriate doses, in order to have the optimal ovarian response and to avoid the occurrence of OHSS, which is a complication that can have detrimental effects in a woman hoping to become pregnant. The completion
of the Human Genome Project has greatly aided to understand the uniqueness of each person and has emphasized the need to analyze the role of genetic variability in modern personalized medicine.
The Human Genome Project The Human Genome Project, which started in 1990, aimed at
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