I have stood in that exam room more times than I care to admit, my hand lingering on the door handle, searching for a way to tell a patient that she has no viable embryos to transfer because her egg quality is poor. “Poor egg quality” is not a diagnosis but an observation, and one that leaves us uncertain whether the problem is intrinsic to the patient or a response to the stimulation protocol itself. If the latter is true, there may be a chance for improvement, but only if we can move beyond the standard manual.
By the time we reach this impasse, we have usually exhausted the conventional tools. We have tweaked stimulation protocols, scrutinized IVF laboratory conditions, and rechecked every box that can be integrated into the efficient “health care of scale.” Eventually, the conversation narrows to a painful binary: recommend donor eggs or acknowledge that this case no longer fits within the boundaries of routine care. What we rarely say out loud is that, at this point, the patient’s case has effectively become a research project, and I now need specialized help to help my patient.
Translational medicine is a unique set of expertise
Approaching a specific clinical case as a research project requires domain-specific translational medicine expertise. This is a specialized field with physicians and scientists trained to sift through mountains of publications in search of “nuggets” ready to be transferred into clinical practice.
In assisted human reproduction, this applies primarily to ovarian stimulation protocols. Currently, IVF relies on a narrow set of clinical markers: follicle size on ultrasound and circulating estradiol levels. For most patients, this framework works well enough and has enabled the standardization of IVF care. Difficult cases, however, expose its limitations: Follicle size reflects granulosa cell activity rather than egg competence. Likewise, what we define as oocyte “maturity” is a weak surrogate for true developmental potential; an oocyte may meet morphological criteria for maturity yet still lack the capacity for fertilization and embryo development.
Bringing translational fertility into my practice
While the benefits of translational medicine in difficult clinical cases are clear, I had many questions when I decided to reach out to an expert. Will patients doubt my competence? How do we share patient data securely and without too much hassle? How do we discuss evolving data in real time while remaining privacy-compliant? Who pays for this additional service? How do I retain control of care and remain the only voice communicating with the patient?
For me, the process of incorporating translational fertility assistance for difficult cases began nearly four years ago with a call to a prominent translational fertility expert, Dmitri Dozortsev, MD, PhD, who, in collaboration with Michael Diamond, MD, a prominent authority in reproductive medicine, had just published a new ovulation paradigm redefining the roles of reproductive hormones, with implications that extend across the broader framework of reproductive physiology.
We started working together in 2022 with a particularly difficult case: a 37-year-old patient who had produced no viable embryos across two IVF cycles. We formulated a hypothesis grounded in this revised physiology, spent a month tracking the patient’s unique benchmarks during a diagnostic cycle, and constructed a fully customized treatment plan. One critical change was extending stimulation to 17 days, rather than her previous stimulations, which were standard 13-day cycles, while maintaining follicle-stimulating hormone (FSH) within a narrow range. This approach is highly unconventional in routine IVF practice. That cycle resulted in several high-quality embryos and ultimately a live birth.
A second patient was 42 years old, with repeated gross chromosomal abnormalities in her embryos. Once again, the case was resolved with a live birth, due in large part to additional translational fertility analysis and individualized management. Both of these cases were later published in IVF Worldwide as evidence that this physiology is not merely conceptually disruptive, but clinically actionable.
Patients embrace a new opportunity, and I get the credit and the blame
All my original concerns were resolved: My patients do not think less of me; instead, they greatly appreciate that I am able to include a world-renowned scientist in their clinical team.
They also understand that I remain in control of their care and accept full credit or full blame depending on the final outcome. Yes, even with all the translational fertility support, not every difficult case ends with a happy outcome. Some patients choose to stop treatment; others accept donor eggs. But however they leave my care, they feel that everything possible has been tried, and this provides a sense of comfort and closure.
While the service carries an added cost to patients, I view this as a necessary first step; those who can afford this customized care today are effectively paying for a future in which these insights become standardized and affordable for everyone.
Why not AI?
Emerging analytical tools, including AI-assisted systems, can act as physician extenders. However, we must recognize a critical limitation: These tools are often unhelpful in unusual cases. Just like practitioners, AI systems are often heavily authority-biased and mainstream-biased. Because most algorithms are trained on standardized success stories, they can struggle to function as effective “translators” for outliers who require a conceptually disruptive approach. In other words, AI can identify the pattern, but the translational scientist identifies the exception to the pattern.
What began as an improvised collaboration evolved into a secure, structured platform and a mobile application that allows clinicians to invite translational experts into specific cases. Built with privacy and auditability in mind, it enables the sharing of relevant clinical data without disrupting my clinical workflow or burdening my nursing staff.
Standardization has advanced reproductive medicine enormously, but it has limits. Recognizing when a case has crossed from routine care into investigational territory, and having a structured way to address it, offers something powerful: not just better science, but renewed hope for patients who have already been told they have none.
Lina Gabriela Villar Muñoz is an obstetrician-gynecologist in Mexico.
