Europe's 5 Most Influential IVF Pioneers to Watch in 2024

1. June ISSUE-03 2024 Europe’s Most Influential Pioneers to Watch in 2024 Dr. Juana Crespo Medical Director Equipo Juana Crespo JUANA CRESPO Innova?ng Hope and Life in IVF

2. Forget about all the reasons why something may not work. You only need to ?nd one good reason why it will.

4. Editor’s Note

5. Compassion in Action I Our team at Euro Health Leaders has invested considerable time and effort in curating this list, ensuring we bring you insights into the most groundbreaking developments and the visionaries behind them. As you turn the pages, you’ll be transported into the world of IVF, where cutting-edge science meets compassionate care. n healthcare, few fields hold as much promise and emotional weight as in vitro fertilization (IVF). This technology’s profound impact on countless lives offers a beacon of hope to those yearning for parenthood. Our latest issue, ‘Europe’s 5 Most Influential IVF Pioneers to Watch in 2024,’ shines a spotlight on the remarkable individuals at the forefront of this field. These innovators aren’t just advancing medical science but crafting miracles, turning heartfelt wishes into joyful realities. This issue serves as a testament to the power of human ingenuity and empathy. It reminds us that behind every medical breakthrough are individuals driven by a genuine desire to make a difference. As we explore their stories, we’re not just learning about scientific advancements; we’re witnessing the embodiment of hope. What truly sets these pioneers apart is their dedication to a higher purpose. In an era often dominated by profit-driven motives, these professionals stand out for their commitment to making dreams come true. Their work transcends the boundaries of conventional medicine, entering the realm of life-changing interventions that resonate deeply with the human experience. Let’s celebrate these unsung heroes who work tirelessly to bring the gift of life to those who dream of it. Natalie May Natalie May - Natalie May

6. CONTENTS Profiles 18 Edona Mirakaj Empowering Dreams of Parenthood with Advanced IVF 26 Jordana Mata Shaping the Future of Fertility with Vision and Expertise Articles 22 Ethical Considerations and Public Attitudes towards IVF in European Societies 30 Innovations in IVF Culture Media and Their Impact on Embryo Quality in Europe

7. Cover Story 08 Juana Crespo Innovating Hope and Life in IVF

8. L E A D E R S EUR Health Editor-in-Chief Thanh Truong Managing Editor Pearl Shaw Executive Editor Natalie May Visualiser David King Art & Design Head Samuel Martinez Co-designer Paul Belin Art & Picture Editor Grace Brown Business Development Manager Emily Jones Business Development Executives Anna Smith, Jack Miller Marketing Manager Bill Thompson Sales Executives Mike, Carl, Heidi Technical Consultants David, Robert Assistant Technical Head Joseph Taylor Technical Head Jacob Smile Assistant Digital Marketing Manager Daniel Jones Digital Marketing Manager Alina Sege SME-SMO Executive Gemson Research Analyst Eric Smith Circulation Manager James Carter sales@eurohealthleaders.com June, 2024 Contact Us: Insights Success Media and Technology Pvt. Ltd. Survey No.133/134, Brand Square, Office No. 512, Kunjir Chowk, Pimple Saudagar, Pune, Maharashtra 411027. Phone - India: 7410033802, 8956487823 Email: info@eurohealthleaders.com For Subscription: www.eurohealthleaders.com https://twitter.com/eurohealthleaders Insights Success Media Tech LLC 555 Metro Place North, Suite 100, Dublin, OH 43017, United States Phone - +1614-602-4132 Email: info@eurohealthleaders.com For Subscription: www.eurohealthleaders.com Follow us on : www.facebook.com/eurohealthleaders/ We are also available on : Copyright © 2024 Insights Success Media and Technology Pvt. Ltd., All rights reserved. The content and images used in this magazine should not be reproduced or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior permission from Insights success. Reprint rights remain solely with Insights Success Media and Technology Pvt. Ltd. Euro Health Leaders is powered by Insights Success Media and Technology Pvt. Ltd.

9. EUROPE'S 5 MOST INFLUENTIAL IVF PIONEERS TO WATCH IN 2024 Featuring Person Company Brief Caroline is a visionary leader in fertility care, advocating for personalized, technology-driven solutions to transform the IVF experience for women and couples. Apricity Caroline Noublanche CEO apricityfertility.com Dr. Juana Crespo is a leading expert in reproductive medicine, specializing in complex fertility cases, and offering personalized care to individuals facing infertility challenges. Equipo Juana Crespo juanacrespo.es Dr. Juana Crespo Medical Director Edona, a seasoned IVF expert, is revolutionizing reproductive healthcare through innovative technologies and personalized patient care. BestFertility bestfertility.de Edona Mirakaj Founder & CEO Jordana is a leading reproductive medicine specialist with over 20 years of experience, dedicated to advancing fertility treatments. Jordana Mata Medical Director of HC Fertility HC Marbella hcmarbella.com Martha is a dedicated fertility expert focused on providing compassionate support and innovative treatments, empowering individuals on their journey to parenthood with personalized care. Martha Kaeslin CEO fertisuisse fertisuisse.ch

10. COVER Story JUANA CRESPO Innova?ng Hope and Life in IVF At Equipo Juana Crespo, innova?on and research are fundamental cornerstones of our philosophy. ‘ ‘ ‘ ‘

11. Dr. Juana Crespo Medical Director Equipo Juana Crespo

12. Europe’s 5 Most Influential IVF Pioneers to Watch in 2024 T he desire to have children is a profound and universal human experience, yet for countless individuals, the road to parenthood is paved with obstacles and heartache. In the complex field of reproductive medicine, where hope often hangs in the delicate balance, one name shines brightly as an epitome of expertise, compassion, and relentless dedication - Dr. Juana Crespo. With over three decades of experience in treating highly complex fertility cases, this leading gynaecologist has earned a reputation as one of the world’s foremost authorities in her field. At the helm of clinic in Valencia, Spain, Dr. Crespo and her team have achieved remarkable success rates, offering solace and solutions to patients struggling with seemingly insurmountable challenges. From late motherhood and recurrent miscarriages to uterine pathologies, ovarian dysfunction, and unexplained infertility, this clinic has become a trusted ally for those seeking highly specialized and personalized care. Equipo Juana Crespo , a renowned fertility The Juana Crespo Team is committed to redefining the standards of IVF and assisted reproductive technologies, seamlessly blending medical expertise with the most innovative treatments to offer hope and healing to individuals and couples facing infertility. Dr. Crespo’s visionary leadership, coupled with her team’s ongoing commitment to research and ethical conduct, has brought the clinic to the forefront of reproductive medicine, heralding new avenues of possibilities and advances in patient care. Childhood Inspiration Sparks a Lifelong Calling Dr. Crespo’s path to reproductive medicine was marked by a childhood experience that left an indelible mark on her heart and mind. “I always wanted to be a doctor,” she says, reflecting on the pivotal moment when the intervention of a dedicated physician saved her mother’s life from eclampsia. From that moment on, she knew her purpose lay in the noble pursuit of healing and compassion. Dr. Crespo’s dedication to her work has earned her numerous awards from international scientific societies in assisted reproduction, gynecology and surgery, where she has shared her experience as a speaker and researcher. With state-of-the-art facilities, including in-house IVF, cryopreservation, genetic diagnosis and andrology laboratories, as well as a hospitalization area and operating rooms, the Juana Crespo Team is truly a high-level center for those seeking the most advanced treatments and innovative techniques, such as Revitalize, which has shown promising results in achieving successful full-term pregnancies in patients with many previous failures. Driven by her early experiences and a deep sense of determination, Dr. Crespo pursued her medical studies with resolute determination. It was during her fourth year of medical school that she discovered her calling for gynecology and obstetrics. “I was so impressed after attending a birth and knew I was born to be a mother,” she recalls, describing the profound impact of witnessing the miracle of life. With a new sense of purpose, she embarked on a journey to specialize in a very new field of medicine but one that could bring hope and joy to countless families. Let’s discover the pioneering work of Dr. Crespo and the Juana Crespo Team in reproductive medicine, driven by innovation, science and ethical leadership!

13. of surgical expertise and cutting-edge technology, Dr. Crespo and her team have achieved noteworthy success in enhancing egg quality and increasing the chances of successful pregnancies for patients with poor reproductive prognosis. Throughout his illustrious career, he has participated firsthand in the remarkable evolution of IVF and fertility treatments. From the early days of laparoscopic surgery to the advent of advanced genetic diagnostics, he has been a driving force and key figure in the development of this medical discipline in Spain. “Over the past 40 years, assisted reproduction has evolved tremendously,” he observes, reflecting on the transformative changes that have shaped the field. From improvements in laboratory techniques to advances in genetic testing, the landscape of reproductive medicine has undergone a profound transformation, offering new hope and possibilities to patients around the world. Despite extraordinary advances, challenges remain, and age-related infertility has become a major concern. “Without a doubt, age is the biggest challenge,” acknowledges Dr. Crespo, who highlights the clinic’s multifaceted approach to tackling this complex problem. By focusing on improving ovarian quality, applying personalized stimulation protocols and developing innovative laboratory culture systems, the clinic works tirelessly to overcome the barriers posed by age and maximize the chances of success for patients over 40 who wish to become mothers with their own eggs. ‘ ‘ Pioneering New Frontiers in Reproductive Medicine As the medical director of Equipo Juana Crespo, Dr. Crespo has been at the forefront of innovations in IVF and assisted reproduction technologies. Guided by a relentless dedication to excellence and a passion for pushing the boundaries of possibility, her clinic has become a source of hope for individuals and couples seeking to start or expand their families. ‘ ‘ I consider it a privilege to be able to dedicate myself to a profession that I am passionate about and that involves helping people with difficul?es to have children. “At Equipo Juana Crespo, innovation and research are fundamental cornerstones of our philosophy,” she affirms, underscoring the clinic’s constant devotion to advancing the field of reproductive medicine. From the latest telemedicine models to revolutionary surgical techniques, the clinic’s commitment to innovation knows no bounds. One of the clinic’s most significant contributions to the field has been the development of the Revitalize procedure—a groundbreaking technique designed to improve ovarian quality in women with menopause. Through a combination

14. JUANA CRESPO

15. ‘ ‘ ‘ ‘ of human intelligence and creativity in addressing the unique needs of individual patients, particularly those who fall outside the conventional fertility curve of standard protocols. Mentoring the Next Generation The primary founda?on of this clinic is ethics with the pa?ents. As an influential leader in the field of reproductive medicine, she is deeply committed to mentoring and supporting the next generation of IVF specialists. Recognizing the complexity of personalized medicine, she stresses the importance of hands-on training and experiential learning in developing the skills and expertise necessary to navigate the intricacies of the field. “Training and more training,” she asserts, highlighting the clinic’s dedication to providing comprehensive education and mentorship opportunities for aspiring IVF specialists. Through personalized training programs and immersive experiences, the clinic ensures that each trainee receives the guidance and support needed to excel in their careers and make meaningful contributions to the field. Empowerment through personalised care At Equipo Juana Crespo, patient care goes beyond conventional boundaries, embodying a philosophy based on absolute personalisation and the latest medical advances. “Our whole philosophy revolves around designing tailor- made treatments, as if we were haute couture tailors,” she says, emphasising the clinic’s commitment to tailoring treatment options to meet the unique needs of each individual. Celebrating the Rewards of Service For Dr. Crespo, the most rewarding aspect of her job lies in the profound impact she has on the lives of her patients. “I consider it a privilege to be able to dedicate myself to a profession that I am passionate about and that involves helping people with difficulties to have children,” Dr. Crespo shares, reflecting on the joy of witnessing the birth of every child conceived through IVF. Her personalised protocols, in-depth knowledge of uterine dynamics and high standards ensure that each patient receives the highest level of care and the best treatment at the clinic. “My main motivation is seeing the result, each and every one of those children born,” she adds, underscoring the deep sense of fulfilment that comes from knowing that her work has brought happiness and hope to countless families. Harnessing Technology for the Future of Reproductive Medicine Ethical Leadership in Action As technology continues to advance, Dr. Crespo believes that data-driven insights and artificial intelligence will play an increasingly vital role in shaping the future of reproductive medicine. While data-driven technologies have the potential to revolutionize certain aspects of patient care, she emphasizes the importance of maintaining a human-centered approach to medicine. At Equipo Juana Crespo, ethical principles and evidence- based practices form the foundation of every decision and action. Driven by a commitment to prioritize patient well- being above all else, the clinic adheres to the highest standards of medical ethics and professionalism. “The primary foundation of this clinic is ethics with the patients,” she asserts, emphasizing the clinic’s devotion to placing patient health and safety above financial considerations. By upholding the principles of beneficence “AI will be a significant advancement as support,” she acknowledges, highlighting the potential of artificial intelligence to improve embryo selection and enhance clinical outcomes. However, he also stresses the crucial role

17. ‘ ‘ and non-maleficence, the clinic ensures that every decision is guided by the imperative to do no harm and to always act in the best interests of the patient. Looking Towards the Future My aspira?on is to achieve healthy and evolu?onary pregnancies in women over 40 years old with their own eggs. ‘ ‘ As Dr. Crespo looks towards the future, her aspirations for Equipo Juana Crespo and her own career in reproductive medicine are driven by a singular goal: to continue pushing the boundaries of what is possible in IVF and to ensure that every patient receives the highest standard of care. “My aspiration is to achieve healthy and evolutionary pregnancies in women over 40 years old with their own eggs,” she shares, outlining her vision for the future. With a focus on innovation, compassion, and excellence, she remains committed to advancing the field of reproductive medicine and transforming the lives of patients worldwide.

19. YOU YOU BRAVER , SEEM THAN YOU ARE BELIEVE STRONGER THAN YOU SMARTER THAN , AND THINK .

20. Edona Mirakaj Founder & CEO BestFertility EDONA June 2024 www.eurohealthleaders.com 18

21. Europe’s 5 Most Influential IVF Pioneers to Watch in 2024 Edona Mirakaj Empowering Dreams of Parenthood with Advanced IVF C this transformation is BestFertility, a pioneering fertility clinic that combines advanced medical innovations with personalized treatment plans. The driving force behind this exceptional institution is Edona Mirakaj, a veteran in the IVF sector with an impressive eighteen-year career that spans multiple leadership roles across Germany. utting-edge technologies, individualized patient care, and constant dedication to excellence are redefining the fertility industry. At the forefront of These decades of experience range from basic positions to managing renowned fertility clinics in Ulm, Stuttgart and Ravensburg. These roles not only enabled me to gain deep insights into the challenges and opportunities of reproductive medicine, but also to play a key role in the development of innovative organizational structures that significantly improved the efficiency and quality of patient care. The step to founding BestFertility was a natural transition for me to realize my vision of a clinic that combines state- of-the-art technologies with individually tailored care. During my extensive career, I have worked through all major clinical and administrative processes, from patient assistance to overall management. I was actively involved in key business decisions and was instrumental in all inspections and audits, including ISO 9001 certifications and 17025 accreditations, as well as audits by the regional council. Edona Mirakaj, Founder and CEO of BestFertility, started on her journey in reproductive medicine long before her formal studies in healthcare management. Her extensive experience in managing fertility clinics provided her with invaluable insights into the industry’s challenges and opportunities. These experiences reached its peak in the creation of BestFertility during the coronavirus crisis, a clinic designed to integrate state-of-the-art technologies with a patient-centered approach. Under Mirakaj’s leadership, BestFertility has rapidly distinguished itself through its comprehensive services, including in vitro fertilization and specialized genetic testing. The clinic’s commitment to leveraging technology is evident in its fully integrated digital patient platform, which enhances communication and transparency, ensuring patients are actively involved in their treatment journey. My in-depth knowledge of the legal framework and my extensive practical experience enabled me to identify weaknesses and implement targeted solutions. I brought this expertise to the founding and development of Bestfertility, a company that I launched during the coronavirus crisis. My focus is now on breaking innovative ground with Bestfertility and continuously improving patient care in reproductive medicine. Let’s dive into the interview to uncover Edona Mirakaj’s journey, the innovative services at BestFertility, and the latest trends in fertility care shaping the future! What services does BestFertility offer, and how do you differentiate yourselves from other fertility clinics? Can you tell us about your background and what inspired you to start BestFertility? BestFertility offers a comprehensive range of services, from in vitro fertilization to specialized genetic testing. A key difference from other clinics is our team of experienced physicians and embryologists, whom I know from my previous work and who have joined our innovative organizational structure. My professional career in the IVF sector began 18 years ago, long before my studies in healthcare management. June 2024 www.eurohealthleaders.com 19

22. This team brings a depth of experience and expertise that allows us to address the individual needs of each patient - a far cry from the schematic treatment often practiced in overburdened centers. Can you share some key milestones or achievements of the company since its inception? Since our inception, we have expanded steadily and have been able to constantly improve our services by incorporating the latest technologies. We are particularly proud to be one of the first clinics in Germany to introduce a fully integrated digital patient platform, allowing our patients to track their treatment and progress in real time. We are also in the process of expanding our presence and plan to open additional sites that will offer ideal working conditions for doctors, scientists and staff similar to those already established in Ulm. What are some of the latest trends or advancements in the fertility industry that excite you the most? The advancing use of artificial intelligence and machine learning in diagnostics and treatment planning is particularly fascinating. These technologies make it possible to adapt therapies more precisely to the specific biological conditions of our patients and promise a further increase in success rates. In particular, the application of swarm intelligence, where we augment the collective knowledge and experience of our medical team with AI models, has significantly improved our ability to make optimal treatment decisions quickly and efficiently “ I would like to emphasize that there is hardly anything more motivating than the gratitude and joy of our patients when a pregnancy occurs. This is the driving force behind everything we do and encourages us every day to create the best conditions and treatment options so that our patients can fulfill their family wishes. How is BestFertility leveraging technology to improve patient experiences and outcomes? Our approach integrates the latest technologies into every step of the treatment process. We use advanced imaging, genetic analysis and data- driven decision making to create individualized treatment plans. Our digital platform not only improves communication and transparency, but also supports comprehensive care for our patients. June 2024 www.eurohealthleaders.com 20

23. In addition, our AI-powered language models allow us to communicate in any language and provide detailed information in a timely manner. This is a key benefit for our international patients and improves the overall accessibility and comprehensibility of our services. pregnancy occurs. This is the driving force behind everything we do and encourages us every day to create the best conditions and treatment options so that our patients can fulfill their family wishes. We pride ourselves on creating a working environment in our clinics that attracts highly motivated professionals and enables them to give their best - for the benefit of our patients. What are some of the biggest challenges you face in the fertility industry, and how is your company addressing them? One of the biggest challenges is the rapid change in technology and the need to keep up to date with the latest scientific research. We meet this challenge through continuous training of our team and regular updates of our systems and protocols. Our perfect quality management and constant organizational improvement are key components that enable us to provide first-class patient care despite the fast-moving developments in medical technology. What are your future plans for BestFertility in terms of expansion, new services, or technological advancements? I would like to emphasize that there is hardly anything more motivating than the gratitude and joy of our patients when a June 2024 www.eurohealthleaders.com 21

24. Ethical Considerations Public Attitudes towards IVF European Societies June 2024 www.eurohealthleaders.com 22

25. I n vitro fertilization (IVF) has revolutionized reproductive medicine across Europe, offering hope to countless individuals and couples struggling with infertility. As this technology continues to advance, it brings with it a host of complex ethical considerations and varying public attitudes. This article explores the multifaceted landscape of IVF in European societies, examining both the ethical challenges and the evolving public perception of assisted reproductive technologies. Ethical Considerations: Navigating Uncharted Territory The rapid progress of IVF technology has outpaced the development of comprehensive ethical frameworks, leaving healthcare professionals, policymakers, and society at large grappling with profound questions. One of the most pressing concerns revolves around the status and fate of cryopreserved embryos. As IVF clinics accumulate vast numbers of stored embryos, debates rage over who holds the ultimate authority to determine their future – the genetic parents, medical institutions, or regulatory bodies. The advent of preimplantation genetic testing (PGT) has sparked intense discussions about the ethical implications of embryo selection. While PGT offers the potential to prevent hereditary diseases, critics argue that it treads dangerously close to eugenics, raising fears of a "designer baby" future. The technology's ability to screen for non-medical traits further complicates the ethical landscape, forcing society to confront questions about the limits of reproductive autonomy and the value of human diversity. The commercialization of IVF has introduced its own set of ethical quandaries. The proliferation of unproven "add-on" treatments in some clinics has raised concerns about patient exploitation and the prioritization of profit over medical efficacy. This trend highlights the delicate balance between fostering innovation and protecting vulnerable June 2024 www.eurohealthleaders.com 23

26. patients from potentially harmful or ineffective interventions. effectiveness of IVF, potentially leading to unrealistic expectations and emotional distress. This highlights the need for improved public education and transparent communication from healthcare providers and policymakers. Access to IVF remains a contentious issue across Europe. While some advocate for universal access regardless of marital status, sexual orientation, or age, others argue for restrictions based on various social, economic, or medical criteria. The high cost of IVF treatments has sparked debates about healthcare equity and the role of public funding in assisted reproduction. These discussions often intersect with broader societal values regarding family structures and reproductive rights. Balancing Progress and Ethics As IVF technology continues to evolve, European societies face the ongoing challenge of reconciling scientific advancements with ethical considerations and diverse public opinions. The development of comprehensive, culturally sensitive regulations will be crucial in addressing concerns around embryo status, genetic testing, and commercialization. The practice of cross-border reproductive care, colloquially known as "fertility tourism," presents its own ethical challenges. As individuals seek more affordable or less restrictive IVF options in other countries, questions arise about the potential exploitation of women in economically disadvantaged regions, particularly in the context of egg donation and surrogacy. Fostering informed public discourse on IVF is essential for shaping policies that reflect societal values while respecting individual reproductive rights. This will require ongoing collaboration between medical professionals, ethicists, policymakers, and community leaders to navigate the complex intersection of science, ethics, and public opinion. Public Attitudes: A Shifting Landscape Despite the ethical complexities surrounding IVF, public opinion in Europe has generally trended towards acceptance and support for assisted reproductive technologies. Large- scale surveys have revealed predominantly positive attitudes towards IVF across diverse demographic groups. This growing acceptance reflects changing societal norms around family formation and an increasing recognition of infertility as a medical condition deserving of treatment. However, public attitudes are far from monolithic. Religious beliefs continue to play a significant role in shaping individual perspectives on IVF, with more conservative religious communities often expressing reservations about certain aspects of the technology. Cultural factors and national histories also influence public opinion, leading to variations in acceptance levels across different European countries. Ultimately, the future of IVF in Europe will depend on striking a delicate balance between embracing the potential of assisted reproductive technologies and ensuring that their development and application align with ethical principles and societal values. As public attitudes continue to evolve, so too must the frameworks governing this transformative medical field. - Natalie May One notable trend is the generational divide in attitudes towards IVF. Younger Europeans tend to express more open and positive views on assisted reproduction, reflecting broader shifts in societal values around family, gender roles, and personal autonomy. This generational difference suggests that public acceptance of IVF is likely to continue growing in the coming years. Public understanding of IVF success rates and limitations remains an area of concern. Studies have shown that many individuals hold overly optimistic views about the June 2024 www.eurohealthleaders.com 24

28. Jordana Mata Medical Director of HC Fertility HC Marbella International Hospital

29. Europe's 5 Most Influential IVF Pioneers to Watch in 2024 Jordana Mata Shaping the Future of Fertility with Vision and Expertise I evolves, the need for forward-thinking leaders who combine technological advancement with compassionate care has never been greater. Jordana Mata is one such visionary, whose remarkable journey and innovative contributions make her a leading figure to watch in 2024. n a world where hope meets science, the pioneers of IVF and fertility treatments are shaping the future of countless families. As reproductive medicine rapidly As the Medical Director of HC Fertility at HC Marbella International Hospital, Jordana brings a wealth of experience and resolute dedication to the complex science of fertility. HC Marbella, renowned for its advanced medical services, provides the perfect setting for Jordana's transformative work. Her drive to enhance fertility treatments is evident in the significant advancements she has led, from implementing cutting-edge genetic diagnosis techniques to introducing less invasive procedures. Jordana’s career is defined by a relentless pursuit of excellence and a deep-seated passion for reproductive medicine. Her early fascination with embryology and pregnancy during medical school laid the foundation for her distinguished career. Now at HC Marbella, Jordana continues to innovate in fertility treatments, ensuring that each patient receives personalized and advanced care. Let's get into the interview details to see how Jordana Mata is paving the way for future generations of fertility specialists, ensuring that empathy and innovation remain at the heart of reproductive medicine! June 2024 www.eurohealthleaders.com 27

30. “ I strongly believe that there are unnegotiable topics in fertility, and ethics is the first one. There are certain limits we must not overlook, even in cases where our eagerness to help and the willingness to calm the unease and despair of our patients would make us want to do it. “ Please tell us a bit about your background and how you got involved in the field of fertility and IVF. Minimally Invasive Surgery in Gynaecology in Spain and validated all my degrees to start working in Europe. I started my interest in fertility when I studied pregnancy and embryology as a medical student. The complexity of the beginning of a human life and the multiple events linked together that take place for each one of us to come into this world, utterly amazed me. After becoming a doctor and while I was preparing for the medical residency entrance exam, I had the opportunity to work for several months in a fertility clinic helping one of the specialists and continued my studies in the field during my whole training to become a gynaecologist. Once I got my specialist degree in obstetrics and gynaecology, I kept working at the hospital where I had done the residency, focusing on minimal invasive surgery of gynaecological patients, mainly those who had a gestational desire for the future. At the same time, I started my 3 year-long subspecialty in fertility, where I got the opportunity to consolidate my basal knowledge in the field and start a lifelong career upgrading. Can you share some of the innovative approaches or technologies you have helped implement at HC Marbella International Hospital? When I started working at HC Marbella, my first motivation was to upgrade the services of the Fertility Unit. The average age of fertility patients is increasing, and, although technology is making quantum leaps forward, the cases of fertility patients are also becoming more challenging every step of the way. Since HC Fertility is part of HC International Hospital, we can count not only on all the technology a state-of-the-art fertility clinic has, but also on the backup infrastructure of a whole multidisciplinary hospital. Working side by side with our embryologists, we implemented, improved and refined several techniques used as genetic preimplantation diagnosis of the embryos, and I also implemented the hysterosalpingo-foam sonography to study the tubes, giving the patient much less discomfort than with the otherwise routinely used hysterosalpingography. Furthermore, we are currently starting to prepare the Unit for future transvaginal radiofrequency ablation of fibroids. What have been some of the key milestones and achievements in your career so far? I graduated from medical school with a Gold Medal of Honour in 2003 when I was still very young, and ever since then I have pursued excellence, motivated in giving patients distinctive care. Once I became a gynaecologist and a fertility specialist, I was given the position of Head of Reproductive Medicine and Reproductive Endoscopic Surgery at Sanatorio Allende Córdoba, one of the best private hospitals in Argentina. I got a master’s degree in How have you worked to improve access to fertility treatments and support for underserved populations? While in Argentina, I was part of a public program for fertility treatments and cooperated in collecting medication for patients that couldn´t afford it. I now cooperate giving June 2024 www.eurohealthleaders.com 28

31. considerations, in HC Fertility we have many international patients, and it is very important they learn about the Spanish legislation and how those local regulations can change the treatment options available for them; and we, as their fertility doctor, are the ones responsible for giving this information in a certain and clear manner. Where do you see the field of fertility and IVF heading in the next 5-10 years, and what role do you hope to play in shaping its future? I believe that artificial intelligence will be the new guiding star of our future, but as with all innovative technologies, our biggest challenge will be to not lose our training and expertise in giving treatments that irreplaceable human touch. I will be one of the fertility doctors that witnessed the whole spectrum of fertility techniques, from simple, low budget treatments to state of the art technologies that allow us to do things we would have been deemed impossible almost 40 years ago, and I will be proud to pass on all that experience to future generations of fertility doctors. free online fertility counseling to patients in developing countries, trying to adapt the diagnosis process as well as the treatment to the techniques available at their homeland. What advice would you give to someone interested in pursuing a career in fertility medicine and IVF? What have been some of the biggest challenges you’ve faced in your work, and how have you overcome them? I would tell them to understand that most of the time we are dealing with a person’s biggest life project. That sometimes that person might have a limited number of opportunities to make it real, and that we have to be fully aware of the responsibility it implies for us. In this field you must put your brain and your heart at service, every day, and commit to keeping yourself updated, in a field that progresses rapidly and will challenge us every day of our career until we finish our service as doctors. My biggest challenge was to renew the fertility unit at HC Marbella when I had just arrived in Europe. As a new medical director of HC Fertility, I was hired to update several aspects of the service, for which I had to not only study the different legislation, but also study the technologies available in Spain and the best way to implement them, so we could give our patients the best option for their fertility problems, always focusing on an accurate diagnosis and tailor-made treatments. How have you navigated the ethical and regulatory considerations around fertility treatments? I am a big advocate of ethical issues in our field. I strongly believe that there are unnegotiable topics in fertility, and ethics is the first one. There are certain limits we must not overlook, even in cases where our eagerness to help and the willingness to calm the unease and despair of our patients would make us want to do it. Furthermore, explaining the personal clinical situation according to the studies’ results, the treatment options available with their corresponding success rate in their particular case, and the few but never null risks a technique might have, is key to ensure transparency in the outcome. Regarding the regulatory June 2024 www.eurohealthleaders.com 29

32. IVF Culture Media Embryo Quality in Europe I heart of this groundbreaking process lies a critical compo- nent often overlooked by the general public: the culture media in which embryos develop. Recent years have witnessed remarkable progress in this field, particularly in Europe, where innovations in IVF culture media are reshaping the field of reproductive medicine. n the world of assisted reproductive technology, in vitro fertilization (IVF) stands as a beacon of hope for countless couples struggling with infertility. At the The Journey from In-House to Commercial Media The early days of IVF saw laboratories concocting their own culture media with limited quality control measures. This practice, while groundbreaking for its time, left room for inconsistencies and potential risks. The advent of commercially produced media marked a significant turning point in the industry. These standardized products, manu- factured under strict quality guidelines, brought a new level of reliability and safety to the IVF process. Commercial media formulations are carefully crafted to provide embryos with an optimal blend of nutrients, vitamins, and growth factors. This precision in composition aims to mirror the supportive environment found within the female reproductive tract, fostering healthier embryo development and improving the chances of successful implantation. Sequential Media: Mimicking Nature's Design One of the most notable innovations in IVF culture media is the development of sequential media systems. These sophisticated formulations are designed to change over June 2024 www.eurohealthleaders.com 30

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34. time, reflecting the dynamic nutritional needs of developing embryos as they progress through various growth stages. By closely replicating the shifting conditions an embryo would encounter in vivo, sequential media have shown promising results in enhancing embryo quality and boosting implantation rates. Another significant hurdle is the need for more extensive clinical trials to validate the efficacy and safety of new culture media and techniques. While smaller studies have shown promising results, larger-scale investigations are crucial to establish the broader applicability and long-term effects of these innovations. The Future of Embryo Culture The impact of these advancements is not merely theoretical. European researchers have conducted numerous studies to evaluate the effects of different culture media on embryo development and pregnancy outcomes. One particularly intriguing study from the Netherlands compared two widely used media: Vitrolife G-1 PLUS and SAGE 1-Step. The findings revealed that embryos cultured in SAGE 1-Step exhibited accelerated growth, especially in male embryos, compared to those in Vitrolife G-1 PLUS and naturally conceived embryos. This discovery underscores the profound influence that culture media composition can have on embryonic development trajectories. As we look to the future, emerging technologies hold the promise of further revolutionizing IVF culture media and embryo assessment. Researchers are exploring the potential of metabolomic profiling and proteomic analysis to evaluate embryo quality based on the molecules secreted into the culture medium. These non-invasive techniques could provide unprecedented insights into embryo health and viability, potentially leading to more accurate selection of viable embryos and improved pregnancy rates. The ongoing refinement of culture media formulations, coupled with advancements in embryo assessment tech- niques, is expected to continue pushing the boundaries of what's possible in assisted reproduction. As these technolo- gies evolve, they have the potential to not only increase the success rates of IVF treatments but also to provide valuable insights into early human development. Time-Lapse Technology: A Window into Embryo Development The quest for improved embryo selection has led to the integration of time-lapse monitoring technology with advanced culture media. This non-invasive approach allows embryologists to observe and assess embryo development continuously, without disturbing the delicate culture environment. When combined with optimized culture media, time-lapse monitoring has demonstrated the potential to significantly enhance pregnancy rates compared to conventional evaluation methods. Conclusion The field of IVF has come a long way since its inception, with culture media playing a pivotal role in its evolution. From the early days of in-house preparations to today's sophisticated commercial formulations and sequential systems, each advancement has brought us closer to optimizing the conditions for embryo development outside the womb. Challenges on the Horizon Despite the remarkable progress in IVF culture media, several challenges persist. One of the primary concerns is the variability in media composition across different manufacturers. This inconsistency can lead to discrepancies in embryo quality and pregnancy rates, complicating the standardization of IVF protocols across clinics. As research progresses, we can anticipate further innova- tions in IVF culture media and embryo assessment meth- ods. These advancements promise to enhance our under- standing of early human development and improve the outcomes for couples seeking assistance in their journey to parenthood. With continued dedication to research and innovation, the future of IVF holds the potential to trans- form reproductive medicine, offering hope to an ever- growing number of individuals and couples around the world. In response to this issue, some IVF laboratories have opted to produce their own synthetic sequential media in-house. This approach allows for greater control over media components and the ability to tailor formulations to specific patient needs. However, it also reintroduces some of the quality control challenges that commercial media had initially aimed to address. - Natalie May June 2024 www.eurohealthleaders.com 32

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