Nicolas Vulliemoz discusses his vision of reproductive medicine and analyses the latest challenges inherent to a practice that combines ethics, technologies, and human relationships
Nicolas Vulliemoz, director of the Reproductive Medicine Unit at the CHUV
NV / I was taking part in the Erasmus study abroad programme in Bristol when I decided to go into obstetrics and gynaecology, even though I was only in my fourth year of medical school. I met a very experienced professor nearing retirement who absolutely fascinated me. He had taken part in the first-ever “in vitro” fertilisation trials with the Nobel-winning scientist Robert Edwards, who developed the technique. Assisted reproduction technology (ART) quickly became my passion, and it has met and exceeded my every expectation. The blend of technology and patient interaction makes this
job incredibly vibrant. Receiving a baby photo from our patients is priceless!
NV / It’s one of the facets of my job, and it makes it even more interesting. I’ve had a very good experience, actually, because transferring an embryo is always something magical. I respect people’s opinions, but you should be against it for the right reasons. Religious reasons are okay, but a misunderstanding of the treatment shouldn’t be. I’m not here to sell my services, but rather to offer medical options for addressing infertility. You have to be able to demystify a certain number of issues related to ART and accept others’ opinions.
NV / Absolutely. Switzerland’s law on assisted reproductive technology is a good thing and limits abuses. Even with the new law, the legal framework in Switzerland remains strict. In our unit, we organise symposiums to discuss legal and ethical issues. We’ve had to refuse treatment when, following a multi-disciplinary evaluation, we found the parents were not able to raise their child to adulthood, as stipulated in the law.
NV / Yes, that is a risk. Because the Swiss health insurance regime does not reimburse IVF, patients can undergo treatment wherever they want. In addition, IVF has grown significantly in the private sector—so much so that people don’t always know that it is also performed in university hospitals. These types of institutions play a vital role in research, education and ethics.
NV / Yes. One cycle of IVF costs 8,000 to 10,000 Swiss francs, and prices are more or less comparable throughout Switzerland. A twelve-month round of ovarian stimulation and three inseminations are reimbursed up to the age of 40.
NV / I hope so, because price is a real barrier to treatment. In my opinion, it will be reimbursed eventually. But strict criteria regarding age,
weight and tobacco use will apply.
NV / Yes. It’s extremely important. Switzerland’s
law on assisted reproductive technology specifies that patients must receive psychological support. Our unit employs specialised nurses and psychologists. All our patients are referred to these specialists. The greatest failing in reproductive medicine is that patients who underwent treatment and did not become pregnant did not receive adequate psychological support.
NV / Yes. This is the reality of modern society.
We receive a lot of requests, but at the same
time we don’t want it to turn into a business.
We assess the relevance of the procedure
for each individual and don’t hesitate to say
no when the benefits of the treatment are too
low. For example, if the woman is 44, it’s not
NV / Nearly 40 years after the first test-tube baby,
we have enough perspective and quality studies
to know the long-term consequences of births using ART. On a cognitive level, there is no difference. However, there is an increased risk of developing certain malformations in the heart and urinary tract. These malformations are nevertheless rare, and their causes are not fully known. ⁄
An expert in reproduction Nicolas Vulliemoz has been the chief physician at the Reproductive Medicine Unit since April 2015. At Lausanne University Hospital, he created a multi-disciplinary consultation programme for endometriosis, which provides patients with individualised follow-up care. He also coordinates the French-speaking Swiss Cancer and Fertility Network, which helps patients undergoing oncology treatment protect their fertility. Nicolas Vulliemoz has previously worked at the Fribourg Cantonal Hospital, Columbia University (USA)