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When Dr. Zaher Merhi started his fertility practice, he did what every other reproductive endocrinologist does: he followed the standard playbook. High-dose stimulation medications. Weeks of preliminary testing before a patient could even begin treatment. Protocols built around consistency, meaning what worked for the average patient was applied to every patient.
He was good at it. But he kept running into the same wall.
Women would come to him in their early 30s, healthy, motivated, with good ovarian reserve, and the system would swallow them whole. Four to eight weeks of intake testing before their first injection. Thousands of dollars in medication, much of it unused. Embryo assessments done by a technician eyeballing cells under a microscope twice a day, then putting the embryos back in an incubator and hoping for the best. They’d leave exhausted and $20,000 lighter, with outcomes that didn’t reflect how hard they had worked.
He kept thinking: there has to be a smarter way to do this.
The Problem With “One Size Fits All” Medicine
Photo Credit: Aurea
Fertility treatment, like most of medicine, was designed around averages. Clinical protocols are built from population-level data, then applied uniformly. The result is a system that works reasonably well for a theoretical average patient, but that theoretical patient doesn’t actually exist.
Every woman’s hormonal profile, her ovarian reserve, her response to medication, it’s distinct. And yet, most clinics start everyone at the same stimulation dose, adjust based on crude blood test markers, and select embryos using subjective visual assessment.
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