A Day in the Life of Dr Apostolos Tsironis, Consultant Gynaecologist and Fertility Specialist
We speak to Harley Street's fertility specialist Dr Apostolos Tsironis about his work with the IVF Select team and how developments to preimplantation genetic testing technology could improve IVF success rates further in the future.
My name is Dr Apostolos Tsironis and I’m a consultant gynaecologist and fertility specialist at the London Women’s Clinic in Harley Street. I studied Medicine in Athens and completed my specialist training in Obstetrics and Gynaecology at the University Hospital of Ioannina, Greece which is my hometown. Since I was a medical student I was fascinated by human reproduction and knew that this was what I wanted to specialise in. During my training in Obstetrics and Gynaecology I was given the opportunity to do a placement abroad in a specific area of interest, so I chose reproductive medicine and spent 10 months at the Leeds Centre for Reproductive Medicine. After finishing my training, I moved to the UK and worked in Leeds and Glasgow before moving to London. I live in London with my wife and little boy. We enjoy travelling together and meeting friends. Before joining LWC in 2018, I have worked as a fertility Specialist in Homerton University Hospital and in another private centre.
A day in my life
A normal day for me includes seeing patients for consultations. This could be their initial consultation at the clinic to find out the results of their fertility tests, a follow up consultation to start planning treatment or a review meeting if treatment has sadly been unsuccessful. I scan all my initial consultation patients myself and have a special interest in 3D ultrasound. Different ultrasound machines and operators can give different views and I find it fascinating to try and get the best possible images. I work closely with the sonographers at the LWC to make improvements to our service and ensure best practice for our patients. Twice a week I work in theatre performing egg collections and embryo transfers. I’m definitely a perfectionist and I try my best to achieve the best outcomes for patients.
I have a special interest in Preimplantation Genetic Testing (PGT) and I’m a part of the IVF Select team at the LWC. IVF Select is an IVF programme that involves the genetic testing of embryos prior to freezing then the transfer of a normal (“euploid”) embryo in a later cycle. Embryos with abnormal numbers of chromosomes (known as aneuploidy) rarely develop in to a pregnancy so using a technique called Preimplantation Genetic Testing for Aneuploidy (PGT-A) means we can select only normal embryos.
IVF Select can be particularly useful for patients who have had recurrent implantation failure, previous genetic issues, recurrent miscarriages or women who are over 40. Having said that it’s reasonable for most patients to have PGT-A as part of their IVF cycle. Using genetic testing we can reduce the time to pregnancy by selecting the best embryo. PGT-A isn’t the answer for everything, however, and human reproduction is very complex with so many factors to consider.
The best part of my job
The best part of my job is receiving the baby pictures from patients who have had successful treatment! This is the reason why I do my job. I like being able to support my patients through treatment as there is so much emotional and financial investment involved. It takes a lot of effort to even come through the door and have an appointment at a fertility clinic. Infertility is still considered a taboo and can cause so much stress. I like to make my patients feel comfortable and to give them the best opportunity to have a baby. It’s important to me to constantly strive to make improvements to our practice to help our patients.
The future for me is to continue to work with the genetics team at the LWC. We are currently trialing a new pathway for IVF Select patients which we will review in the next six months. This involves improvements to treatment plans and protocols but also ensuring patients have continuity in their care as there is going to be a dedicated team involved. We hope that this will help us achieve the best possible results.
I’m also looking forward to attending ESHRE this June, the world’s largest conference dedicated to reproductive medicine. I hope to learn more about mosaic embryos and the development of techniques which will change the way we screen embryos. The current technology of Next Generation Sequencing (NGS) has its limitations. Testing involves taking a few cells from the outside layer of the embryo (the trophectoderm) which will later become the placenta. We know that sometimes the genetic composition of the embryo itself may be different from the trophectoderm (a term called mosaicism). New technology is under development to examine embryonic DNA which will change completely the PGT approach in a few years.
The LWC has always been at the forefront of genetic testing technology and I’m privileged to be a part of it. We have a long history of providing Preimplantation Genetic Testing (PGT) in our London Bridge clinic. Working with Mr Michael Summers, the LWC’s specialist in PGT I have been able to learn from his experience and adopt new insights on planning and interpreting results. I’m grateful for his advice and stimulation which has led to my improvement. Genetic testing is one of the most research active areas of reproductive medicine and I’m pleased to be a part of it.