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Biomarkers in reproductive medicine: the quest for new answers.

Personalized medicine in assisted reproductive technologies (ART) is still in its infancy. Precision medicine, based on objective molecular tools added, to clinical medicine is well-accepted and developed in oncology and other potent medical disciplines. The impact of personalized medicine in cancer is broad, from screening to diagnosis, with the stratification of patients into cancer subgroup categories, facilitating individualized therapies that impact treatment effectiveness and disease recurrence (Diamandis et al., 2010; Hamburg and Collins, 2010). In reproductive medicine many ‘unknown black boxes’ still exist. These will only be unraveled with the timely application of novel technologies and knowledge from modern medicine, complementing classical clinical protocols. Albert Einstein wrote: ‘If you want different results, do not do the same’. This quotation is applicable to the current status of our field. In addition to classic single molecular markers, high-throughput approaches may be used for personalized diagnosis, including next generation sequencing (NGS), single-nucleotide polymorphisms (SNP), microarray analysis or mass spectrometry. A common trend among these tools is their ability to analyze a myriad of targets simultaneously. Consequently with the addition of bioinformatics and systems biology to the equation, the sensitivity, specificity, and accuracy, as well as the complexity of new biomarkers discovered, is increasing. The complication of applying personalized medicine in reproduction is that it is not ‘personalized’ to one individual but in fact three; the