Dr. Dimitrios Kafetzis, Medical Director and Founder of Almond Blossoms Fertility & Wellbeing Centre in Dubai shares how advanced diagnostics, personalised medicine, and emerging technologies are transforming fertility outcomes.
For many couples, being told their infertility is “unexplained” can feel like hitting a dead end. Standard tests come back normal, yet the path to pregnancy remains elusive. But as fertility science advances, specialists are increasingly uncovering the subtle, often overlooked factors that lie beneath the surface.
According to Dr. Dimitrios Kafetzis, Medical Director and Founder of Almond Blossoms Fertility & Wellbeing Centre in Dubai, unexplained infertility is rarely without cause – it simply requires a deeper, more personalised approach. From cutting-edge diagnostics to tailored treatment strategies, today’s fertility care is moving beyond one-size-fits-all solutions, offering new hope to patients navigating complex reproductive challenges.
Unexplained infertility can feel especially frustrating. What are the most common hidden factors that standard tests might miss, and how can patients advocate for deeper investigation?
Unexplained infertility does not mean there is no cause; it means standard testing has not yet identified it. In many cases, subtle or combined factors are involved.
Common “hidden” contributors include mild endometriosis, sperm DNA fragmentation, implantation issues related to the endometrium, immune or inflammatory factors, and egg or embryo quality that routine tests cannot detect.
Patients can advocate for themselves by asking about more advanced assessments, such as detailed sperm testing, uterine cavity evaluation, or endometrial receptivity. Equally important is choosing a clinic that takes a holistic and individualised approach, featuring a variety of related specialists (like andrologists, endocrinologists etc) rather than relying only on basic protocols.
When everything appears “normal” on paper, how do you approach building a treatment plan, and what role does personalised medicine play in these cases?
When standard results are normal, the real answer is usually found “in between the lines”. We very often see couples being falsely advised that sperm parameters are normal or that fallopian tubes are open, when a problem existed in the first place.
This is where personalised medicine is essential. We tailor stimulation protocols, timing, embryo selection strategies, and sometimes adjunct treatments based on the patient’s age, ovarian reserve, previous responses, and even subtle clinical patterns.
Rather than applying a one-size-fits-all approach, we focus on improving egg quality, fertilisation, and implantation potential – often making small but meaningful adjustments that significantly improve outcomes.
Are there emerging diagnostic tools or biomarkers that are improving how we understand unexplained infertility today?
Yes, the field is evolving rapidly. New tools are helping us look beyond traditional diagnostics.
These include sperm DNA fragmentation testing, advanced embryo assessment using time-lapse imaging, and endometrial receptivity tests that evaluate the optimal timing for implantation. Research into the uterine microbiome and uterine immune environment is also providing promising insights.
While not all of these tools are needed for every patient, they are helping us move toward a more precise and personalised understanding of fertility.
Recurrent pregnancy loss and advanced treatment options.
For women experiencing recurrent pregnancy loss, how do you balance medical intervention with the emotional toll of repeated cycles?
Recurrent pregnancy loss is both a medical and emotional journey. It is essential to address both aspects with equal care.
Medically, we focus on identifying any underlying causes and creating a clear, structured plan. Emotionally, we ensure patients feel supported and informed, and we are the ONLY IVF clinic in the UAE with a separate and dedicated department with fertility psychologists. They are there to hold the couple’s hand all the way until they have their baby and beyond.
Sometimes, taking time to investigate thoroughly before the next attempt can be just as important as treatment itself. Psychological support and continuity of care play a key role in helping patients regain confidence.
What are the most common underlying causes of recurrent miscarriage that are often overlooked, and how are they treated?
The most common cause is chromosomal abnormalities in the embryo, particularly with increasing maternal age. However, other often overlooked factors include uterine abnormalities (such as polyps, fibroids, or adhesions), hormonal imbalances, thyroid disorders, clotting conditions, and immune-related factors.
Treatment depends on the cause. This may include surgical correction of uterine issues, hormonal support, anticoagulant therapy in selected cases, or IVF with genetic testing to improve embryo selection.
Can you explain the role of genetic testing – such as embryo screening or parental karyotyping – in preventing further loss?
Genetic testing plays a crucial role, especially after repeated losses.
Parental karyotyping can identify balanced chromosomal rearrangements that may not affect the parents’ health but can lead to miscarriage. Embryo testing (PGT-A) during IVF allows us to select embryos with the correct number of chromosomes, significantly reducing the risk of miscarriage.
While it does not guarantee success, it can improve the chances of a healthy ongoing pregnancy in selected patients.
What newer or less widely known treatments (e.g., immunological therapies, uterine procedures) are showing promise in this space?
There is growing interest in treatments targeting implantation and the uterine environment.
These include hysteroscopic procedures to optimise the uterine cavity, personalised timing of embryo transfer, and in selected cases, immune-modulating therapies. However, it is important to emphasise that not all emerging treatments are supported by strong evidence.
A careful, evidence-based approach is essential to avoid unnecessary interventions while still offering innovative options when appropriate. The experience of the medical team is absolutely essential, as many times our doctors will go beyond the guidelines and recommend new medical treatments years before they become mainstream.
Innovations in IVF, ICSI and fertility preservation.
What are the most exciting recent innovations in IVF and ICSI that are improving success rates or patient experience?
Recent advances are improving both outcomes and patient experience. Time-lapse embryo monitoring allows us to select embryos more accurately without disturbing their environment. Improvements in laboratory conditions and culture media have enhanced embryo development. In ICSI, techniques for sperm selection are becoming more refined.
Additionally, milder stimulation protocols and better cryopreservation (freezing) methods are making treatment safer, more comfortable, and more flexible for patients.
Finally, in the field of genetics, soon we will be able to apply more extensive tests on the embryos, in order to predict and prevent schizophrenia, autism, Alzheimer’s and other genetic conditions. This is an exciting prospect, albeit one we must carefully evaluate.
Fertility preservation is becoming more common – how should women decide the “right time” to consider options like egg freezing?
There is no single “right time,” but age remains the most important factor. Egg quality and quantity decline gradually, and more significantly after the mid-30s. For women who are not ready to conceive but wish to preserve future options, considering egg freezing earlier – ideally before 35 – offers the best chances.
The decision should be individualised, taking into account personal, medical, and life circumstances. A consultation with a fertility specialist can help assess ovarian reserve and guide timing realistically.
Looking ahead, how do you see technology – such as AI, lab advancements, or genetic science – changing fertility treatment outcomes over the next 5-10 years?
The next decade will likely bring a shift toward even more precision and personalisation. Artificial intelligence is already being used to assist in embryo selection and may improve decision-making further. Advances in genetics will enhance our understanding of embryo viability and implantation. Laboratory technologies will continue to optimise culture conditions and success rates.
Perhaps most importantly, treatment will become increasingly tailored to the individual – improving outcomes while reducing unnecessary interventions.
Dr. Dimitrios Kafetzis
Dr. Dimitrios Kafetzis, Medical Director and Founder of Almond Blossoms Fertility & Wellbeing Centre in Dubai, is a globally recognised Consultant in Reproductive Endocrinology, IVF, Obstetrics, and Gynecology. With more than 16 years of international experience in fertility medicine and women’s health, he has built a reputation for combining precision-driven, science-led care with deeply personalised patient treatment.
Accredited by the British Fertility Society, Dr. Kafetzis specialises in complex and unexplained infertility, recurrent pregnancy loss, advanced IVF and ICSI treatments, fertility preservation, and genetic testing including PGT-A and PGT-M.
Dr. Kafetzis is recognised internationally as a Key Opinion Leader in reproductive medicine and regularly presents research at top global fertility conferences such as the European Society of Human Reproduction and Embryology (ESHRE), American Society for Reproductive Medicine (ASRM), and Middle East Fertility Society (MEFS).
