How can technology help doctors and embryologists?

Technology and IVF has exploded in the last couple of years. The first one is the introduction of time-lapse technology, so historically what happened was, you would have your egg collection, they would go into an incubator, we take them out of the incubator mix the sperm, we’d check them the next morning, they’d go back in the incubator, you might check them on day 2, you might check them on day 3, you might check them on day 5 and again on day 6, so all you get is little snapshots and you’re having to remove them from their environment to check them. Bear in mind embryos have to be cultured in high CO2 environments, not 20% oxygen which is what the normal atmospheric conditions are. You’re disrupting their environment by doing that. With time lapse, what it allowed to do, was to basically put a camera into the incubator and you can monitor all of those embryos every 10 minutes without disturbing that environment and what that allowed us also to do is see the whole development throughout their entire process and that allowed us to deselect embryos, so for an example, on the old system if you checked an embryo and it was fertilized and then a two cell and then an eight cell and then a blastocyst you’d think it was good. With the time lapse you might see the fertilization, then that divide straight into three cells and then which is not a good development point, you might see it not be as good on day three and then but it still makes a good quality blastocyst and it’s allowing you to deselect those embryos and look at the what’s called morphokinetics to help us select the best embryos for patients and given the highest chance of pregnancy.
Now, when you compare the outcomes, so if you look at clinical pregnancy rate per transfer whether it’s a time-lapse embryo or a conventional incubator embryo, the pregnancy rates are identical but what the laboratory key performance indicators have shown actually in the time-lapse incubator you get a lot more blastocysts formed, significantly amount improved blastocyst formation rate and what that does is allows us to freeze more blastocysts – so say you get four blastocysts frozen in a time lapse and three in a conventional incubator, you’ve then got up to four attempts of frozen embryo transfers of getting pregnant versus three with a conventional, so you have a higher cumulative life birth rate using time lapse technology. Everything is of all the success rates and the way things are set up is to measure pregnancy and live birth rate per transfer that’s all well and good but if you’re having one egg collection and that’s costing you the most money, that’s the biggest chunk of your pot of cash that you have for your facility treatment, you want to have as much sort of bang for your buck as you like and that gets you the most embryos and more chances of achieving a pregnancy. Over sort of the last 12 to 18 months because we’re accumulating all of this time-lapse data and these morphokinetic time stamps, you can pour hundreds of thousands of embryos which have been transferred, you can do it between clinics you can do it internationally you can do it from all different countries, you can pull all of the data together all of the time stamps, you can look at which ones got patients pregnant, which ones didn’t get patients permanent and you can build artificial intelligence algorithms based on known implantation data.
Actually, when an embryologist comes to look at the embryo selection for patient and transfer, they may be having a bad day, they may not have had their coffee in the morning and they may change their mind – there’s more subjectivity there. The beauty of AI is: it doesn’t have that subjectivity, it’s more consistent, it will make the same decision time and time and time again. When you you apply this ai algorithm, it will look at things so all the movements of the egg, all of the divisions, the amount of fragmentations and it will tell you which embryo to transfer and the repeatability and the prediction of those AI models is pretty good and the fact that how consistent it is – is also pretty good. It’s an exciting time for technology, particularly in IVF and time lapse.

Technology is a means to an end but it does not overcome the impact of biology. If you have the technology from NASA (that is the National Space Agency of the United States), it will not help you if you don’t have the material to work with. If the eggs are in short supply, if the sperm is so so poor – technology will not help. So it’s important to take this because so much investment is being made into technology, so much aggressive marketing is being put into technology but should never forget biology is king.

How can technology help doctors and embryologists? It’s well known that there is a growth of automation, new technologies such as artificial intelligence, machine learning. These technologies are also arriving in the lab and they are now a daily reality.

These new technologies can be used for different purposes, for example, in the IVF lab, we have time-lapse incubators, tools helping to select a donor. When using new technologies we base IVF processes on scientific arguments that help avoid mistakes. For example, Fenomatch is based on artificial intelligence and allows doctors and embryologists to measure the facial resemblance of the recipient patient and compare it to the donor, giving us a score. This score is the scientific argument we need to find the right donor for the patient.