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Artificial Intelligence in IVF: Reproductive Medicine in the Media

Artificial Intelligence in IVF

AI or not, embryo selection is still a flawed concept

Scientific American blog recently suggested that artificial intelligence (AI) may be able to flag the most viable embryos “far better than humans.” Quoting yet another start-up, we, once again, are offered the promise of “embryo selection.” The VOICE has repeatedly discussed the concept of embryo selection, making the point that this idea has been around for almost as long as IVF exists but has never panned out. And when a hypothesis fails to be proven over and over again, at some point one has to start wondering whether the hypothesis may not be wrong?

We here at CHR thought that this recognition may have, finally, taken place when the concept of closed incubation systems with concomitant embryo imaging imploded after IVF centers mistakenly spent hundreds of thousands of dollars on the promise of better embryo selection; but, apparently, the hypothesis is still being pursued, with investors still being enticed to fund yet other start-ups, though the underlying hypothesis makes little biological sense.

Artificial Intelligence in IVF

Let us one more time explain why that is: Embryos are the biological end product of a long process that starts with recruitment of a so-called primordial follicle (the most immature state of follicles and eggs) into a journey of 2-3 months, called folliculogenesis, during which follicle and egg mature. Most eggs do not survive this journey. Indeed, in natural cycles usually only one follicle does; in cycles of fertility treatments a small cohort of follicles survives. The eggs from those follicles are retrieved in an IVF cycle and fertilized with sperm. In that process the sperm enters the egg’s environment and an embryo is created.

That the sperm enters the environment of the egg is important because it explains why the egg quality is so much more important for embryo quality than the sperm. In other words, the quality of the embryo is almost completely (likely, around 95%) a reflection of the egg and much less so (ca. 5%) of the sperm. To, therefore, believe that after 2-3 months of biological experiences during maturation of t he egg, the quality of the embryo can still be significantly affected, sounds biologically naïve.

Our advice to investors interested in getting “best” embryos would, therefore, be to invest in a start-up that tries to improve egg quality during these 2-3 months of maturation of the eggs. And if you really do want to select a marginally better embryo in a cycle cohort of embryos, don’t look at the embryos; go upstream, and look at the eggs from which those embryos were made. Maybe it will take a female investor to get this point!

This is a part of the March 2018 CHR VOICE.

Norbert Gleicher, MD

Norbert Gleicher, MD, FACOG, FACS

Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned specialist in reproductive endocrinology, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.

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