It’s been over 40 years since the first live birth from IVF. Although there has been some progress, success rates are still very low. IVF, which stands for ‘in vitro fertilisation’, is a form of fertility treatment where an egg is taken from a person’s ovaries and is fertilised with sperm in a lab to create an embryo which is then implanted into a womb to grow into a baby. Glamour Contributing Editor Anne-Marie Tomchak reports on the realities of this fertility technique which has historically relied on the experience and gut instinct of clinicians and embryologists and is now undergoing big changes because of the arrival of artificial intelligence.
“Before I started doing IVF, I had this idea that it would be a quick and easy solution to all of my fertility woes. But I could not have been more wrong. It was neither quick nor easy,” says Susie*, 44, a furniture store manager in London. “Until you go through it yourself, it’s hard to put into words just how intense IVF is. I remember bursting into tears the day that the nurse gave me a quick demo of how to use syringes to inject hormones into my body ahead of doing an egg collection a week or so later. The whole thing was so overwhelming.”
Little did Susie know that she would effectively become a human pin cushion for the best part of the next four years and that she would have seven miscarriages before finally giving birth to a baby boy after she had turned 42. “I never thought I would lose all of my 30s to infertility and recurrent miscarriage. It took a few years to even get an NHS referral for treatment, as patients need to have had more than three pregnancy losses to qualify. I couldn’t afford private treatment, and at that stage, I felt I still had time on my side. But it took so long to get to the bottom of what was going wrong. To be honest, I still find it difficult to talk about that chapter in my life. I was just in survival mode. I can never get that time back.”
Susie is among the 50,000 people annually who undergo IVF treatment in the UK. She was born in 1978, the same year as Louise Brown, the first baby conceived through IVF. Since that Nobel prize-winning birth, over a million IVF cycles have been carried out in the UK, resulting in 390,000 babies. (It’s likely that figure is even higher as HFEA only started recording information in 1991.)
Although IVF birth rates are three times higher than in 1991, the success rates are still pretty low at 30%. Big hopes are being placed on artificial intelligence to address what’s now being referred to by the World Health Organisation as “a disease that does not discriminate.” Away from the apocalyptic headlines of robots taking all of our jobs and AI leading to the extinction of humanity, artificial intelligence could actually be what saves us and helps us bring life into the world.
One in six people will experience infertility in their lifetime, according to a recent report by the WHO. It says people end up in a medical poverty trap and that solutions for preventing, diagnosing and treating infertility – including IVF – are underfunded and still out of reach to so many because of “a persistent lack of data.”
Up until recently there was very little use of data to influence outcomes. But that’s changing. “Artificial intelligence can look at vast amounts of data and analyse it in a way that human beings cannot, which is gradually going to revolutionise IVF treatment” says Dr Amit Shah, a consultant in reproductive medicine with Fertility Plus on Harley Street. “Time is one of the biggest obstacles when doing IVF as outcomes are age-dependent, and people find themselves in the dark seeking a diagnosis for years. But machine learning could be used to identify patterns and risks associated with infertility, resulting in more accurate and early diagnosis. AI-powered image analysis could also help doctors detect subtle abnormalities in ultrasound scans, in some cases, reducing the need for invasive procedures.”
Dr Shah believes that AI also has the potential to improve the quality of care provided as it will do the heavy lifting for consultants leaving space to focus on patient needs. “Patients are often given a generic plan. With artificial intelligence, treatment could become more personalised with improved patient monitoring throughout the process and more tailored recommendations for lifestyle and medication,” says Dr Shah.
Hyper personalised care could also help to make IVF treatment more environmentally friendly. Anyone who has done IVF will know about the sheer volume of medications that are prescribed. So much of it never gets used leaving hundreds of pounds worth of meds sitting in a box or in the fridge. So there is an opportunity to reduce waste and costs with tailored plans and very specific doses of medication.
In addition to giving a more bespoke treatment plan, selecting the best embryos is another way that AI could improve outcomes in IVF treatment. This is already happening at the Centre for Reproductive Health (CRGH) in London – one of the first UK clinics to introduce AI into how it works. Their team of embryologists have been using an artificial intelligence tool called CHLOE as part of the treatment they provide. “CHLOE collects millions of data points for each embryo and analyses things that we couldn’t possibly gather manually. For the embryologist, it makes things a lot easier, because it automatically tells us whether the embryo has normally fertilised or not,” explained Suzanne Cawood, director of embryology at CRGH in an interview with FemTech World. “Of course, we go and double check all of that to make sure that we agree with it, but overall, it saves us time and makes everything a lot more efficient.”
“I was trying to get pregnant. It was a challenging road for me, the baby-making road.”
CHLOE was built by Fairtility, an Israeli tech startup which prides itself on bringing more transparency into the fertility sector. Eran Eshed, Fairtility’s founder and CEO says that CHLOE is improving the experience for patients because it helps doctors to make better decisions by scoring embryos in a standardised way so the best one can be selected for an embryo transfer. And it gives embryologists additional context about how an embryo formed as it can analyse time lapse videos cell by cell. “The doctors that are considered to have the best bedside manner are not necessarily the ones with better outcomes. When there is a failed embryo transfer, for example, CHLOE allows the physician to explain why something didn’t work, bringing additional transparency into the process.” adds Eshed.
IVF can, at times, feel like a roll of the dice. So the more information and autonomy that patients can have throughout the process, the better. Yet a cut and paste approach still prevails leading to a feeling of overwhelm and isolation for patients who end up relying on advice from friends and anecdotal information in order to figure out how to navigate the process and make life changing decisions. This is something that Danielle Fox, 37, noticed while undergoing treatment five years ago. Fox, a health and beauty editor at the time and now the founder and Chief Egg Officer of the fertility and reproductive health brand OVA, spent a year trying to get pregnant. After initial testing through the NHS and privately, she and her husband were handed the term “unexplained infertility.”
“There wasn’t really anything that was standing out as an issue for us so we were given this umbrella term which was just so frustrating. I wanted to take a functional approach to my fertility and was met with a bandaid,” she says. After trying a softer approach (ovarian stimulations and intrauterine inseminations which didn’t work), Fox moved on to IVF. She fell pregnant after a successful frozen embryo transfer and gave birth to a baby boy 3 years ago.
Fox says her support group became something of a lifeline during treatment and inspired her to set up OVA, which is building a fertility focused community and support network online and developing an affordable range of science-backed and clinically tested fertility supplements specifically targeting egg and sperm health. The first consumer product is expected to be released in 2024. “I often say that it was really these women, my 10 cheerleaders in this WhatsApp group, that got me pregnant as that’s where I got the most useful information from. You go into this process having to be your own consultant and mixologist. It feels like the space has remained stagnant and hasn’t moved on much for decades. So I think artificial intelligence has huge potential to improve outcomes.”
While the use of AI at CRGH in London is very exciting and will come as good news to patients who are about to embark on IVF treatment there, the fertility sector more broadly still has many challenges to overcome before AI can be routinely used in clinical decision making. A report in the Lancet emphasises the need for participants from diverse backgrounds in clinical trials and a focus on transparent digital tools that won’t reinforce hidden biases. “We need to identify ways of providing more specific care for diverse groups of people. There is a big gap across maternal health for black people and ethnic minorities, for example. AI could open up more space for clinicians to be more attentive,” says Dr Amit Shah of Fertility Plus.
It’s worth reiterating that IVF treatment is still a huge commitment – physically, emotionally and financially. It can result in painful trauma and big debts. A typical IVF cycle costs about ten thousand pounds and that’s before you include add ons like genetic testing or potential future costs of more egg collections and embryo transfers. And there isn’t always a baby to cuddle and love at the end of the process. However, science and technology is on a trajectory to help reduce the financial and emotional burden. And women like Danielle Fox of OVA are taking what they’ve learned from their personal and professional experience and finding fresh ways to support people’s reproductive health because as Danielle says: “Infertility sucks and we want to make it suck less.”
But is AI actually leading to more babies being born? It’s worth noting that the words “could” and “may” still feature a lot in conversations about the impact of AI on the future of fertility and it’s still not possible to categorically say that AI is leading to more babies being born but progress is being made. “When you’re talking about positive outcomes, with IVF, a positive outcome is a baby. It’s challenging to provide clinical evidence in a controlled trial because being pregnant in the world for 9 months carries so many different factors such as stress levels, nutrition, environment and so on.” explains Eran Eshed of Fairtility. “What we can demonstrate are interim outcomes. For example, embryos that stick two weeks after a transfer, where there is a heartbeat. That is a good end point to prove clinically (for now).”
If you are experiencing infertility and need additional support the NHS recommends connecting with Fertility Network UK and Fertility Friends. If you’ve been affected by pregnancy loss you can seek support at the Miscarriage Association Helpline 01924200799. To find out more about OVA go to: http://theovaco.com *Susie’s full name has not been disclosed at the interviewees request.
