Success Rate of IVF Increased Manifold Due to Advanced Technologies: Nitiz Murdia

How is the use of AI aiding in IVF procedures in India and around the world?

The introduction of artificial intelligence (AI) into the world of reproductive medicine has catalysed a rapid change in the field. Traditionally in the field of assisted reproductive technology (ART), of which in vitro fertilisation (IVF) is a part, much of the assessment is done with the help of medical specialists and embryologists. AI has helped change gears to an ecosystem where human bias is eradicated by roping in new automation, standardisation, and precision. This has been done in two ways – one, by creating a treatment plans for couples who seek a solution to infertility and second, by aiding in embryo grading. 

When a couple comes in for a consultation for their case of infertility, a questionnaire is shared with them to identify a few basic parameters related to their fertility factor. This is followed by a host of panel tests that ascertain any health conditions that the individuals may have. This information is then fed into a software that helps chart out the course of treatment, based on a database of thousands of patient cases.  

Studies have been carried out where imaging of the ovary using ultrasound is fed into an AI system where it can predict the volume of the ovary, the count of the follicles, and its size. Based on this, AI also suggests a particular dose of gonadotropin injection to be used for a particular patient. Moreover, it can assist with uterine evaluation wherein ultrasound image of the uterus and the endometrium (the lining of the uterus) is fitted into the AI system to check its contours. AI then predicts the implantation potential based on the uterine and endometrial conditions following which corrective surgeries and medication may be given. 

In an ART cycle, after egg and sperm samples are collected, fertilisation takes place wherein techniques such as microfluidics is used to fuse only the good quality sperms with the eggs. After this, they are allowed to develop for five days till the point they achieve the blastocyst stage. This blastocyst is ready for implantation however, before it is transferred into the uterus, it undergoes two more steps – PGT and AI screening. PGT checks for any genetic anomalies in the blastocyst which can result in genetic conditions in the child such as Down’s syndrome, Turner syndrome, thalassemia, and haemophilia among others. In addition to this, an AI screening helps grade blastocysts on their quality by drawing information from a database of blastocyst images; the blastocysts from the current cycle are compared with images from previous cycles that determines which one can lead to a successful outcome.  

These interventions reduce the number of miscarriage cases; genetic anomalies in the blastocyst are one of the primary reasons for the phenomenon. Additionally, since the best blastocyst from the cohort is chosen for transfer into the uterus, single blastocyst transfer can become the norm as opposed to multiple blastocyst transfer wherein more than one entity is introduced into the uterus; this paves way for healthy growth of the child as well as ensures maternal safety. As a consequence of this, the number of ART cycles required for a live birth is cut down and hence, the financial and emotional expenditure during the process is reduced as well. 

Do you think the use of AI in IVF betters the success rates of pregnancy?

The success rate of IVF has been increased manifold by the introduction of advanced technology such as closed working chambers, advanced incubators and microfluidics, as well as testing and treatments that include sperm DNA fragmentation index (DFI), quails, testicular sperm aspiration (TESA), micro TESA, and pre-implantation genetic testing (PGT). Such technologies did not exist four decades back when the first IVF child was born and ART would depend, to a great extent, on luck. Innovation in the field with the aforementioned technologies has put in place a number of check gates that ensure only the best of outcomes. AI is one such disruptive technology that improves outcomes of the ART cycle.  

AI helps in a few ways to improve success rates. It standardises the selection of blastocysts across geographies and practitioners since the selection parameters would remain the same. Subsequently, this helps eradicate human bias in the procedure. It should be noted that since AI in reproductive medicine is still in its nascent stages, human intervention is still a necessity to improve software and hence, outcome. Software modification is dynamic as patient cases are unique.  

 Bandwidth is not a limitation with AI. An embryologist can assess only a limited number of blastocysts on a given day however, AI can not only grade more blastocysts simultaneously but also has a combined experience of more than what an embryologist would owing to the vast datasets contained therein.  

Are there any challenges that come with AI aiding in IVF?

AI aiding IVF is in its nascent stages wherein there is always scope for improvement. While human bias can be eradicated while leveraging on this technology, it is also true that human intervention is required. This is through embryologists “training” the AI system to learn how to grade embryos and the ART specialist feeding in knowledge about ART treatment. 

With the fertility rates decreasing in India, how big of an impact will the use of AI in IVF going to create in the future?

To understand the impact of the use of AI in IVF, it is imperative to understand why IVF is required in the first place. The human body is remarkably intertwined in its regular activities and consequently, ailment of one causes a disruption in other parts. Health conditions in the human body such as diabetes, obesity, thyroid disease and hypertension among others can thus, have a cascade effect to different mechanisms, including impairment of one’s infertility. Infertility can also be caused due to genetic predispositions, surrounding environmental conditions, and harmful lifestyle choices. 

According to the recent data from the National Family Health Survey-5, it has been found that the total fertility rate (TFR), which is the average number of children born to a female in her lifetime, in India has dropped to 2.0. This can be attributed to an increase in the number of both males and females with below normal and overweight/obese body mass index (BMI), a shoot up in the number of individuals with anaemia, as well as increase in the number of people with high blood sugar and hypertension. 

These trends show that the number infertility cases are slated to grow further in the foreseeable future. IVF and its umbrella treatments, ART, have been increasingly accepted among the Indian diaspora where traditionally, infertile persons are discriminated against. As more people accept medical treatments for infertility, the volume of patients will only increase in India. 

Keeping this in mind and empowered by AI, we can aspire to reverse the TFR in India from the “below replacement level” status we are currently in. The treatment procedure not only helps couples conceive, but also brings into light any ailments they may have. Remedial steps such as medication for these disease can help treat patients of their existing health conditions as well. 

With the increasing trend of medical tourism in India, especially for IVF, what do you think lies ahead for IVF treatment centres in India?

India has emerged as a frontrunner in the infertility treatment space, especially IVF (In vitro fertilization). Before the COVID-19 pandemic hit us and cross-border travel were paused, there was an increased influx of people coming for IVF treatment to India as they could avail world class treatment, cutting-edge technology and cost- effective healthcare services here in the country. The global IVF services revenue market generated $12,505 million in 2018 and is projected to reach $26,376 million by 2026, growing at a CAGR of 9.8 per cent from 2019 to 2026. Asia-Pacific accounted for the largest share in terms of the number of IVF cycles being performed in 2019, with India, China, and Japan being the foremost contributors to the region. As per EY’s Call of Action 2015 report, IVF industry in India is expected to grow at a rate of 20 per cent annually. 

The high rate of success of IVF procedures in our country has been the major driving factor for its advancement in the field of medical tourism. At present, India has around 18 per cent of the worldwide medical tourism market and the number is anticipated to go up. COVID-19 has impacted these numbers due to travel restrictions however, with the re-opening of international borders, there will be a positive push to the exponential growth of medical tourism. 

In India, medical tourism for IVF is primarily supported by people from the neighbouring countries of Bangladesh, Nepal, Sri Lanka, as well as from Philippines and Indonesia. Couples from African countries also come to India for their IVF treatment due to lower costs and higher success rates.