DISCLAIMER: Today’s episode is paid content from our feature sponsor, who helps Inside Reproductive Health to deliver information for free, to you! Here, the Advertiser has editorial control. Feature sponsorship is not an endorsement, and does not necessarily reflect the views of Inside Reproductive Health.
In the realm of fertility, many claim to prioritize personalized care. But how often is this a reality versus following predefined profiles?
Daniella Gilboa, Co-Founder and CEO of AIVF, shares her thoughts and leverages her experience as a seasoned clinical embryologist to shine a light on where fertility can improve patient care and how AIVF is stepping up to the challenge.
With Ms. Gilboa we discuss:
Her definition of personalized care (Contrasting with what is being done today)
The micro & macro of what’s happening in the IVF field
New technologies improving efficacy & efficiency (And where the two come together)
AIVF’s innovations allowing embryologists to do more cycles more effectively (And its impact on the embryo)
How this same technology can provide non-invasive genetic screening.
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Transcript
[00:00:00] Daniella Gilboa: So we've been hearing about personalized medicine for some time now. And it's it became like a, slogan, like we do personalized medicine, but what's the essence and where does it meet us? the, IVF ecosystem, do we really. give personalized medicine? So the answer is no, not yet.
then IVF clinics, that's as they work now, as we work now, there's no personalized medicine. There's we understand like profiles of patients and this is what we could treat like profiles of patients.
[00:00:34] Sponsor: This episode was made possible by our feature sponsor, AIVF, the pioneering force behind the revolutionary EMA platform.
AIVF is at the vanguard of transforming reproductive medicine through cutting edge AI technology. The EMA platform sets new standards in precision IVF care. Learn how EMA can grow your fertility's efficiencies by going to aivf.co/precalc. That's aivf.co/precalc.
Announcer: Today's episode is paid content from our feature sponsor, who helps Inside Reproductive Health to deliver information for free to you.
Here, the advertiser has editorial control. Feature sponsorship is not an endorsement and does not necessarily reflect the views of Inside Reproductive Health.
[00:01:30] Griffin Jones: Personalized care. Nearly every fertility provider of a fertility practice says they want to provide personalized care to their patients. But are we delivering truly personalized, individualized care, or are we following profiles to deliver care? If we're being honest, I think we all know the answer to that.
Now imagine if one of your most talented embryologists noticed that. And after 15 years of experience in the IVF lab, got the backing and started a company to solve for exactly that. That actually happened. That's the story of my guest today, Daniella Gilboa. She's the CEO and co founder of AIVF. She was a clinical embryologist for 15 years.
She has a master's in biostatistics and epidemiology. And through this background, we look at the macro and the micro of what's happening in the IVF field in the soaring demand, but also from her experience as an embryologist, the insights for the limit of supply. Listen to Daniella's definition of personalized care and contrast that with what's being done today.
Then listen to how new technology is improving efficacy and efficiency and where the two come together. Are we really going to be the most effective in clinical success rates? Are we really going to be the safest in operating an IVF lab? If half of the workload that embryologists are doing can be offloaded today, what would you do if you had twice the number of embryologists?
Daniella explains how her technology allows embryologists to do more cycles more effectively. How does this technology provide non invasive genetic screening? What's the impact that will have on the embryo, on the field? And then toward the end, listen to Daniella double down on what so many embryologists have said recently, where she says time lapse incubation is a way of life.
As you listen to her explanation, I think, are we ever really going to be able to scale fertility care if we're manually collecting data points and manually entering them into various disconnected channels? If you're interested in AAIVF, they have an efficiency calculator on their website. It will be linked where this episode is distributed.
I recommend you go to the AAIVF website and use that calculator. But if you also just want to get in touch with Daniella, feel free to ping me for an intro. I hope you enjoy this conversation as much as I did. Ms. Gilboa, Daniella, welcome to the Inside Reproductive Health podcast.
[00:03:33] Daniella Gilboa: Thank you for having me.
[00:03:35] Griffin Jones: I have been interested in following the efficiency improvements in the lab, the efficacy improvements in the lab.
I'm also really interested in the AI revolution and you're at the seat of where all of those things come together, because I really do believe that AI is going to conquer every segment of our, world for in different purposes and every place in the marketplace and our field is no exception, but I guess even before we get to some of the technologies.
Your background, you're coming into this not first as a tech entrepreneur. To me, it sounds like tech entrepreneur came later, but you have what? Some 15 plus years in the IVF lab as an embryologist. Tell us about that. Tell us about the challenges that you were seeing that then brought you to the areas of interest that you're in now.
[00:04:35] Daniella Gilboa: Yeah. So first of all, I wanted to thank you for this amazing opportunity. My passion is really to talk about IVF and AIVF. So thank you for that. And yes, I'm a passionate clinical. I actually have two hats, clinical embryologist and a biostatistician. So I look at IVF, sorry, I look at IVF from the very, from let's say bottom up from the, from the clinical work and embryology and facing patients.
And also let's say from the top down as in looking at the data and trying to understand like different trends and correlations. so this gives me, I think, a holistic view of IVF from the inside and out and inside again. So I'm a passionate embryologist. I live and breathe embryos. I'm a big believer in time lapse.
I think time lapse, the introduction of time lapse into the IVF. Labs was something that empowered embryologists. It gave us real true knowledge of, embryo, sorry, embryo development and evaluating embryos. I think it became, it, brought us embryologists to do more of a data driven decision guesstimation.
So I'm a big believer in time lapse, and I've been working with time lapse for many years. It was introduced to the market, I think in 2012. So yeah, so it really, and time lapse for me was really the first step of AIVF because what time lapse did mostly is introduce data to clinics. Time lapse allows the clinics to actually generate data, and once you generate data, you're not only relying on embryologists copying, the patient's folders into Excel.
Once you generate data, you have the power and the knowledge and you have real value. So I think this is, this was the first step that the industry of IVF and the IVF professionals became to realize. That they have something here that could, I, think us as an interest, industry realized that we have something that could really take us forward and really move the needle.
And so this is where, IVF was, born due to the realization that A, we now have data we can work on. So we could transfer IVF from a very clinical biology into tech. Enabled ecosystem. so this was, the, understanding that labs have are able to generate data. And the other reason of course, is what I've been experiencing as an embryologist in terms of how, you work as an embryologist and the workflow and the success rates and the interactions with the physicians and interactions with, patients and with, my peers, with.
other embryologists and maybe can we really take this very complicated and sophisticated setup and do it maybe different to help more and more patients realize the dream of having a baby. So this was like a very vague kind of concept. back in around 1960, 1917. And I'll just add, this is where I started thinking about maybe doing something else than a clinical embryologist.
And I started my PhD thesis. It was in the field of biostatistics and IVF. And so the, company was born from, my years as a PhD student.
[00:08:48] Griffin Jones: with a background in embryology and biostatistics, it seems to me like you'd have a pretty unique point of view on both the macro and the micro and how they come together.
So tell us about the, macro that you were seeing and the micro that you were seeing and Where they come together, how that's affecting personalized patient care or a lack thereof.
[00:09:18] Daniella Gilboa: So, we've been hearing about personalized medicine for some time now and it's it became like a slogan, like we do personalized medicine, but what's the essence and where does it meet us?
the, IVF ecosystem. Do we really give. personalized medicine? So the answer is no, not yet. then IVF clinics as, they work now, as we work now, there's no personalized medicine. There's we understand like profiles of patients and this is what we could treat, like profiles of patients.
So we talk about different age groups, for example. So we talk about the 34, the 34 year old patient or the young patients or the, advanced age patients, but it's not, There's nothing personalized here. So it's, profiling. going down to the, if, I analyze the industry as an industry or, IVF from the bottom up and top down, so I think we realized two major trends and this is very interesting and so let's start with 40, 000 Viva.
48, 000 feet above ground and understand like the macro. So what happens macro and, this is interesting is a trend, I think a decade now of IVF becoming not just under medical indications, but rather something that we might choose to do. Like we want to plan our fertility journey. So like 40, 000 feet above ground, we see two major trends.
This one is IVF is now not only under medical indication, but rather something that we might choose to do. Like we want to plan our fertility journey, we want to understand more and maybe even control it. So this is a way for us, so IVF is a way for us to do it. First, I think it's, a decade now, I think 2013, we can freeze our eggs.
We want to delay childbirth. IVF is a way to do preventive medicine through PGT. New families, surrogacy, all this drive IVF to be social IVF, not under medical indications. So more and more people are seeing IVF or, are looking to do IVF, not because they have any medical indications, because they actually choose to do IVF.
So this is an important and interesting trend, and we see it more and more, and there's even a very interesting, paper that was published, I think, in Nature, trying to predict the effect of IVF by the end of the century. And, the numbers are about 3. 4, 3. 5 or 4 percent of global population would be IVF.
So this is big numbers. This is enormous. This is amazing, unbelievable. So this is the demand. Demand is IVF is growing enormously and it's not going to stop. And then there's the supply. The supply, the clinics are limited because we do mostly things, it's an art. We always say the art of ART, so it's, an art.
It's subjective human analysis, and it's really based on, on. the, group of embryologists and, everything in IVF is expertise. So it's not just OBGYNs, it's IVF experts and it's not nurses, it's IVF nurses and it's not biologists, it's embryologists. So it's another layer of expertise.
And so the fact that we have scarcity of IVF specialists and scarcity of embryologists, and, the way. we communicate and we do IVF by hand. So this makes the supply side to be limited, so unable to scale, not able to scale. And then the demand is huge. So demand versus supply, huge demand versus limited supply.
The only way for us to ever bridge that gap is by technology. And so this is where IVF comes in and we say, we come from the supply side, deep within the supply side. We understand the supply, we understand the state of mind, we come from within and we know what it means to do IVF and good IVF. And we know what, it means to have a group of embryologists that are, the end of the day doing the magic.
So we are here to create this technology, this magic that will help the clinics scale. the clinic's scale, more demand, or patients are able to realize the dream of having a baby. at the end of the day, this is the way to really move the needle and help more and more people.
[00:14:30] Griffin Jones: On the macro, you have the giant global demand, the increasing global demand, not just from what's currently come from a medical diagnosis from infertility, but those that are doing their family planning in many different ways, whether they're same sex or single women or delaying childbearing, or perhaps more so in the future, those that are, that want to prevent genetic diseases.
And then there will perhaps be more implications in the future after that. And then on the micro side, you're seeing where, why the supply is falling short of the demand because you're working in the IVF lab, and the only way that the supply will be able to meet that demand is through a technological revolution through major technological advancement.
We're not there yet. And it sounds from talking to a lot of people, it sounds like we're, far and we're close. Like we're both far and close at the same time. You, which one do you think? Do you think we're further or closer?
[00:15:30] Daniella Gilboa: No, I think we're there and I think that technology is there and I could only speak about the IVF, but I think that technology is there and I think that there's excitement now, and we see it, in the industry and people are willing to try and understand that this is part of, the evolution. It's not a revolution, it's an evolution. And so I think, it's there and it's, and I'm very optimistic.
I think we're now in a very exciting Time where we actually see the industry that we so much care for and you know the science IVF science Really changing and evolving into the next generation and you know We are there to lead it and it's very exciting and in fact I see the industry, of new technologies that is now forming.
And it's an industry and it's actually an industry. It's not just a bunch of companies. It's not just groups of, university groups in universities. It's an actual industry and we see it forming. And, we've, we even have a conference every two years of the, IVF. So, the, technology industry of IVF.
So I think, we're forming groups and working groups and think tanks and we work together as an industry and we sit in conferences, the, domination of the very dominant pharma. That is a bit, slowing down, and we see the rise of the, our industry, and it's very exciting.
It's exciting for all of us. It's us, exciting for the, for the physicians, and embryologists, and nurses, and patients, and, all the stakeholders in, in the IVF ecosystem, because at the end of the day, this is a real revolution, a revolution in evolution of, a new industry.
[00:17:32] Griffin Jones: So by being so close, that the technology has finally seemed to arrive and now it's not, I'm starting to see people implement it at rates faster and higher than they were even just two years ago.
You mentioned that we're not there yet with regard, meaning, meaning what the average patient is experiencing right now is not personalized medicine yet. what exactly needs to happen in order. for that patient to receive true personalized medicine, not just profiles.
[00:18:05] Daniella Gilboa: Yeah, so that's a good point.
So just to clarify, clinics who are not using any new technology, the very old fashioned clinics or the conventional way of doing IVF, this is not personalized medicine. This is profiling. I think with the arrival and the introduction of these new technologies, we, are going to be able to provide personalized medicine as in I'm Daniella Gilboa.
this is my medical history, my age, this is where I come from. How will this affect my chances of conceiving? When is it going to happen? How long? Will it take me how much? Will I have, to, how much time do I have to commit to doing that? Do I have to stop working? Can I change my job while I'm doing IVF?
Can I maybe pursue doing my PhD when I'm, while I'm doing IVF? All of these questions, how, how much it will cost me, all of these, this is personalized medicine. So what exactly like the, what medication? Will, is the best for me, what protocol will be the best for me to produce, six, eight, ten mature eggs.
It's like, all of these, this is personalized medicine, and if I'm diabetic, how will this affect my chances of conceiving? If I had, if I have, I don't know. Some, disease in the background. How will this affect? Can I conceive? Maybe I should do, surrogacy. All of these, this is personalized medicine, but we don't have any personalized medicine in IVF today as it is today.
So it's not just the efficiency of the clinic and the lab. But it's always, it's also providing real, real precise medicine and all of this can only be, can only happen if we introduce technology and, AI driven decisions and data driven decisions and, that we get used to working with.
data and really monitoring different KPIs and understanding what KPIs are and what KPIs we want to, monitor and who's going to monitor that. Maybe, I'm a simple embryologist, instead of just doing the wet embryology and the wet work and ICSI and IVF and thawing and freezing, part of my routine task would be, checking the different KPIs and, analyzing the data.
This is another layer. That IVF labs needs to be doing on a daily basis, not just when they want to publish something, but on a daily basis as in part of really understanding how good you are is looking at the data and looking at the data. You have to have data. When do you have data? When you work with data, you need an EMR that's connected to a time lapse, and that's gen, actual generation of data that you could, work and analyze, and it, needs to be part of your thinking, part of the method, part of who you are as an embryologist.
[00:21:12] Griffin Jones: It's messed up, isn't it? How this level of personalization is in areas of sales and marketing, but not in areas of healthcare yet. Like on Amazon, Amazon isn't targeting people that, watch golf and therefore might like bourbon. They're targeting people who bought a very specific type of bourbon and then can send them, ads for.
Particular types of whiskey glasses. And you bought this and oh, you bought this bourbon at this frequency for the last two years, and therefore you probably want this next bottle coming to your house on March 24th. we've got this in areas of sales and marketing, but we're, pretty behind on it in many areas of healthcare, including fertility.
It's a way of life for you as you're describing it, this bringing technology to. the fertility field to provide personalized care in this way. Tell me specifically, what is, what's AIVF doing? Wow.
[00:22:12] Daniella Gilboa: Okay. So thank you for asking. So we are, a great company. And the reason I say it is it's not just a company that's developing AI or, or like a product, it's a company that lives and breathes.
Breathe is embryos and IVF and the patient journey, because we have here a bunch of people, from different domains, all of them looking at embryology and asking, how can we make it better? How can we really make an effect on the patient and on the physician? The embryologist. So what I love about IVF is that we have mathematicians and physicists and product people, and engineers and marketers and sales and legal and finance.
All of them are looking at I-V-I-V-F and the IVF journey from different aspects. So this is great because as an embryologist, my interaction was only with. Fellow embryologists and physicians, but now we all, we've, we, I think we opened up the IVF ecosystems to so many other domains that is just really exciting.
So this is, so IVF or AIVF is, deep in the sense of that we do technology and we do science and we even do basic science and, and we really create. The next generation of, IVF clinics. And so now I'll dive into IVFs, AIVF. So we're, I said before, we come from the deep within the supply side, the clinics, and we're developing the operating system of a clinic.
What we want, what we provide now to the market is a one single system that everyone. So we take, we're integrated in the IVF lab, and this is where the magic happens, the IVF lab. And we connect the IVF lab to the physician, one hand, and to the patient, on the other hand. So it create, it becomes like a transparent lab.
so any data that the physician needs In order for them to deliver the news to the patient or to, make decisions, clinical decisions, they have on the palm of their hand any, needs or information that the patient needs. They don't have to rely on the nurse, or the administrator, or the physician.
They have, they sit. Decision making will always be with, the, physician, and with The, embryologist or the lab, but it's like empowering all different stakeholders to access the data and to see, to understand and access the data. So it's like a transparent lab and again, the lab is really the essence because this is where the magic happens.
So it's the connector. And so we are the operating system and how we do that. We're connected to all different systems you normally have in a clinic. Like it could be a freezing system. It could be an EMR, of course, the incubator, whether it's time lapse or non time lapse, and we collect all the data and this is where we come in.
So for different decision points that you have throughout. The process. We have our own very deep AI algorithms to help you make better decisions. It'll never be an AI that makes decisions without the expert, but it's part of your methodology. It's another layer of information that helps you assess and understand and and evaluate whatever you need to evaluate.
Whether you're an embryologist or. a physician. And about the AI, I'll talk more in a moment because it's, very interesting. And apart from that, there's a very deep engineering and product that needs to be facing different stakeholders and needs to be interacting well and needs to be very easy and friendly and empowering.
So it's, it's, there's expertise there. But at the end of the day, the way we envision IVF is that you log in the morning, you open the lab, you open the clinic, you log in into IVF, and everything is there. Everything. We bring so much, value to clinics that we work with, it's in terms of the AI, in terms of more and more modules, that it's just become something that you cannot do, you cannot live without.
And this is something that we hear from many clinics we work with and, for me, this is what takes us, what makes us wake up in the morning and, A good IVF clinic and happy physicians and embryologists and a good IVF clinics means many more pregnancies.
[00:27:35] Griffin Jones: You've got a lot more on the horizon it sounds like in terms of increasing the number of solutions that, that clinicians, the lab directors can't live without and right now using AIVF to make decisions that they aren't making on their own, that they're using technology to make much more.
informed decisions. What are the operational efficiencies that you're helping with?
[00:28:01] Daniella Gilboa: So the two KPIs that we collect and we monitor, as AIVF are efficiency and efficacy. Efficacy is success rates. And I truly believe that AI, any AI solution could do a better job than myself as an embryologist without any other tool.
looking at embryos and evaluating embryos and predicting which embryo is bound to be a healthy baby, which embryo should I transfer, freeze, when to transfer, how many to transfer. This needs to be I need an aid here, and any, it's, by the way, humans can never predict, we can only identify. We're not good predictors, we don't know how to predict.
So this is where, this is really the next gen, and having such systems help us with understanding. What are the chances of each and every, embryo to become a baby? and the prediction of the genetic makeup of the chromosome. By the way, this is interesting. I'll talk about that in a minute.
It's our genetic tool. So efficacy is really success rates and increasing success rates. And yes, we can do it because once you work with AI and AI helps you make decisions, you will see it in the success rates. It's that simple. and, the other metrics is, efficiency and efficiency is how well we work in an IVF lab and how we can take the group of embryologists and get them do more cycles.
So this is having them focused on the wet clinical biology and all the, about 50 or 60 percent of the IVF workflow, workload is due to reporting and documenting and QA, QC risk analysis, safety analysis. There's much work here. All of this could be automated. I don't need as an embryologist to do, to, to do reports.
You could have AI do the report for you, and frankly, it will, do a better report than I can do. so all of this is efficiency. This means that we can really save time. We could really reduce the workload. We could really get the group of embryologists do more cycles. See more cycles because 50 or 60 percent of their load could be offloaded
[00:30:51] Griffin Jones: 60 percent
[00:30:52] Daniella Gilboa: but something like that 50 or 60 percent, you know as you know from clinic as a whole is We do a lot of reporting and documenting and, speaking to physicians and delivering news to the physicians and on the phone and making, trying to make decisions with the physicians and consulting and all of this could be aided and offloaded from us.
So you know. As an embryologist, and I consider myself a very good embryologist, I'm gonna do the one, the, the tasks that are not yet, could not yet be automated, like ICSI, or thawing, and then, the actual biology, which we all love. And part of the, training, and part of the day to day tasks that I love, like embryo evaluation, which takes a lot of time, and if you do it correctly, it takes a lot of time.
This needs to be aided by AI. And so the way we would do embryo evaluation from now on is a bit different. It's less, looking at the different biological features and trying to realize whether it's, exactly right or it's, working with the data and understanding the data. So it's a bit different, but I think it empowers us as embryologists and as physicians to work with data and understand the data and leverage the data.
[00:32:28] Griffin Jones: I'm glad you brought up physicians because one of the implications of technology that technology should have is it should allow physicians to practice more personalized care. I think some physicians are worried about some sort of vending machine type of future where it's only robots delivering care and I don't think that's the case.
I've always said that human beings should be Must be doing that which human beings should be doing, and human beings must not be doing that, which human beings should not be doing that. We should be using this technology to deliver more personalized care. So how does this allow doctors to practice more personalized care, to give more individual attention to their patients?
[00:33:13] Daniella Gilboa: imagine you have everything out there for you and not really, not, not needing to look for the data. So you, open the, computer, you open your iPhone and you have, meet, this is Daniella, you see the picture, you see all the different information, medical information, medical history, everything is out there for you.
You don't have to look for anything and this is not even talking about AI, it's just really, accessing. the data. And so this is one thing. And the other thing, of course, is this is personalized medicine. It's like not profiling, but understanding who sits in front of you and being able to provide the best IVF care that is specific for this patient.
And this is part of the macro and micro that we talked to before is like someone who's, I don't know, it's like diabetic. We don't know now if it really affect. the, the treatment and the, chances. We don't know, you don't know what type of medication you should consider if she has some kind of, medical background.
This is one specific example, but all of this We'll help, we'll guide you, or we'll help you, much better doctor, if you are able to provide personalized medicine, and really know your patient from the inside and out. Not just a profiling of, okay, you're 35, and you've been getting this and that. So let's see, the way we do now IVF is, okay, let's see how you react, and let's see how many eggs you'll have, and let's see, the fertilizations rate, and let's talk to more and see, what we get from the lab, and let's decide.
Just before the, transfer, how many embryos, whether it's one, maybe two, we don't know how many will, grow to be a blastocyst. So let's wait and see how many will be able to really freeze. And we'll, we'll be in touch. You're always, it's like a, it's an ongoing thing. So it could be better.
It could be different.
[00:35:32] Griffin Jones: When you talk about being able to, offload half of the embryologist's workload, I want people to think about that another way, which is, what could you do if you had twice the embryologists? And people often think of it in those terms. We gotta get more embryologists, we gotta try to recruit more, we have to try and take the other embryologists from the Other labs in town, we have to figure out some way of training junior embryologists up and many of those solutions need to happen, but also what we have to do is take away some of the things that the embryologists are doing right now because it, we The recruitment problem is not going to solve itself.
It's going to be around for a little while. And even if you can figure out the recruitment challenge to a degree, as the demand continues to increase, you're always going to have that same problem. And then add to that, Daniella, when I'm talking to younger embryologists, like people and by younger, I just mean like under 40.
And many of them want to get out. of the lab because, not because they don't like the science. They just, they don't want to do these rote tasks. They don't want to do all this manual stuff. They don't want to sit in a little box where they're just like, punching in numbers into spreadsheets and.
So talk to us a little bit more on that.
[00:36:58] Daniella Gilboa: Okay. So imagine a different world where you would have embryologist experts in different things. So you will, have like more of a data embryologist, someone who's working on the data and, getting trends from the data. You would have more of a basic science, so you could actually see if you have, if you have enough embryologists, you could do basic science.
This is really interesting. You could do what I call computational embryology, and, this is a new, field. that is now emerging through the, by, because of the fact that we have data and actual new technologies. So this is computational embryology. I'll give you an example. Again, another way of doing research in the lab and really understanding embryonic development.
So It's part of empowering the, the embryologist. It's not just routine tasks. And I'll give you an example because you have AI that identifies different features in the embryo and features that cannot be seen by the human eye. then now you have a sack of new features that you haven't, you, never realized and are, were identified by.
machine learning. How does this affect embryonic development? It's a new way of doing research, and it's part data, and it's part basic science, but it's very interesting. It's computational embryology. It's like you have biostatisticians, which are, the intersection of statistics and medicine. Now we have computational embryology, which is the intersection of, embryonic development or embryologist with embryology with computer science.
So it's a new field that is emerging, and it's not only going, it's not the new, it's not the, only one that's going to be emerging, it's, one of, out of many, I, think. So, you've got research, you've got data, you've got the ones that are, really clinical embryologists doing the day to day, the ICSI, you've got the ones.
Doing more maybe patient facing and more consultation. And so you could have different layers. If you have enough embryologists, you could, you could have different layers. And you have this IVF system or, a new system that really manages everything in the lab and collects all the, data and all the information into one single point where, one single dashboard.
This is huge. This is really unbelievable. And then you have different tools, like prioritizing. What task am I doing first? I come in the morning. Which of the embryos I have to look first? Which one is, emergency? What's, like, All of this is through, a new type of solution. It was never handled before in a, in a conventional lab.
what if there is an emergency? Something is happening in one of the incubators. I will have no idea. But now I can't. So it's part of safety, and it's part of efficacy, and it's part of efficiency, and empowering the patients. And I think all of us caregivers, through working with AI, our jobs or our positions are going to be slightly changed.
And we just need to accept it. And I think it's, very exciting for me. It's very exciting. So one more thing about efficiency and, why AIVF is really, affecting the IVF in terms of scalability is that imagine you have the best embryologist in the world In each and every clinic, you don't have to actually look for, these, for that embryologist.
It's there. This is seeing IVF is the best expert in the world. It could be the best physician, IVF expert. It could be the best embryologist, but it's there. And it does exactly this, it does, efficiency and efficacy. So I think it really, changes. The way we do IVF, this is clinic patient as patient wise and this we see, we've been collecting data for some time now and we see that it really affects time to pregnancy.
[00:41:31] Griffin Jones: you're sharing different aspects of efficiency, but I, and efficacy, but I'm seeing how they bridge together that you have to have the embryologist doing that which the embryologist should be doing, or otherwise there's too many distractions and too much wasted work. And that can lead to safety issues.
And we've seen safety issues of. A lot of different kinds happened in the IVF lab the past some years. They're all bad. They're all, really bad for that particular lab, that particular clinic. They're bad for that person's career. They're bad for the patient because dreams are shattered.
They're bad for our field because of the public relations that happens from it. There's things going on right now with lawsuits happening. And, and we have embryologists doing. manual work that could be automated. if we have them unaided where technology could be aiding them, then I think we would expect to see more incidents where there could be less.
[00:42:36] Daniella Gilboa: Definitely. Definitely. And I think the way it will affect our lives is. Something that we measure and we monitor as we speak, and it's seeing a chat GPT for the last, I don't know, a year or so, and seeing the responses and the interactions of people with this tool, and each one of, us work with it differently, so I think we're, this is something that we will see in IVF clinics as we go along, and some clinics would see it more as a, most of my embryologists are junior, now I have a very, senior best embryologist in the world here, I'm more relying on this.
so I don't care about the reporting and documenting. I just need that all of the, decision making would be made by AIVF, of course with the embryologists, but something that they would be more relying on. such systems. And some other clinics would say, great, this is a great tool for, for AI and for embryo evaluation.
But the other modules are something that are much more needed in this specific environment and in this specific lab. So I think it's just, it's different for, different settings. And it's very interesting to see the, different effect. For me, I think everything is important, but for me seeing embryologist interacting with the AI, it's really like iterations, like asking questions.
And as an embryologist, working with something like that and having such another layer of information that helps me make better decisions, real decisions, like which embryo has the most chances of becoming a baby and which embryo is. genetically normal or abnormal, even without subjecting it to biopsy.
I now have a tool that predicts ploidy status. This is huge. This is a game changer. And I just need to realize, and it is an embryologist, that all of this data empowers me and makes me I'm a much better embryologist, a much better caregiver, and, the system as a system would do much better IVF care.
I truly believe in it, and I see, now clinics are much more interested and excited, and I think they understand the value.
[00:45:21] Griffin Jones: Is this what you're talking about, being able to see the aneuploidy of a, of an embryo? Is this moving towards non invasive genetic testing?
[00:45:32] Daniella Gilboa: Yeah. And again, it's a screening tool.
It's not a diagnostic tool. It's not PGT. It will never be PGT because it's not a diagnostic tool, but as a screening tool, yes, it's, exactly this. And it gives us a prediction. And a very good indication of, okay, we have a bunch of embryos here. Should we subject to biopsy? Should we not? We can consult the patient, maybe the patient would say, this is And now for me, I have two, good looking embryos, they seem to be normal, let's transfer one, freeze the second, I don't need to do PGT, I don't want to do PGT, I'm afraid of the biopsy, or I only have one embryo.
And I'm 42 years old. I do not want it, never ever biopsied. So up until now, people really didn't have a choice because part of the game and part of the, state of mind is not only is it a good looking embryo, but is it normal, abnormal, is it healthy? And so I think now, so for, before AIVF, the only way to answer such a question is to do biopsy.
most. Really, most cycles are PGT, but now we have another layer. And this not, another layer, this layer is very interesting. It's another way for the physician and patient really consult and discuss and the end, of the day, everyone wants the best for the patient and they want her to succeed.
We want her to succeed. So it's just another tool for us to discuss how can we create this, how can we get this cycle to, to be the best for you.
[00:47:21] Griffin Jones: Tell me more about the impact that's going to have on the field, because I recently recorded an interview and that one might actually air after yours, but I was asking the person, what do you see as the, this is the biggest need, that'll come down in the future and yeah, after, the interview, she said, Oh, it was, non invasive genetic testing.
That's what we need. So what is, what impact do you see this non invasive genetic screening having on the field?
[00:47:49] Daniella Gilboa: I think it's a game changer. I think it's exactly like the NIPT. What NIPT did to, pregnant women, and, it's being able to access screening tests and understand, by the way, it's really understanding the, what you're going through.
And PGT is really sophisticated and complicated, and it's, it's massive. Like you you free, you, go home as a patient. First of all, you do, A fresh cycle and you go home, without a transfer, right? And then you ship it out to genetic test, genetic lab, sorry, you do the biopsy, you ship it out, you freeze the embryos.
As a patient, I really wait for the result to come in and understand whether this cycle is worth something because it's. Are my embryos are normal or not? I don't know, and the embryos are frozen and then I have to come back again and throw the embryos and throw the only one that is normal. So this is the patient side.
Science side, this PGT is controversial because of the, fact that it has, we see a high rate of false positive, which is, it's there, it's there. So I'm not talking about the fact that the biopsy is a biopsy needs to be done by the best embryologist in the world. And if you, a clinic do not have the best embryologist in the world to do a biopsy, it's really, it might harm the embryo, right?
And the biopsy is a biopsy harms the embryos. This was something that was proven and even, published here and there, but it harms the embryos. It alters. The, timing of the development, there is, an effect, okay? And then, and the, hustle of everything, so you, need to have embryologists doing the ICSI, you need to have embryologists doing the biopsy, and you have to have a double witness everywhere, it's like a hustle, the, we all work for this hustle, and, but it's a diagnostic test, right?
it's a diagnostic test, but, and that's okay, that's great. So we're going to have PGT, always. But then, it's another layer in between that might, some of the patients would say, I want the screening tool. And, yes, I want to verify or validate that the embryos that were screened as normal are in fact normal.
Let's also do a biopsy on these embryos. That's great. Some patients would say, this is enough for me. Some patients would say, I don't want the screening tool, I just want the PGT. That's great. But I think the more tools we have and the more options we have, it empowers us to really give best IVF care. And now we have it.
And it's a game changer. I'm excited to see it. I'm excited to see it in work. we've been testing it. A lot before launching it and we're still always, collecting data and always, running studies in the publishing results and it, doing very good science and doing very good study designs is part of this ecosystem because It is science, so we always have to speak this language, but we actually see it happening and it's, very exciting and it's, here.
[00:51:28] Griffin Jones: At the beginning of the conversation you were talking about being a big believer in time lapse and I keep hearing that from people and so I started asking every embryologist, every lab person that comes on the show, I ask them, is time lapse a nice to have or a must to have? And everyone has been saying, I think it's a must to have.
And I've never worked in. an IVF lab. I don't have an embryology degree, so I need you to educate me a little bit. But the first time I asked you that question, is time lapse a nice to have or a must have? You said time lapse isn't just a must have. it's a way of life. What did you, mean by that?
And what helped me as somebody who's never stepped, or of course I've stepped foot in a few IVF labs, who's never worked a day in an IVF lab to understand why it's a way of life.
[00:52:16] Daniella Gilboa: Okay, before that, I want to tell you a story, I'll call it a story. So I think in the first days of, time lapse, so people, the, first response was, let's see if it's a better incubator than the conventional incubators.
So every, everyone like ran studies on the time lapse incubator, versus. It's the conventional incubator and it's like the same, like you don't see more or less, like you don't see more pregnancies in time lapse versus a conventional incubator. So like the, so, everyone were, was very frustrated with, okay, so why do we need to spend so much money on time lapse?
It's a gimmick. the, IVF center where I worked, huge IVF center in Israel. So they were saying like, it's a gimmick and we don't need time lapse. And it's not, and this is not the question. And I was like, really, I was angry, so much angry. And I said, it's not the right question. You're not studying.
The right question. it's not an incubator versus an incubator. Timelapse allows you to generate data. This is it. Okay. it's a, it's an incubator. It's closed system, which is of course better than any open system, but it's a closed system that has a camera built inside that captures images of the embryo.
Every 10 15 minutes, something like that, and so you end up after 5 6 days, you end up with hundreds of images that are translated, this is time lapse, okay, translated into a short video of the developing embryo. So do not tell me that you could do better evaluation based on one single image every day you have 3 4 points, rather than hundreds of points.
This is data driven decision making. And this was the early days of data driven decision making in IVF. This is one thing. The other thing, it generates data. Real data, okay? It's not me, copying to an Excel sheet, row after row. It's, automatic generation of data. Once you have data, and now, you, we can connect everything and we could connect the patient's history to the embryos and to the child that is born.
This is like longitudinal database, which is huge in terms of the value and the understanding of IVF and your IVF center. And all this could be done if you generate data. And data generation is not me copying things to an Excel sheet. this was like the early days. And now, it's a way of life.
Because, again, this is, this decision making could, should be made by looking at data and understanding what I do good and what I do wrong. And by the way, when we train algorithms to understand embryonic development and we see that an AI or, an algorithm that was trained on one single image cannot extract enough data rather than, the entire development from day zero to day five or six.
So I really don't understand, I don't understand clinics who are saying no to time lapse, I admit.
[00:56:05] Griffin Jones: I think you may have summed up the crux of the technological revolution. IVF is that we'll never scale this if we're manually entering data into spreadsheets in order to scale, you have to have data and you have to have mechanisms for According and producing that data, then you've walked us through a lot in what's happening in the AI revolution in the IVF lab today, we talked about personalized care and what it actually means to deliver personalized care versus what's currently being done, talked about how that can be used to give doctors more time to practice personalized care and have a better experience for the patients you talked about specific operational efficiencies.
in the IVF lab and talked about the impact of non invasive genetic screening here, now, and perhaps more on the horizon. You talked to us about why time lapsing is a way of life, how it unleashes, and what you're doing unleashes the power of time lapse incubators. How would you like to conclude about the problems that AIVF is solving?
[00:57:13] Daniella Gilboa: That's a good question. let me finish by some optimistic, Looks or, or just the optimism of this industry. I think we're now in a time where things are happening and it's, a, it's an, we're going through an amazing process of technology coming into our lives and we have to find in within ourselves, as clinicians and as, embryologists, as.
As, IVF centers, we have to understand that this is the time for us now to really engage ourselves with these new technologies and to understand that's more and more to come. And we, if we choose not to engage ourselves with technological innovations, then we'll lose at the end.
We'll just stay behind. And the, the. these innovations are happening in a very fast pace. It's just going so fast. And what's now, beginning of 2024, it will be completely different. In six months and in a year time, it is what it is. It's not going to take forever. It's not going to take five years.
Like in five years, it's like my mentor in the PhD, she said to me, she said, you're going to have an amazing PhD, but in five years you'll end up with a very nice publication. And someone else. We'll actually create it and put it in IVF labs. So what I think you should do is you should found a start, you should go and do a startup.
This is what she told me and, yes, it's so right because it's just going so fast. So I think we're now in a point in time that we see these changes happening and it's just exciting and it's great and we have to do it. So join us. Everyone, join us in the science, in the technology, in the quest of what's next for IVF and how we can help more patients realize the dream of having a baby and help us really bring this evolution slash revolution to life.
[00:59:46] Griffin Jones: I hope they do and thank you for sharing this vision of the future of a more effective and more efficient form of delivering IVF and fertility care to patients that need it in a personalized way that aren't getting it in that way today. Thank you for sharing that vision with us. Thank you for taking the time to come on the Inside Reproductive Health podcast.
[01:00:10] Daniella Gilboa: Thank you so much, Griffin. It's just a pleasure.
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