90% OF Fertility Centers Still Doing Manual Witnessing, Exec Says
A boom in demand for fertility treatment means more embryologists are turning to management to invest and implement processes and systems to modernize fertility care through implementing automated technologies.
“As the UK regulator of fertility treatments, we expect clinics to have robust systems in place to ensure eggs, sperm, and embryos are safely stored for patients,” Rachel Cutting, Embryologist and Director of Compliance & Information at the Human Fertilisation & Embryology Authority (HFEA) told Inside Reproductive Health.
Long-standing, antiquated, manual tools have traditionally been the process of choice, despite the risks associated with being prone to human error and inconsistencies that subsequently compromise the standard of care.
However, some fertility managers and embryologists are changing their approaches to embrace automation and ensure they continue to deliver a standard of care to patients that provide cell transparency and safety. For example, managers want to automate the tracking and storage of frozen eggs and embryos.
Swapping antiquated for automated
Regarding IVF laboratories, the main problem with automation and artificial intelligence (AI) is “a lack of standardization”, Danilo Cimadomo, Science and Research Manager of GeneraLife IVF, told Inside Reproductive Health.
While there is a “very good concordance and reliability”, among people working within the same IVF center, the same is not true across different centers. “When it comes to the procedures as well as to the assessments that we make, there is not very much concordance between embryologists,” says Cimadomo.
Global managers are exploring automation in response to the estimated over 300 million anticipated to be born from IVF by 2100. Automation enables them to continue to provide cell transparency and safety – while ensuring compliance.
“Advances in technology have meant greater success for patients using cryopreserved eggs and embryos and therefore, more patients are storing them for treatment or to preserve their fertility,” Cutting shares.
“Even now, around more than 90% of fertility centers around the world are still not using any form of electronic witnessing,” says Matt Pettit, Chief Scientific Officer at IMT International, responsible for developing and implementing Matcher, an electronic witnessing and quality management system. Many fertility centers still handwrite Petri dishes, test tubes, and items.
“It is still a problem within the industry, still a change that needs to take place,” says Pettit. Serious adverse events are still happening, he continues. There are still reported incidents, year after year, where incorrect sample handling means babies are born to the wrong parents or embryos have been discarded.
As a result, today, we are seeing “a paradigm shift towards the use of electronic systems”, Pettit notes, continuing, “we are seeing a big wave now where there has been a very rapid
adoption of electronic systems”. “Covid has expedited that realization,” Pettit adds.
Despite the release of the Toft Report almost two decades ago, implementing new automation-led processes and systems to support the fertility sector has been slow to adopt. Yet, increasingly, managers are conducting audits to recognize risks in manual systems and seeking tech to reduce the risks of these existing systems.
Managers are exploring tech with specific features to improve digital tracking, robotic automation, and 24/7 remote monitoring to take the burden off of manual staff procedures and overcome identified risks. They see the benefits of automating embryo tracking and storage to reduce errors and ensure their infrastructure is robust to meet patient demand.
Advancing tech encourages acceptance and adoption
Electronic tech innovations are entering the reproductive health space and finding acceptance in the wider healthcare sphere, helping to foster trust and uptake among managers of fertility centers and donor banks.
With a focus on automation, transparency, and standardization, the tech connects to the company’s software, which assigns a unique identifier for each specimen and captures real-time information. It aims to reduce most manual inputs that risk failure in the existing cryogenic process.
“Systems such as electronic witnessing systems and other automated technologies are becoming more commonly used, and clinics will use these to ensure security and safety is optimized,” Cutting details.
Electronic witnessing systems are currently “the easiest and most effective way” for fertility centers to embrace automation and AI, Cimadomo says, describing it as “one of the most impactful automation tools” he has seen implemented in his clinic.
Fertility centers and donor bank managers are implementing automated patient tracking information to reduce errors, like Matcher IVF electronic witnessing technology. Described as a double-checking system, IMT’s Matcher tech is a barcode-based electronic witnessing, labeling, scheduling, traceability, and data insights system.
Teaming up with academia to provide education on the potential of automation in IVF is a priority for fertility researchers, clinicians, and embryologists. The electronic witnessing system’s upgrade is in response to an increasing number of treatments that require labeling, identifying, selecting, and matching a specific embryo for a predetermined fate, such as biopsy, transfer, cryopreservation, or disposal.
In an MIT Technology Review, researchers found almost three-quarters of health professionals (72%) show significant interest in implementing AI in their work. Embracing the technology appears more likely as professionals perceive it to be an extension rather than an extinction of professional capacity in health care. Research has found that the number of AI publications in medicine and health has also grown, with 61.6% of the papers dated between 2008 and 2017.
Encouraging change through embracing convenience
Sharing information between databases is a powerful tool. It enables centers to cross-reference data across different systems and use that to effectively help drive further efficiencies, mitigate error, and for root cause analysis.
Describing this realization as “probably the tipping point”, Pettit continues, it means people will “very rapidly adopt these types of technologies because it is more about the collection of data and that knowledge is power than it is about the prospective error prevention”, says Pettit.
“The real advantage of automation will be for smaller centers that do not get the same experience as centers that are managing large volumes in terms of procedures,” says Cimadomo. However, cost-effectiveness remains a barrier to implementation. “That perhaps is the reason why we still do not have any automatic tool in the IVF laboratory, you need an investment in terms of money that should be justified from the volumes you have,” Cimadomo adds.
The use of technology and its specific applications varies from lab to lab. Research labs, for example, may require automatic timing and sanitation, whereas a lab engaging in clinical activities may not need this data. Therefore, the technology and the strategies need to be framed for the country, the regulations applied, the population of patients, and the specific center’s needs.
“There is not really any effective automatic tool in the lab, it is still very manual the activity that we do, but that doesn't mean that there's no research,” says Cimadomo.
Automation
However, researchers have found that the answer does not have to lie in automation. Scientists developed an embryo tracking system (ETS) with six control steps to see if it increased the safety, efficacy, and scalability of massively parallel sequencing-based preimplantation genetic testing (PGT). The researchers found that the ETS approach precluded error-prone manual checks and did not impact preimplantation embryos’ genomic landscape.
Yet, increasingly, the benefits of automation in assisted reproduction technology (ART) are being recognized. Researchers of the review, Paving the Way for the Future of Infertility Treatment, said in August 2022 that implementing novel technologies to automate ART “will soon become a reality”.
On 13th May 2023, the Italian Society of Embryologists Reproduction (SIERR) is dedicating its 2023 event to understanding the role of AI in IVF, demonstrating the growing interest in the possibilities of automation in fertility. Understanding how AI applications in embryology and reproductive medicine work and defining the state of the art is the goal of the 2023 event.
“We thought it was about time to talk about AI because there are lots of companies commercializing tools and are approaching us in the laboratories, and there are people who do not know what AI is”, says Cimadomo, a member of the Italian Society of Embryologists at Production and Research.
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