Using AI to Predict a Viable Pregnancy During IVF

November 02, 2022 - At the American Society of Reproductive Medicine’s 2022 Scientific Congress and Expo, Fairtility announced the results of studies on its new AI embryo quality assessment tool CHLOE EQ. CHLOE, short for Cultivating Human Life through Optimal Embryos, is a tool used to determine the likelihood of an embryo becoming a viable pregnancy.

LifeScienceIntelligence sat down with Cristina Hickman, PhD, embryologist and VP of Clinical Affairs at Fairtility, to discuss the difficulties of in vitro fertilization (IVF) and how AI may help alleviate some of those burdens.

CHLOE EQ

Hickman began by sharing, “the idea behind the project is to help embryologists better understand the viability of embryos by using time-lapse imagery. It uses data to help us make better clinical decisions. This is personalized down to each embryo.”

The Basics of CHLOE EQ

“Fairtility has something called the time-lapse incubator. That means as an embryo is developing — from its formation, day zero, all the way to day five or six — during those six days of development, we take pictures of the embryo every 10 minutes or so. The pictures are taken at different focal points,” revealed Hickman. “This generates a huge amount of image data.”

Collecting the data is a small portion of this procedure. Once collected, the technology can analyze what the images mean.

“From that, embryologists use CHLOE EQ as a group of algorithms that analyze these images. In that, it interprets the biomarkers of the embryo, which it then uses to predict which one is most likely to be viable. If there's only one embryo, CHLOE EQ tries to understand the chance of that one being a genetically normal embryo, implanting, or leading to live birth,” she stated.

Benefits of AI Technology in IVF

“Most of our embryos, as human beings, will not be capable of becoming a baby. That's just human biology,” asserted Hickman. “In IVF, embryologists create more eggs than normal. Rather than the one egg a month that humans usually release, we try to get about nine eggs with IVF.”

Considering the rarity of a viable human embryo, it is crucial to understand the probability of the chosen embryo becoming a pregnancy that can be carried to term.

“After culturing those eggs, clinicians must first understand which one we will transfer. If we get that right, that’s great. If we get it wrong, then the patient must wait until the next cycle, another month, to have a frozen embryo transfer,” stated Hickman.

Embryos considered suitable for treatment are cryopreserved in case the initial embryo transfer cannot be carried to term. Other unsuitable embryos are not frozen.  Clinicians must decide which embryos to implant, cryopreserve, or discard.

“Embryologists wouldn't discard an embryo that we would consider could help the patient get pregnant. It is our job to make that decision consistently correct,” remarked Hickman. “Unfortunately, embryologists are human, and we are presented with a lot of information coming from these time-lapse incubators. As a field, embryology recognizes our limitations as humans in consistently making the correct decision.”

She shared that that’s where AI tools, such as CHLOE EQ, come in. She commented, “ultimately, embryologists are the ones making the decision. However, suppose we can have the information all organized and processed to prevent missing critical information or reinforce things we have already seen. In that case, we won't be discarding viable embryos, and we'll prioritize the embryo, maximizing the chance of live birth for the patient.”

The Challenges of IVF

After introducing the CHLOE EQ technology, Hickman discussed the difficulties and challenges associated with IVF for both patients and providers. The IVF process is expensive, exhaustive, and emotionally grueling for patients, their families, and providers.

Workflow and Time Management

Hickman shared that the workflow in an IVF lab is exceptionally complex, with multiple steps. “IVF labs are highly regulated. Especially in the UK, we are highly regulated in terms of what information we must document and capture every step of the way,” noted Hickman. “For that reason, we have to document everything all the way. This means that the process is extremely administrative.”

She added, “70% of the time, embryologists are not doing a clinical procedure. We are writing something down or typing it into a computer and doing administrative tasks because of the sheer amount of documentation we have to do for the procedures we're performing.”

“This means that embryologists generally are overstretched, overworked, overburdened, working very long hours, and the irony is that they're in the clinic taking care of people's future babies, but they don't have time to take care of their own at home,” Hickman pointed out.

“This is the reality of our field, and what we are trying to do with CHLOE is not just maximize the chance of live birth for the patient but also improve the quality of life for the embryologist while improving standards of care, so the embryologists shouldn't have to leave such a stressful, burdened life.”

Emotional Burden

The IVF journey is emotionally straining for both the patients and providers involved. For many patients, this is not the first step in their path of trying to conceive. According to Fertility IQ, on average, patients undergo 2.3–2.7 rounds of IVF. An unsuccessful IVF cycle can be another disappointment and discourage patients from moving forward. Increasing the statistical probability of a successful IVF cycle and being able to prepare patients for the likely outcomes of a given process can prove to be valuable.

Hickman stated, “historically, embryologists transfer an embryo, and we wish the patient good luck. But now, with CHLOE, we can sit down with the patient and say, ‘look, we're going to proceed with the transfer, but you need to understand that this embryo we're transferring has a lower chance of implanting. We want you to understand this. We're going to transfer, but we want you to go through the next two weeks expecting a negative test.’”

She shared that this helps emotionally prepare patients for the outcome of each cycle. Rather than feeling stripped of hope, patients can prepare for the result.

“By giving the patient the information up front, they spend these two weeks grieving and processing that negative news. But by the time they get a negative test, they’re expecting it and ready to start the next step of their treatment,” explained Hickman.

Cost of IVF

As many people know, the IVF process is a costly one. According to the Advanced Fertility Center of Chicago, the average price of a single cycle of IVF is $12,000, excluding eligibility testing, medications, embryo storage, pregnancy testing and monitoring, and physician consultation. That number is typically duplicated 2–3 times for each patient.

LifeScienceIntelligence asked Hickman how this tool would impact the cost of IVF. While her clinical position at Fairtility does not focus on the pricing side of CHLOE, Hickman stated, “I don't know the exact pricing, but I can tell you it's a nominal amount. It is lower than what's the cost savings that the clinic gets.”

Looking Forward

As the research on CHLOE and other AI technology is shared, clinicians may consider weighing the benefits of this tool or a similar one.  Hickman concluded, “We are about to enter this era of knowledge in embryology. There will be a boom of knowledge coming in, hopefully leading to improvements in decision-making or understanding of infertility. This is an exciting time to be an embryologist.”