Automation in ART

Since its inception, there have been many technological advances to help streamline the process of IVF and make the workflow easier in the lab for embryologists and andrologists worldwide. We will discuss our opinions on the future of Automation in ART, a summary of the presentation provided by our team during the Southwest Embryology Summit (SWES) in January 2024.

Necessities for a Successful Cycle

How do you make a baby? You need an egg and sperm of course! An IVF professional needs to select the best egg and sperm to increase the chances of producing a successful pregnancy. Sperm Analysis helps verify sperm counts, motility parameters, progressive motility, concentration, and volume, which helps the andrologist understand the patient's ability to fertilize the egg. Sperm DNA Fragmentation and sperm morphology are also used as analysis metrics to verify male factor infertility.

During the 1980's and early 1990's, semen analysis was performed manually by using a Neubauer hemocytometer and later, the Makler Counting Chamber. A technician would need to manually look through a microscope to verify sperm counts and concentration. The manual method is not time-efficient and is considered an objective process. The process also runs the risk of technician bias and inaccuracy.

In 1985, Computer-Assisted Sperm Analysis (CASA) was introduced into the ART field. Hamilton Thorne Inc. is proud of our legacy in developing an easier method to assist in determination of male factor infertility and creating the IVOS CASA system. Since then, we have evolved our portfolio and now offer a variety of CASA system solutions such as the SCASCOPE CASA system and Bonraybio's LensHooke X1 Pro for USA clinical markets. CASA systems help provide reliability, speed, accuracy, and precision in the lab. It also assists lab technicians tackle higher volumes of samples compared to manual methods.

According to the article, "Sperm Selection for ICSI: Do We Have a Winner?" published in Cells by Baldini et al. in 2021, selecting competent spermatozoa with the highest fertilization potential is essential for the process of intracytoplasmic sperm injection (ICSI). On the other hand, just as important is the selection of the most viable egg.

Without a healthy egg, a successful pregnancy cannot occur. Methods for oocyte quality selection and grading include visual assessment for morphology criteria under a conventional microscope and invasive methods such as using fluorescence-based staining.

Technology helps bridge this gap by providing a non-invasive method for egg grading that avoids the risk of potential staining damage. Our Oosight Imaging system helps provide an advanced method for evaluating viable eggs without the use of labels or stains. By showing spindle multi-polarity and abnormal microtubule alignment, the Oosight makes it possible to reject eggs that would likely result in aneuploid embryos. By using this technology, improved pregnancy outcomes can occur by selecting embryos that exhibit structurally "normal" spindle and zona at the time of ICSI.

Automated ART Recent Developments

A more recent technological advancement is the automated ICSI system (ICSIA) where a robot automated system performs sperm injection, which includes injection pipette advancement, zona pellucida and oolemma penetration with piezo pulses, and pipette removal after sperm release. The world's first babies were conceived through ICSIA in May 2023. . "The use of less invasive techniques that can reduce oocyte damage resulting from ICSI procedures combined with the development of automated systems to simplify the control of the micropipettes and microinjectors holds potential to help standardize results, allow less experienced embryologists to carry out the procedure and democratize access to infertility treatment by reducing labour costs." (Costa-Burges et al. Reprod Biomed Online 2023).

Conceivable Life Sciences is a group focused on creating automation technologies for the next generation of IVF. The group's goal is to increase the accessibility of IVF to more people around the world with the help of new automated solutions. The demand for IVF has increased significantly since its inception back in 1978. Societal norms and stigma surrounding IVF have changed to a positive outlook and families are choosing to delay childbirth till later stages in life. By examining growing trends and birth rates of IVF, "it is likely that in the near future, as many as 10% of all children will be conceived through IVF in many parts of the world." (Costa-Kushnir et al. Reprod Sci. 2022).

Outlook on Automation in ART

As the demand for these services increases, the need for embryologists increases as well. With the help of technology advancement and automation, more families will be able to access their dreams of having babies. Referring to the previous example of examining sperm counts manually to the modern-day use of CASA systems, history has shown that technology can help improve a lab's workflow and productivity. There will always be a need for a skilled operator in the lab working in tandem with these new technologies. New automation technology in the future will no doubt change the landscape of the roles of many jobs in the industry, but change doesn't mean a role will be eliminated. The role can change and evolve to work alongside the new technology and meet the ever-growing demand of IVF services.

References:

Kushnir VA, Smith GD, Adashi EY. The Future of IVF: The New Normal in Human Reproduction. Reprod Sci. 2022 March; 29(3): 849-856. doi: 10.1007/s43032-021-00829-3. Open Access Article

Baldini D et al. Sperm Selection for ICSI: Do We Have a Winner? Cells. 2021 Dec; 10(12): 3566. doi: 10.3390/cells10123566. Open Access Article

Costa-Burges et al. First babies conceived with Automated Intracytoplasmic Sperm Injection. Reprod Biomed Online. 2023 Sept; 47(3): 103237. doi: 10.1016/j.rbmo.2023.05.009. Open Access Article

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