Funding for To The Contrary provided by: This week on To The Contrary: You have the doctor saying, I know it works.

We've actually had a stud where we—a peer reviewed study; we showed it works, but we can't tell you 100% why it works.

This procedure was accomplishe remotely and so the IVF itself was performed in Mexico from New York.

These are very expensive technologies, and not every individual is going to be able to have access to this.

Hello, I'm Bonnie Erbé.

Welcome to To The Contrary, a discussion of news and social trend from a variety of perspectives.

Robots and artificial intelligence are transforming fertility treatments.

Automated systems can now select genetic material, fertilize eggs and create embryos, all of tha with little or no human input.

These breakthroughs promise to make in vitro fertilization faster, cheaper, and more consistent.

They also promise to potentially expand access to it for millions worldwide.

Trials have already led to healthy births, showing that machines can transform delicate procedures once done only by expert human hands.

Researchers hope this new wave of robotic IVF will reduce costs, ease emotional strain and make parenthood possible for many more people around the world.

With us to discus this story are science reporter Elana Spivak the Washington Post's Elizabeth Dwoskin, and the Dallas Morning News Miriam Fauzia.

Let's start out with this apparent revolution in what has been, up until now, a pretty high tech field, becoming a hugely high tech field.

What are the mai transformations that are taking place that are making it cheaper and more widely available?

Artificial intelligence is assisting embryologists in selecting sperm, which can be quite difficult, especially in people who have a condition known as azoospermia, which can cause extremely low sperm counts.

And so in one instance from Columbia University's fertility center, researchers couldn't find sperm in a sample for two days.

And then AI reportedly found 44 in an hour.

So that's one example.

How does it do that?

And what powers does it bring to the tabl that haven't been there prior?

Well, it uses computer vision, which are the same algorithms that a self-driving car can use if you, you know, when a self-driving car need to identify, for example, a huma or a traffic stop on the street, they're using a technology called computer vision, essentially algorithms that have been trained on millions and millions of images in the real world.

So to build some of these systems, you had embryologists teaming up with computer scientists.

I would say for almost the past eight years, they were only starting to see some of the revelations now or the capabilities now.

They were trainin these systems with pick images that they were collecting of real sperm, millions of sperm swimming around in petri dishes, and they trained the computers to recognize the patterns that show healthy sperm by looking at the pregnancy outcomes and the insemination and fertilization outcomes for some of that imagery.

And that's really— that's all that it was that led to this revolution of sorts?

I think it's a lot more than that.

I think you also have to look at robotics.

So a couple, a couple of weeks ago, I had the opportunity to see an amazing clinical trial in Mexico City.

It's one of the first clinical trials of a first fully robotic IVF system.

And just to lay the groundwork, you have 1 in 6 people in the world suffering from infertility at some point in their lifetimes.

So it's a deeply painful personal problem that afflicts many more people than is often discussed.

Many more people would want to have families, would want to have choices around their families.

And yet IVF only works about half the time.

It's very hard to get numbers for how successful IVF is.

But, you know, some clinic might have slightly over half, depending on the age of the people that come i and the problems that they have.

Other people might have less.

So it's not— IVF is not the solution.

And so one question about why IVF doesn't work.

There's a lot of reasons why IVF probably doesn't work, but one of them would be the fragility and the ability of the human hand to do a process which is called ICSI.

It's the insemination process.

Embryologists are human beings just like anywhere else.

They wake up, they hav good days, they have bad days.

They might be tired, they might be hungover.

It might be the end of the day.

They're not like a robot tha does it the same way every time.

And there's some research suggesting that this human fallibility factor is one factor into wh IVF doesn't work all the time.

And so when I went down to Mexico City, what I saw was a fully roboticized system that not only did it select the sperm using computer vision, it selected the egg.

It put the egg in the incubator, it cleaned up the egg and then aspirated it, put it into a incubator.

After a couple days, those eggs incubate.

Then it comes in.

It's already selected the best sperm from the petri dish, and then the robot itself without a human there.

And I saw it with my own eyes.

The robot itself does the actual ICSI, the actual fertilization.

Fascinating.

Now every good side just about seems to have a bad side.

What are, and if somebody else wants to jump in, what are the bad sides of making this more— having the scienc lean more heavily on robotics?

And what are the possible consequences of that?

More lawsuits, I don't know.

You tell me, youre experts on this.

I did a story for the Dallas Morning News about a company there called Overture Life.

They've started— They're opening a lab in Old East Dallas.

And essentially they're going to be offering an AI powered embryo viability screening test where instead of taking a sample of the embryo, and testing to see whether it's viable or not before it's being transferred into the individual.

They instead are going to test the metabolites that are excreted by the embryo as it's being cultured.

And they told m that they have an AI algorithm that basically screens all the metabolites and then can predict whether or not that embryo will be viable and lead to a successful pregnancy.

Something that I think about is that with AI, the result that we get, the outcome we get is only as good as the data that the AI is built on.

So there's a question abou where does this data come from?

How good is this data?

Because again, with a lot of these companies, it is very proprietary.

So, you know, it's a question of like, how much can we rely on this proprietary knowledge, and on these AI models.

And so that's like something I think about a lot.

A lot of the algorithms that we're seeing now were being created in conjunction with actual IVF clinics.

And those IVF clinics for years, like the one I saw in Mexico City.

Those IVF clinics for years were filming their embryos and were filming their sperm petri dishes and were filming eggs and follicles.

So they have thousands and thousands and thousands of hours of footage.

I think Miriam's point is how much footage you actually need to be as accurate as a human doctor, as the average human doctor.

And what are you— what's your benchmark?

Is it the doctor on their best day?

Is it the average rate of IVF success, which is fairly low?

Like what, what benchmar do you even need for accuracy?

And then, yeah, how?

And then one of the things that has been done to combat the problem that Miriam is talking about th challenges is just there's been various research studies which have looked at the performance of these algorithms.

And so in some of the studies they show, I think even Overture Life has a few that are published, peer reviewed studies where they'll show that in some cases, as Elana indicated, some of thes algorithms are performing better than human beings might—tha the average human being might, according to the industry rates, of course.

Another question is the industry is opaque too, so what the human does, like— you can only compare the algorithm to the human if you have an accurate picture of what human beings do.

And that varies immensely from lab to lab.

Why is that?

Well, I think it's—the one thing is the human factor.

Two is that IVF and producing IVF, it is a very artisanal process.

You know, it's a specific kind of training.

You spoke about opaqueness.

And tying this into the question of drawbacks is that in some cases, for example, in Conceivable Lif Sciences, based in Mexico City, they don't always understand an AIs selection for sperm, for example, or for a particular, oocyte or egg cell.

And so that creates a black box.

And it's really hard after a point to sort of relinquish that control and understanding of why an intelligence is goin to select one cell over another.

You have the doctor saying, I know it works.

We've actually had a study where we—a peer reviewed study, we showed it works, but we can't tell you 100% why it works, because even to some degre their algorithms are a black box to them.

No there is a whole emerging field of auditing algorithms and figuring out computer science techniques where the algorithms try to figure out what the algorithms are actually detecting.

But some of these patterns are so—they're so subtle.

They're not— The human eye couldn't see them.

Like one example is that, when they were when I think it was Conceivable was looking at sperm, they— The AI identified thi particular movement of a sperm, like the specific little corkscrew, the sperms are all— sperm is all floating around in a petri dish.

You can see the imagery on the Washington Post, but they found this one particular type of corkscrew move that the sperm does.

And if they see that corkscrew move a certain number of times, it turns out that that sperm has a higher success rate in fertilizing an egg.

Now, that's not that was such a subtle corkscrew that no human being at— no human doctor— that wasn't in the medical literature.

There was no human doctor saying that.

So the AI found it and they were able to actually go back and figure out what the AI was seeing.

But as Elana said, and as I've written too, they say that they don't always know.

I once knew a woman who had gone through in vitro and she explained the whole process to me.

And first and foremost, I did not realize how painful it is or can be, particularly, of course, for whom else, for the woman.

Because once they have the sperm that have been, you know, that mixed with eggs and are now ready to be implanted and grow into human beings.

They then have to get them into the woman system, and they do that by injecting them into her abdomen.

And that can be incredibly painful.

I'm shocked some of these women are able to go through it more than once or more than twice, because it really can be, not for everybody, but it can be incredibly painful.

Is that something that this new technology is working to get around somehow?

Full disclosure, my mom is actually a reproductive endocrinologist.

I didn't, I fell out.

Yeah.

I felt like that week that I wrote that story, I was just writing stories that my mom would be interested in, but— And so I definitely— I can—not that I've ever undergone IVF, bu I have seen in my mom's clinic how painful that procedure— Because you have to give women a round of injections hormonal injections to stimulate egg growth.

You have to retrieve those eggs.

It's a very painful process.

And I do not know if I have the right answer for this, but there—the physical aspect, I don't know if AI would be able to mitigate that.

I mean, maybe if Elana or Elizabeth have, you know, can bear better insight, but, I mean, if somehow AI is integrated into, for example the egg retrieval process where you could potentially— because there are— there is research looking into kind of like what Elana was talking about with like, you know, using AI to identify the best sperm.

What Elana and both Elizabeth were talking about, maybe if that's worked in during— and that's also happening for eggs, oocytes to see which is the most viable oocyte.

So if that is worked into, for example, egg retrieval, then maybe there would be less pain for a woman having to undergo multiple IVF cycles.

So the most painful part of IVF, as Miriam alluded to is the retrieval part of it because you have to g through all those medications.

It's also one of the reasons why IVF is so expensive.

We haven't talked about the cost, but you know, 25, $30,000 per cycle.

Most people who do IVF are doing multiple cycles.

So they're going through tha physical burden, multiple times, and this huge financial burden.

There's another startup that Im planning to write about that is called Gameto that actually uses the stem cell technology to reduce the drugs that the woman has to take to stimulate her ovaries to produce more eggs.

That's what the drugs are.

They stimulate the ovarie to produce more egg follicles.

And that's what makes this bloating, this pain.

Because your body is, like turning into this egg production factory, you know, hyped up on drugs.

The biotech, instead of doing all that to the woman's body, they just do like 1 or 2 injections.

They take the egg out and the follicle out, and they actually reproduce more eggs with stem cells.

All right.

And while we're at this juncture and you mentioned cost, let's talk about cost.

What makes IVF so expensive?

And how does the advanced technology work to cut back expenses, if at all?

One aspect, in which it reduces cost is that at least in Conceivables case, this procedure was accomplished remotely.

And so the actual injection, the IVF itself was performed in Mexico from New York, you know, different countries, and miles and miles apart.

So that could at least reduce costs by eliminating a travel barrier.

If the technology is in the place, then, people who are undergoing these IVF procedures won't have to travel.

They can go someplace where there is— there is technology.

But they don't have to make these enormous trips to go see the specialist.

The specialists can come to them through the technology.

IVF can cost anywher between, like, 15,000, $30,000.

Insurance companies typically do not cover IVF.

It really depends on the insurance company.

What kind of fertility, treatments that they do cover.

So when I was talking to Hans Gangeskar at Overture Life, what he said to me is that, like, I mean, there probably will still be the expense, but instead of spending for, like, you know, three IVF cycles, you're only doing one because it is not uncommon for an individual or a couple to do multiple IVF cycles.

Why is that?

It's that IVF can fail.

And so you have no choice but to do it again.

It's like Elizabeth was sayin that IVF doesn't always stick.

People are going to IV because they have infertility.

And it's not always clear.

There's a I think 10% of infertility is called unexplained infertility.

So they don't actually have a reason why.

And even when it's explained, IVF may not be able to overcome that.

And for the aspec that's unexplained, you have the physical fallibility of the doctor in the clinic.

You also might have something mysterious going on in the body of the either partner that science doesn't yet understand.

One thing that you could think about in the future is a surgeon or an embryologist in a lab or an REI, a reproductive endocrinologist like Miriams mom.

Because of the remote factor, you could see her overseeing double the amount of IVF procedures because they can watch it on a monitor.

So you don't need to have them doin the whole physical labor of it.

They can oversee it.

They can watch the robot do it.

Maybe they can oversee two procedures at once or ten procedures at once, and the system is going to flag if it's—flag the doctor if it's having errors.

The cost of these AI systems is very expensive, though, these robots.

I actually respected Overture Life a lot in their answer to this, because not only are they— they're building a full scale robot, an ICSI robot, they also have this box.

And this will interest a lot of women.

They have this box that it's just an egg freezing box.

And they say that they will ship it—in Europe, it just got approved.

They will ship it to doctors off to OB/GYNs, to your regular OB.

You don't have to go to a fertility clinic.

You might just be a woman who's interested in freezing your eggs.

And rather than going through a whole fertility process, your doctors just has a box that does the whole— The doctor does the retrieval.

But this little tiny little robot in the doctor' office can do everything else.

You could just freeze your eggs on your OB/GYN, your regular OB/GYN visit.

They told me they brough that cost to them to under 1000.

What they have alluded to me is that, you know, they do have that box, as you said, and they are trying to bring that cost down of like, of oocyte banking in general.

Yeah.

It's called the DaVitri box.

And it— which sounds a lot like the da Vinci, which is another robotic surgery device.

But the DaVitri box, they said they've gotten their own cost down to under a thousand.

They won't say how much they're charging doctors for it because it's very, very new.

And they're obviously subsidized by Silicon Valley venture capitalist who can make the cost cheaper.

But their whole thing— when I spoke to Hans Gangeskar too, he said, you know, we're not going to be able to sell equipment that costs $1 millio to your run of the mill OB/GYN in wherever you live, they can't afford that.

And that's not going to bring down the cost of the system.

We haven't yet talked about the Trump administration and the changes to the IVF market, but a lot of these future of health IVF companie that the three of us are looking they're actually not proponents, surprisingly, of this stuff being covered by insurance.

Well, they just believe that insurance, if something's covered by insurance, insurance usually finds a way to profit off of it and bring up the cost in the United States.

So coverage is not all for the benefit of humanity, as somebody might put it.

Oh, insurance companies aren't working for the benefit of humanity?

Oh, that's news to me.

Yeah.

I mean, something that I also think about is that when we talk abou costs, it's the accessibility.

Because, again, these are very expensive technologies and not every individual is going to be able to have access to this, even if we talk about in medically underserved areas, whether in the United States or the rest of the world, you could technically have, maybe doctors overseeing, like clinics elsewhere in the world.

But again, it's still requires to have some sort of technological facilities, in those other areas.

And it's a question of how widespread can these technologies, AI and robotics be.

And I'm a little bit skeptical about that.

I'm a little skeptical too.

But there is this concept that's in the medical literature.

We've probably all heard colloquially about food deserts, places wher you can't get fresh groceries.

But there's also a concept called fertility deserts that's in the medical literature, which looks at the inequities around who has access to fertility care.

And it's a really, really small sliver of relatively well-off people in coasta cities, like in San Francisco.

You can throw a stone and you're going to hit an IVF clinic.

But there are entire states I put in my piece, I think Wyoming does not have a single embryology lab in the state.

People who want to seek IV will have to go to another state to get all of the egg retrievals and all the fertility services done.

So, I'm a little bit more of a believer in this idea that at least a piece of it could be farmed off to a small box, in your OBs clini as a concept for how to change this access question.

But I agree with Miriam that the whole thing has to be more accessible, not just the egg freezing.

The whole thing.

And so unless the full robotic system is much cheaper than a doctor, the and you can answer the access, it's not going to change that poor dynamic of it being so expensive to create a fertility lab.

I think it costs something like 4 million to—or 1 to 4 millio to even build a fertility lab.

And so you'd have to have a large amount of capital to build a lab.

You'd have to get the technology, the AI technology to be less than that, to build these remote fertility labs that some of these companies are talking about.

And last question before we go.

Do we have any idea of what percentage of the population is frozen out of going to in vitro for fertility because the expenses are too high?

I feel like there would b a significant amount of people.

I mean, I don't— I can't quote exact numbers, but I know that there's a lot of individuals in the United States who whether it's access, medical access, they're in a fertility desert, whether economic access, socioeconomic reasons or whatever.

There is a huge chunk of people in the United States who are—kind of don' have access to infertility care.

And it's a big thin that even the American Society of Reproductive Medicine thinks about as well.

There's a World Health Organization study on this, exactly this question, the same study that says that 1 in 6 people will experience infertility in their lifetime.

I believe it's the same study or a related stud they did around the same time, which showed that the vast, vast majority of people in the worl who experienced this infertility do not have access to infertility care.

So check out that W.H.O.

study.

It also looks at developed countries as well.

It goes region by region.

So there's more acces in places in the United States.

But I believe even in the United States, the vast majority of people who are experiencing this don't have access for one reason or another.

Which is why, it's interestin how when we talk about stories about IVF, you know, it's often seen as this boutique service for wealthy, professional women who want to— who delayed having kids.

And now they're in their late 30s and they don't know what to do, and they have the money.

And that's just the way the market is right now because of the cost and access issues.

But it has nothing to do with about the scale— It says nothing abou the actual scale of the problem.

So are you saying if they want to cure the lack of children being born to American women, that maybe making IVF universally available would help, would bring more children into this country?

Not necessarily because there's been research showing that, in countries where IVF is more widely available, it doesn't overall increase the number of babies.

It also— and this is, by the way, why the Heritage Foundation and some of the conservative think tanks are—question IVF and are not pro IVF.

They like—you can look in places like Spain where IVF is widely available.

It's government subsidized.

If you have infertility, you can get it, you know, for like $3,000, I think I've read.

And they're, you know, if you look, they're having a fertility crisis.

So, it's possible that more IVF does cure some infertility.

It's also possible that people do delay childbearing if IVF is more available.

So it's very hard to mak a political argument out of it.

That said, I think we can all say—we haven't talked about politics this conversation.

But the reason that Republicans are so forcefully supporting IVF and that Donald Trump put that as part of his agenda is because even among Republicans, IVF is widely supported.

Well, thank you all for your contributions for clarifyin this very complex topic for us.

And we hope that, for people who want it, i becomes more widely accessible.

Thank you so much for joining us.

Thank you for a part of your day That's it for this edition of To The Contrary.

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