Application of artificial intelligence to improve the effectiveness of assisted reproductive technology programs

After completing this article, readers should be able to: 1. Describe the outcomes of assisted reproductive technologies (ART) for singleton, twin, and other multiple births. 2. Describe the role of fertility in adverse outcomes seen with ART births. 3. Review the association of birth defects with ART. 4. Delineate the association of disease of genomic imprinting with ART. 5. Describe the relationship between ART and the subsequent incidence of neurodevelopmental sequelae. In the 1977 ruling “Carey v. Population Services International,” the United States Supreme Court ruled that the decision to bear children is constitutionally protected. (1) Significant interest already had been shown in the development and improvements of in vitro fertilization (IVF) for infertile couples. The first human pregnancy and human birth using IVF were reported by Steptoe and Edwards in the United Kingdom. (2) Their work resulted in the first baby born via reproductive technologies, Louise Brown, born on July 25, 1978, at Oldham General Hospital in Oldham, United Kingdom. (3) She was born via a planned cesarean section, and her birthweight was 2.61 kg. The first successful viable IVF in the United States was performed by Jones and Seager-Jones in 1981 in Norfolk, Virginia. (4) Assisted reproductive technologies (ART) have seen a recent surge in popularity. The Centers for Disease Control and Prevention (CDC) reported that 122,872 cycles of ART were initiated in 2003, resulting in the delivery of 48,756 neonates, (5) accounting for approximately 1% of all neonates delivered in the United States. The percentage is higher in many countries, including Denmark, where it is estimated that 5% of all deliveries are with the assistance of ART. (6) Couples pursue ART for myriad reasons, including tubal transport factors, ovulatory dysfunction, uterine factors, endometriosis, male- and female-specific factors, and when a cause of infertility is unknown. (5) It would be very …

Cumulative live-birth rates per total number of embryos needed to reach newborn in consecutive in vitro fertilization (IVF) cycles: a new approach to measuring the likelihood of IVF success

Day 2 embryo transfer (ET) and day 3 ET afford similar reproductive outcomes in the poor responder

Question Asked How is artificial intelligence (AI) transforming assisted reproductive technologies (ART), particularly in vitro fertilization (IVF), and what are its clinical impacts and limitations? Background AI offers potential to address ART challenges, including high costs, variable success rates, and rising infertility. Applications in embryo selection, gamete assessment, and personalized protocols aim to enhance objectivity and outcomes. Literature Search A systematic review of peer-reviewed articles (2019–2025) was conducted, using terms such as “artificial intelligence” and “IVF.” Studies focused on AI tools (DeepEmbryo, icONE, iDAScore, ERICA) and their performance in ART. Materials and Methods Selected studies evaluated AI applications in embryo selection, gamete assessment, personalized protocols, and outcome prediction. Performance metrics, validation scope, and clinical outcomes were analyzed, prioritizing tools with quantitative data. Results and Discussion AI tools improved clinical pregnancy rates (up to 77.3%), implantation accuracy (92%), and efficiency (35%). icONE and ERICA outperformed traditional methods, reducing subjectivity. However, validation is often limited to single-center studies, with surrogate endpoints (e.g., pregnancy rates) rather than live birth rates. Algorithmic bias, regional data privacy regulations, and high costs limit generalizability and accessibility. Ethical concerns, including data privacy and equity, require robust frameworks. Conclusions AI enhances ART efficacy and personalization but faces validation and ethical challenges. Multicenter studies focusing on live birth rates and inclusive datasets are needed to ensure equitable, clinically relevant adoption.

Real-World Surveillance of FDA-Cleared Artificial Intelligence Models: Rationale and Logistics.

An earlier analysis of abbreviated SART (Society for Reproductive Technology) data for 2007 (n=443) had identified geographical heterogeneity in live birth (LB) rates in the United States resulting from donor egg IVF (In- Vitro Fertilization), and these observations allowed for positing on ecological underpinnings to IVF success. We herein aimed to determine the validity of geographical differences in LB following donor egg IVF through use of a larger study sample of both fresh and frozen embryo transfer donor egg IVF cycles (n=71, 182), after adjusting for a number of variables that are recognized to impact cycle success. Consistent with the earlier observations, geographical location of the IVF clinic emerged as an independent predictor of LB following donor egg IVF; also, highest LB rates with donor egg IVF following both fresh ET and with FET were noted at clinics located in the W compared to centers located in NE of United States (on analyses adjusting for recipient’s age, body mass index (BMI), race, number of embryos transferred (ET), and use of assisted hatching (AH) the likelihood for donor egg IVF related LB for clinics in W compared to the NE:OR 1.28, 95% CI 1.20-1.37 for fresh ET and OR: 1.18, 95% CI: 1.06 -1.30 for FET). This study reaffirms that success of donor egg IVF is susceptible to ecological influences that merit further investigation.

Extremes of body mass index reduce in vitro fertilization pregnancy rates

This review did not find sufficient evidence to support the use of one cycle regimen in preference to another in preparation for FET in subfertile women with regular ovulatory cycles. The most common modalities for FET are natural cycle with or without HCG trigger or endometrial preparation with HT, with or without GnRHa suppression. We identified only four direct comparisons of these two modalities and there was insufficient evidence to support the use of either one in preference to the other.

Infertility, as an emotionally significant and psychologically traumatic factor that threatens the fulfillment of a woman's fundamental biological need for motherhood, has a negative impact on mental health. In vitro fertilization (IVF), while providing a method to overcome infertility, also entails a few neuropsychiatric challenges.Objective: to assess the dynamics of mental health and reproductive function in women with infertility undergoing IVF treatment, based on longterm follow-up.Material and methods. The study included 190 mentally healthy women with infertility undergoing IVF treatment, observed over a two-year period. During this time, IVF led to 144 pregnancies (75.79%), of which 45 (31.25%) resulted in live births, while the majority (76.32%) remained infertile. Emotional state was assessed using the Hamilton Depression and Anxiety Rating Scales, before and after the IVF procedure.Results. Preexisting depression and anxiety were significant risk factors for unsuccessful IVF outcomes. Initially mild depression (63.6%) and anxiety (65.6%) were more common in women whose IVF procedures failed (p≤0.01), with these rates increasing post-failure to 69.7% and 70.7% respectively (p≤0.01). Among women with successful IVF, preexisting depression and anxiety were present in 26.7% and 33.3% respectively. Successful childbirth led to stabilization of emotional state and depression persisted in 6.7% of women and anxiety in 13.3% (p≤0.01). A successful IVF outcome was also associated with increased marital satisfaction and improved spousal relationships (p≤0.01).Conclusion. Infertility, the burdensome diagnostic procedures and surgeries associated with it, and the psychological strain of IVF-especially after unsuccessful attempts-contribute to the development of depressive and anxiety disorders. These, in turn, negatively affect the chances of conception and pregnancy maintenance, even with assisted reproductive technologies. These psychosomatic interactions must be considered in the diagnosis of infertility and in selecting appropriate treatment strategies.

The use of insulin-sensitising agents, such as metformin, in women with polycystic ovary syndrome (PCOS) who are undergoing ovulation induction or in vitro fertilisation (IVF) cycles has been widely studied. Suppression of insulin levels with metformin might reduce the hyperinsulinaemia and hyperandrogenism suppression of the ovarian response. As a consequence, metformin could improve both pregnancy and live birth rates. To determine the effectiveness of metformin as a co-treatment during IVF or intra-cytoplasmic sperm injection (ICSI) in achieving pregnancy or live birth in women with PCOS. The Menstrual Disorders and Subfertility Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, LILACS, the meta Register of Controlled Trials, and reference lists of articles were searched (to week 4, September 2008). Types of studies: randomised controlled trials (RCTs) comparing metformin treatment with placebo or no treatment in women with PCOS who underwent IVF or ICSI treatment. women of reproductive age with anovulation due to PCOS with or without co-existing infertility factors.Types of interventions: metformin administered before and during IVF or ICSI treatment.Types of outcome measures: live birth rate, clinical pregnancy rate, miscarriage rate, incidence of ovarian hyperstimulation syndrome (OHSS), incidence of patient-reported side effects, serum estradiol level on the day of trigger, serum androgen level, and fasting insulin and glucose levels. Two review authors independently extracted the data according to the protocol. The methods of randomisation and allocation concealment, and characteristics of the studied groups were evaluated. This review found no evidence that metformin treatment before or during assisted reproductive technique (ART) cycles improved live birth or clinical pregnancy rates. The pooled odds ratio (OR) for live birth rate (3 RCTs) was 0.77 ( 95% CI 0.27 to 2.18) and for clinical pregnancy rate (5 RCTS) was 0.71 (95% CI 0.39 to 1.28). The risk of OHSS in women with PCOS and undergoing IVF or ICSI cycles was reduced with metformin (pooled OR 0.27, 95% CI 0.16 to 0.47). This review found no evidence that metformin treatment before or during ART cycles improves live birth or pregnancy rates. The risk of OHSS in women with PCOS and undergoing IVF or ICSI cycles was reduced with metformin. Further large RCTs are necessary to definitively answer if the use of metformin in PCOS women undergoing ART improves live birth and pregnancy rates.

What does the SART success rate for a given IVF program mean?

People in low- and middle-income countries face many obstacles when trying to access fertility treatments. These challenges include high costs, the need for specialized medical facilities, and cultural beliefs that may discourage seeking help. This paper explores how artificial intelligence (AI) and automation could help overcome some of these barriers and make fertility treatments more widely available. It examines how AI may improve the accuracy, efficiency, and consistency of different steps in fertility treatments, such as choosing the healthiest embryos, analyzing sperm, evaluating eggs, and planning treatment. The paper also discusses how automation could simplify laboratory procedures, from growing embryos and freezing them for future use to the possibility of fully automating the in vitro fertilization (IVF) process, which could help lower costs and make these treatments more accessible. Finally, this paper addresses the ethical and practical challenges associated with using these technologies, including potential biases in AI, equitable access, quality control, data privacy, job implications, and cultural sensitivities.Lay summaryThis paper explores how AI and automation could help make fertility treatments more accessible in low- and middle-income countries (LMICs). Many individuals and couples face difficulties conceiving, and assisted reproductive technology (ART) – which includes procedures such as intrauterine insemination (IUI) and IVF – offers them a chance to build a family. However, ART is often out of reach in LMICs due to high costs, the need for specialized medical facilities, and cultural barriers. AI and automation have the potential to improve accuracy, efficiency, and consistency in ART procedures, such as embryo selection, sperm and egg assessment, and treatment planning. Automation could also streamline laboratory processes, including embryo culture and freezing, which may eventually lead to more affordable and scalable fertility treatments. By reducing human error and dependence on highly trained specialists, AI-driven technologies could help lower costs and make ART available to more people. This paper also considers the ethical and practical challenges of using AI in reproductive medicine, including potential biases in AI algorithms, fairness in access to treatment, data privacy, workforce impact, and cultural sensitivities. Fertility treatments can be life-changing for those struggling with infertility due to medical conditions, age, or personal circumstances. They also provide opportunities for same-sex couples and individuals who want to start a family. However, in LMICs, infertility is often surrounded by social stigma, economic hardship, and limited medical resources, making access to ART even more difficult. By integrating AI and automation into reproductive medicine, it may be possible to break down these barriers, reduce costs, and create more inclusive and accessible fertility care. These advancements have the potential to bring hope to millions who dream of parenthood but currently lack the means to pursue it.

BackgroundLuteinizing hormone (LH) and progesterone (PROG) on human chorionic gonadotropin (hCG) trigger day are significantly correlated with assisted reproductive technology (ART) outcome. Moreover, LH and PROG are also involved in the functional preparation of the endometrium during the implantation window; however, whether they are related to endometrial thickness (EMT) is still unknown. The aim of the present study was to assess whether EMT has a positive correlation on the live birth rate following fresh embryo transfer (ET), and whether LH and PROG have an impact on EMT.MethodsA total of 2,260 normogonadotrophic women were treated with a GnRH agonist for in vitro fertilization (IVF)/intracytoplasmic sperm injection. Patients with advanced age and poor ovarian reserve were excluded. The levels of LH, PROG, and EMT on the hCG trigger day were divided into binary variables, respectively, by the cutoff values, and which were obtained based on receiver operating characteristic curve analysis of live birth among LH, PROG and EMT levels on the hCG trigger day, respectively. Multivariate binary logistic regression was used to confirm the role of LH, PROG, and EMT on the live birth, and stratified analysis was used to determine whether LH and PROG have an impact on EMT.ResultsEMT and LH were protective factors for live births, with odds ratios (OR) of 1.11 [95% confidence interval (CI): 1.066–1.157] and 1.696 (95% CI: 1.345–2.139), respectively. However, PROG was a risk factor for live birth, with an OR of 0.635 (95% CI: 0.526–0.766). The hierarchical cross-table analysis indicated that EMT had no significant difference for live birth in the combination of low LH and high PROG group. In the other subgroups, thick EMT was associated with a higher live birth rate (P<0.05).ConclusionsOn hCG trigger day, EMT, LH, and PROG all were independent factors that affected the live birth of fresh ETs. Thick EMT can significantly increase the live birth rate. However, multivariate logistic regression analysis showed that EMT does not affect the live birth rate in combination of low LH and high PROG environment.

Professor Emeritus Lars Hamberger, former Chief Editor of Acta Obstetricia et Gynecologica Scandinavica (AOGS), passed away at the age of 82 years on 2 June 2021. Lars Hamberger was an internationally renowned scientist in the field of assisted reproductive technology (ART) and was the initiator and team leader behind the first in vitro fertilization (IVF) baby within the Nordic countries. The birth, in 1982 at Sahlgrenska University Hospital in Gothenburg, occurred only 4 years after the world’s first IVF baby was born. This accomplishment cemented Sweden’s reputation within the international IVF scene as the 5th country in the world to successfully develop the revolutionary technique. Lars Hamberger continued his scientific and clinical work in ART throughout his career, inspiring many young colleagues in Sweden and around the world to pursue careers within this rapidly evolving field. Lars Hamberger studied medicine at the University of Gothenburg and worked at Sahlgrenska University Hospital for most of his career. His doctorate training was in reproductive physiology, specifically ovarian metabolism. His innovative mind led to the development of a micro-diver technique to measure the oxygen consumption of ovarian cells. He became Associate Professor in Physiology in 1968, some months after receiving his PhD. After completing residency training at Sahlgrenska, Hamberger became an Associate Professor in Obstetrics & Gynecology in 1974. He was active in conducting research on ovarian physiology and closely followed the international work carried out to develop a technique that would fertilize the human oocyte outside the body. The successful creation of this IVF technique was largely due to the scientific efforts of Robert Edwards in Cambridge. In 1978, the Cambridge group reported the birth of Louise Brown. Soon after, Hamberger formed a team of clinicians and scientists to set up IVF in close contact with the Cambridge team, proving successful in 1982 with their first live birth at Sahlgrenska. In 2010, Robert Edwards was awarded the Nobel prize in physiology/medicine for the scientific development of IVF. Lars Hamberger was appointed Professor of Obstetrics & Gynecology at Karolinska Institute in 1983 but returned to the University of Gothenburg the following year as a professor. IVF was soon established as a clinical treatment at Sahlgrenska and Hamberger created a large adjoining research laboratory, “Spec-lab”, for translational research in ART. This center attracted scientists from all over the world to work in developing IVF and ART even further. One major IVF invention from the Sahlgrenska center was the forming of transvaginal ultrasound-guided oocyte retrieval in 1987. With this technique it was possible to avoid laparoscopy surgery when obtaining oocytes. Another major invention in ART was intracytoplasmic sperm injection (ICSI), developed by the Brussels group in 1992. Lars Hamberger and his team quickly learned the technique and Sahlgrenska became the second center in the world with a live birth after ICSI. Several major research findings in ART came from the Sahlgrenska center, including the establishment of elective single embryo transfer as a routine, long-term follow-up of IVF children, and uterus transplantation. Alongside all the science in the laboratory, Hamberger also made space for the world-renowned photographer Lennart Nilsson, who created the book “A Child is Born”, with Lars Hamberger as co-author. The book has been translated into 18 languages. Lars Hamberger was not only a scientist and clinician but also an entrepreneur within the business field. He was co-founder of the second private IVF clinic in Sweden, the stem-cell company Cellartis, as well as Vitro Life, now a major global company within the area of Culture media and products for assisted reproduction. Lars Hamberger supervised several PhD students within the Departments of Physiology and Obstetrics & Gynecology and hosted a great number of international visiting scientists. The famous Spec-lab became an international hub for advanced research in ART, greatly aided by Hamberger’s scientific generosity and hospitality. Lars Hamberger became honorary member of the European Society of Human Reproduction (ESHRE) in 2011 and was the Chief Editor of AOGS from 1999 to 2000. On a personal level, Lars had many interests but was particularly passionate about the arts. Lars himself was a talented painter and as a young man dreamed of a future as a painter, despite the disapproval of his father, Professor Carl-Axel Hamberger. However, Hamberger pursued his painting in parallel with his scientific career and had several art exhibitions after retirement. Lars Hamberger will be remembered with warmth and gratitude for being instrumental in the establishment of ART in the Nordic countries and being essential to the development of AOGS.

Predictive factors for live birth in donor oocyte-recipient cycles