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Goss DM, Vasilescu SA, Vasilescu PA, Cooke S, Kim SH, Sacks GP, Gardner DK, Warkiani ME. Evaluation of an artificial intelligence-facilitated sperm detection tool in azoospermic samples for use in ICSI. Reprod Biomed Online 2024; 49:103910. [PMID: 38652944 DOI: 10.1016/j.rbmo.2024.103910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/31/2024] [Accepted: 02/09/2024] [Indexed: 04/25/2024]
Abstract
RESEARCH QUESTION Can artificial intelligence (AI) improve the efficiency and efficacy of sperm searches in azoospermic samples? DESIGN This two-phase proof-of-concept study began with a training phase using eight azoospermic patients (>10,000 sperm images) to provide a variety of surgically collected samples for sperm morphology and debris variation to train a convolutional neural network to identify spermatozoa. Second, side-by-side testing was undertaken on two cohorts of non-obstructive azoospermia patient samples: an embryologist versus the AI identifying all the spermatozoa in the still images (cohort 1, n = 4), and a side-by-side test with a simulated clinical deployment of the AI model with an intracytoplasmic sperm injection microscope and the embryologist performing a search with and without the aid of the AI (cohort 2, n = 4). RESULTS In cohort 1, the AI model showed an improvement in the time taken to identify all the spermatozoa per field of view (0.02 ± 0.30 × 10-5s versus 36.10 ± 1.18s, P < 0.0001) and improved recall (91.95 ± 0.81% versus 86.52 ± 1.34%, P < 0.001) compared with an embryologist. From a total of 2660 spermatozoa to find in all the samples combined, 1937 were found by an embryologist and 1997 were found by the AI in less than 1000th of the time. In cohort 2, the AI-aided embryologist took significantly less time per droplet (98.90 ± 3.19 s versus 168.7 ± 7.84 s, P < 0.0001) and found 1396 spermatozoa, while 1274 were found without AI, although no significant difference was observed. CONCLUSIONS AI-powered image analysis has the potential for seamless integration into laboratory workflows, to reduce the time to identify and isolate spermatozoa from surgical sperm samples from hours to minutes, thus increasing success rates from these treatments.
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Affiliation(s)
- Dale M Goss
- School of Biomedical Engineering, University of Technology Sydney, Sydney, New South Wales, Australia.; NeoGenix Biosciences Pty Ltd, Sydney, New South Wales, Australia.; IVFAustralia, Sydney, New South Wales, Australia
| | - Steven A Vasilescu
- School of Biomedical Engineering, University of Technology Sydney, Sydney, New South Wales, Australia.; NeoGenix Biosciences Pty Ltd, Sydney, New South Wales, Australia
| | | | - Simon Cooke
- IVFAustralia, Sydney, New South Wales, Australia
| | - Shannon Hk Kim
- IVFAustralia, Sydney, New South Wales, Australia.; University of New South Wales, Sydney, New South Wales, Australia
| | - Gavin P Sacks
- School of Biomedical Engineering, University of Technology Sydney, Sydney, New South Wales, Australia.; IVFAustralia, Sydney, New South Wales, Australia.; University of New South Wales, Sydney, New South Wales, Australia
| | - David K Gardner
- NeoGenix Biosciences Pty Ltd, Sydney, New South Wales, Australia.; Melbourne IVF, Melbourne, Victoria, Australia
| | - Majid E Warkiani
- School of Biomedical Engineering, University of Technology Sydney, Sydney, New South Wales, Australia.; NeoGenix Biosciences Pty Ltd, Sydney, New South Wales, Australia.; Institute for Biomedical Materials & Devices (IBMD), University of Technology Sydney, Sydney, New South Wales, Australia..
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2
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Montjean D, Godin Pagé MH, Pacios C, Calvé A, Hamiche G, Benkhalifa M, Miron P. Automated Single-Sperm Selection Software (SiD) during ICSI: A Prospective Sibling Oocyte Evaluation. Med Sci (Basel) 2024; 12:19. [PMID: 38651413 PMCID: PMC11036211 DOI: 10.3390/medsci12020019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/27/2024] [Accepted: 03/20/2024] [Indexed: 04/25/2024] Open
Abstract
The computer-assisted program SiD was developed to assess and select sperm in real time based on motility characteristics. To date, there are limited studies examining the correlation between AI-assisted sperm selection and ICSI outcomes. To address this limit, a total of 646 sibling MII oocytes were randomly divided into two groups as follows: the ICSI group (n = 320): ICSI performed with sperm selected by the embryologist and the ICSI-SiD group (n = 326): ICSI performed with sperm selected using SiD software. Our results show a non-significant trend towards improved outcomes in the ICSI-SiD group across various biological parameters, including fertilization, cleavage, day 3 embryo development, blastocyst development, and quality on day 5. Similarly, we observed a non-significant increase in these outcomes when comparing both groups with sperm selection performed by a junior embryologist. Embryo development was monitored using a timelapse system. Some fertilization events happen significantly earlier when SiD is used for ICSI, but no significant difference was observed in the ICSI-SiD group for other timepoints. We observed comparable cumulative early and clinical pregnancy rates after ICSI-SiD. This preliminary investigation illustrated that employing the automated sperm selection software SiD leads to comparable biological outcomes, suggesting its efficacy in sperm selection.
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Affiliation(s)
- Debbie Montjean
- Centre d’aide médicale à la procréation Fertilys, 1950 Maurice-Gauvin Street, Laval, QC H7S 1Z5, Canada; (M.-H.G.P.); (C.P.)
| | - Marie-Hélène Godin Pagé
- Centre d’aide médicale à la procréation Fertilys, 1950 Maurice-Gauvin Street, Laval, QC H7S 1Z5, Canada; (M.-H.G.P.); (C.P.)
| | - Carmen Pacios
- Centre d’aide médicale à la procréation Fertilys, 1950 Maurice-Gauvin Street, Laval, QC H7S 1Z5, Canada; (M.-H.G.P.); (C.P.)
| | - Annabelle Calvé
- Centre d’aide médicale à la procréation Fertilys, 1950 Maurice-Gauvin Street, Laval, QC H7S 1Z5, Canada; (M.-H.G.P.); (C.P.)
| | - Ghenima Hamiche
- Centre d’aide médicale à la procréation Fertilys, 1950 Maurice-Gauvin Street, Laval, QC H7S 1Z5, Canada; (M.-H.G.P.); (C.P.)
| | - Moncef Benkhalifa
- Centre d’aide médicale à la procréation Fertilys, 1950 Maurice-Gauvin Street, Laval, QC H7S 1Z5, Canada; (M.-H.G.P.); (C.P.)
- Médecine et Biologie de la Reproduction, CECOS de Picardie et Laboratoire PERITOX, Université Picardie Jules Verne, CBH-CHU Amiens Picardie, 1 Rond-Point du Professeur Christian Cabrol, 80054 Amiens, France
| | - Pierre Miron
- Centre d’aide médicale à la procréation Fertilys, 1950 Maurice-Gauvin Street, Laval, QC H7S 1Z5, Canada; (M.-H.G.P.); (C.P.)
- Médecine et Biologie de la Reproduction, CECOS de Picardie et Laboratoire PERITOX, Université Picardie Jules Verne, CBH-CHU Amiens Picardie, 1 Rond-Point du Professeur Christian Cabrol, 80054 Amiens, France
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3
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Hanassab S, Abbara A, Yeung AC, Voliotis M, Tsaneva-Atanasova K, Kelsey TW, Trew GH, Nelson SM, Heinis T, Dhillo WS. The prospect of artificial intelligence to personalize assisted reproductive technology. NPJ Digit Med 2024; 7:55. [PMID: 38429464 PMCID: PMC10907618 DOI: 10.1038/s41746-024-01006-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 01/10/2024] [Indexed: 03/03/2024] Open
Abstract
Infertility affects 1-in-6 couples, with repeated intensive cycles of assisted reproductive technology (ART) required by many to achieve a desired live birth. In ART, typically, clinicians and laboratory staff consider patient characteristics, previous treatment responses, and ongoing monitoring to determine treatment decisions. However, the reproducibility, weighting, and interpretation of these characteristics are contentious, and highly operator-dependent, resulting in considerable reliance on clinical experience. Artificial intelligence (AI) is ideally suited to handle, process, and analyze large, dynamic, temporal datasets with multiple intermediary outcomes that are generated during an ART cycle. Here, we review how AI has demonstrated potential for optimization and personalization of key steps in a reproducible manner, including: drug selection and dosing, cycle monitoring, induction of oocyte maturation, and selection of the most competent gametes and embryos, to improve the overall efficacy and safety of ART.
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Affiliation(s)
- Simon Hanassab
- Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, UK
- Department of Computing, Imperial College London, London, UK
- UKRI Centre for Doctoral Training in AI for Healthcare, Imperial College London, London, UK
| | - Ali Abbara
- Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Arthur C Yeung
- Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Margaritis Voliotis
- Department of Mathematics and Statistics, University of Exeter, Exeter, UK
- Living Systems Institute, University of Exeter, Exeter, UK
- EPSRC Hub for Quantitative Modelling in Healthcare, University of Exeter, Exeter, UK
| | - Krasimira Tsaneva-Atanasova
- Department of Mathematics and Statistics, University of Exeter, Exeter, UK
- Living Systems Institute, University of Exeter, Exeter, UK
- EPSRC Hub for Quantitative Modelling in Healthcare, University of Exeter, Exeter, UK
| | - Tom W Kelsey
- School of Computer Science, University of St Andrews, St Andrews, UK
| | - Geoffrey H Trew
- Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, UK
- The Fertility Partnership, Oxford, UK
| | - Scott M Nelson
- The Fertility Partnership, Oxford, UK
- School of Medicine, University of Glasgow, Glasgow, UK
- Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Thomas Heinis
- Department of Computing, Imperial College London, London, UK
| | - Waljit S Dhillo
- Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, UK.
- Imperial College Healthcare NHS Trust, London, UK.
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4
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Gallagher MT, Krasauskaite I, Kirkman-Brown JC. Only the Best of the Bunch-Sperm Preparation Is Not Just about Numbers. Semin Reprod Med 2023; 41:273-278. [PMID: 38113923 DOI: 10.1055/s-0043-1777756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
In this Seminar, we present an overview of the current and emerging methods and technologies for optimizing the man and the sperm sample for fertility treatment. We argue that sperms are the secret to success, and that there are many avenues for improving both treatment and basic understanding of their role in outcomes. These outcomes encompass not just whether treatment is successful or not, but the wider intergenerational health of the offspring. We discuss outstanding challenges and opportunities of new technologies such as microfluidics and artificial intelligence, including potential pitfalls and advantages. This article aims to provide a comprehensive overview of the importance of sperm in fertility treatment and suggests future directions for research and innovation.
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Affiliation(s)
- Meurig T Gallagher
- Centre for Human Reproductive Science, Institute of Metabolism and Systems Research, University of Birmingham and Birmingham Women's Fertility Centre, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, B15 2TT, United Kingdom
- Centre for Systems Modelling and Quantitative Biomedicine, University of Birmingham, Birmingham, B15 2TT, United Kingdom
| | - Ingrida Krasauskaite
- Centre for Human Reproductive Science, Institute of Metabolism and Systems Research, University of Birmingham and Birmingham Women's Fertility Centre, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, B15 2TT, United Kingdom
| | - Jackson C Kirkman-Brown
- Centre for Human Reproductive Science, Institute of Metabolism and Systems Research, University of Birmingham and Birmingham Women's Fertility Centre, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, B15 2TT, United Kingdom
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5
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Palmer GA, Tomkin G, Martín-Alcalá HE, Mendizabal-Ruiz G, Cohen J. The Internet of Things in assisted reproduction. Reprod Biomed Online 2023; 47:103338. [PMID: 37757612 DOI: 10.1016/j.rbmo.2023.103338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 09/29/2023]
Abstract
The Internet of Things (IoT) is a network connecting physical objects with sensors, software and internet connectivity for data exchange. Integrating the IoT with medical devices shows promise in healthcare, particularly in IVF laboratories. By leveraging telecommunications, cybersecurity, data management and intelligent systems, the IoT can enable a data-driven laboratory with automation, improved conditions, personalized treatment and efficient workflows. The integration of 5G technology ensures fast and reliable connectivity for real-time data transmission, while blockchain technology secures patient data. Fog computing reduces latency and enables real-time analytics. Microelectromechanical systems enable wearable IoT and miniaturized monitoring devices for tracking IVF processes. However, challenges such as security risks and network issues must be addressed through cybersecurity measures and networking advancements. Clinical embryologists should maintain their expertise and knowledge for safety and oversight, even with IoT in the IVF laboratory.
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Affiliation(s)
- Giles A Palmer
- IVF2.0 Ltd, London, UK; International IVF Initiative, New York, New York, USA
| | | | | | - Gerardo Mendizabal-Ruiz
- Conceivable Life Sciences, New York, New York, USA; Departamento de Bioingeniería Traslacional, Universidad de Guadalajara, Guadalajara, Mexico
| | - Jacques Cohen
- IVF2.0 Ltd, London, UK; International IVF Initiative, New York, New York, USA; Althea Science Inc, New York, New York, USA; Conceivable Life Sciences, New York, New York, USA.
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6
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Lustgarten Guahmich N, Borini E, Zaninovic N. Improving outcomes of assisted reproductive technologies using artificial intelligence for sperm selection. Fertil Steril 2023; 120:729-734. [PMID: 37307892 DOI: 10.1016/j.fertnstert.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/06/2023] [Indexed: 06/14/2023]
Abstract
Within the field of assisted reproductive technology, artificial intelligence has become an attractive tool for potentially improving success rates. Recently, artificial intelligence-based tools for sperm evaluation and selection during intracytoplasmic sperm injection (ICSI) have been explored, mainly to improve fertilization outcomes and decrease variability within ICSI procedures. Although significant advances have been achieved in developing algorithms that track and rank single sperm in real-time during ICSI, the clinical benefits these might have in improving pregnancy rates from a single assisted reproductive technology cycle remain to be established.
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Affiliation(s)
- Nicole Lustgarten Guahmich
- Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York
| | - Elena Borini
- Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York
| | - Nikica Zaninovic
- Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York.
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7
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Michailov Y, Nemerovsky L, Ghetler Y, Finkelstein M, Schonberger O, Wiser A, Raziel A, Saar-Ryss B, Ben-Ami I, Kaplanski O, Miller N, Haikin Herzberger E, Mashiach Friedler Y, Levitas-Djerbi T, Amsalem E, Umanski N, Tamadaev V, Ovadia YS, Peretz A, Sacks G, Dekel N, Zaken O, Levi M. Stain-Free Sperm Analysis and Selection for Intracytoplasmic Sperm Injection Complying with WHO Strict Normal Criteria. Biomedicines 2023; 11:2614. [PMID: 37892988 PMCID: PMC10604130 DOI: 10.3390/biomedicines11102614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023] Open
Abstract
This multi-center study evaluated a novel microscope system capable of quantitative phase microscopy (QPM) for label-free sperm-cell selection for intracytoplasmic sperm injection (ICSI). Seventy-three patients were enrolled in four in vitro fertilization (IVF) units, where senior embryologists were asked to select 11 apparently normal and 11 overtly abnormal sperm cells, in accordance with current clinical practice, using a micromanipulator and 60× bright field microscopy. Following sperm selection and imaging via QPM, the individual sperm cell was chemically stained per World Health Organization (WHO) 2021 protocols and imaged via bright field microscopy for subsequent manual measurements by embryologists who were blinded to the QPM measurements. A comparison of the two modalities resulted in mean differences of 0.18 µm (CI -0.442-0.808 µm, 95%, STD-0.32 µm) for head length, -0.26 µm (CI -0.86-0.33 µm, 95%, STD-0.29 µm) for head width, 0.17 (CI -0.12-0.478, 95%, STD-0.15) for length-width ratio and 5.7 for acrosome-head area ratio (CI -12.81-24.33, 95%, STD-9.6). The repeatability of the measurements was significantly higher in the QPM modality. Surprisingly, only 19% of the subjectively pre-selected normal cells were found to be normal according to the WHO2021 criteria. The measurements of cells imaged stain-free through QPM were found to be in good agreement with the measurements performed on the reference method of stained cells imaged through bright field microscopy. QPM is non-toxic and non-invasive and can improve the clinical effectiveness of ICSI by choosing sperm cells that meet the strict criteria of the WHO2021.
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Affiliation(s)
- Yulia Michailov
- Obstetrics and Gynecology Department, Barzilai University Medical Center, Ashkelon 7830604, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 8410501, Israel
| | - Luba Nemerovsky
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
| | - Yehudith Ghetler
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
| | - Maya Finkelstein
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- IVF Unit, Wolfson Medical Center, Holon 5822012, Israel
| | - Oshrat Schonberger
- IVF Unit, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University, Jerusalem 9112102, Israel
| | - Amir Wiser
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
| | - Arie Raziel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- IVF Unit, Wolfson Medical Center, Holon 5822012, Israel
| | - Bozhena Saar-Ryss
- Obstetrics and Gynecology Department, Barzilai University Medical Center, Ashkelon 7830604, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 8410501, Israel
| | - Ido Ben-Ami
- IVF Unit, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University, Jerusalem 9112102, Israel
| | - Olga Kaplanski
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
| | - Netanella Miller
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
| | - Einat Haikin Herzberger
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
| | - Yardena Mashiach Friedler
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
| | - Tali Levitas-Djerbi
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- IVF Unit, Wolfson Medical Center, Holon 5822012, Israel
| | - Eden Amsalem
- Obstetrics and Gynecology Department, Barzilai University Medical Center, Ashkelon 7830604, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 8410501, Israel
| | - Natalia Umanski
- Obstetrics and Gynecology Department, Barzilai University Medical Center, Ashkelon 7830604, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 8410501, Israel
| | - Valeria Tamadaev
- Obstetrics and Gynecology Department, Barzilai University Medical Center, Ashkelon 7830604, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 8410501, Israel
| | - Yaniv S Ovadia
- Obstetrics and Gynecology Department, Barzilai University Medical Center, Ashkelon 7830604, Israel
| | - Aharon Peretz
- IVF Unit, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University, Jerusalem 9112102, Israel
| | - Gilat Sacks
- IVF Unit, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University, Jerusalem 9112102, Israel
| | - Nava Dekel
- IVF Unit, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University, Jerusalem 9112102, Israel
| | - Odelya Zaken
- IVF Unit, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University, Jerusalem 9112102, Israel
| | - Mattan Levi
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
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Salih M, Austin C, Warty RR, Tiktin C, Rolnik DL, Momeni M, Rezatofighi H, Reddy S, Smith V, Vollenhoven B, Horta F. Embryo selection through artificial intelligence versus embryologists: a systematic review. Hum Reprod Open 2023; 2023:hoad031. [PMID: 37588797 PMCID: PMC10426717 DOI: 10.1093/hropen/hoad031] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/17/2023] [Indexed: 08/18/2023] Open
Abstract
STUDY QUESTION What is the present performance of artificial intelligence (AI) decision support during embryo selection compared to the standard embryo selection by embryologists? SUMMARY ANSWER AI consistently outperformed the clinical teams in all the studies focused on embryo morphology and clinical outcome prediction during embryo selection assessment. WHAT IS KNOWN ALREADY The ART success rate is ∼30%, with a worrying trend of increasing female age correlating with considerably worse results. As such, there have been ongoing efforts to address this low success rate through the development of new technologies. With the advent of AI, there is potential for machine learning to be applied in such a manner that areas limited by human subjectivity, such as embryo selection, can be enhanced through increased objectivity. Given the potential of AI to improve IVF success rates, it remains crucial to review the performance between AI and embryologists during embryo selection. STUDY DESIGN SIZE DURATION The search was done across PubMed, EMBASE, Ovid Medline, and IEEE Xplore from 1 June 2005 up to and including 7 January 2022. Included articles were also restricted to those written in English. Search terms utilized across all databases for the study were: ('Artificial intelligence' OR 'Machine Learning' OR 'Deep learning' OR 'Neural network') AND ('IVF' OR 'in vitro fertili*' OR 'assisted reproductive techn*' OR 'embryo'), where the character '*' refers the search engine to include any auto completion of the search term. PARTICIPANTS/MATERIALS SETTING METHODS A literature search was conducted for literature relating to AI applications to IVF. Primary outcomes of interest were accuracy, sensitivity, and specificity of the embryo morphology grade assessments and the likelihood of clinical outcomes, such as clinical pregnancy after IVF treatments. Risk of bias was assessed using the Modified Down and Black Checklist. MAIN RESULTS AND THE ROLE OF CHANCE Twenty articles were included in this review. There was no specific embryo assessment day across the studies-Day 1 until Day 5/6 of embryo development was investigated. The types of input for training AI algorithms were images and time-lapse (10/20), clinical information (6/20), and both images and clinical information (4/20). Each AI model demonstrated promise when compared to an embryologist's visual assessment. On average, the models predicted the likelihood of successful clinical pregnancy with greater accuracy than clinical embryologists, signifying greater reliability when compared to human prediction. The AI models performed at a median accuracy of 75.5% (range 59-94%) on predicting embryo morphology grade. The correct prediction (Ground Truth) was defined through the use of embryo images according to post embryologists' assessment following local respective guidelines. Using blind test datasets, the embryologists' accuracy prediction was 65.4% (range 47-75%) with the same ground truth provided by the original local respective assessment. Similarly, AI models had a median accuracy of 77.8% (range 68-90%) in predicting clinical pregnancy through the use of patient clinical treatment information compared to 64% (range 58-76%) when performed by embryologists. When both images/time-lapse and clinical information inputs were combined, the median accuracy by the AI models was higher at 81.5% (range 67-98%), while clinical embryologists had a median accuracy of 51% (range 43-59%). LIMITATIONS REASONS FOR CAUTION The findings of this review are based on studies that have not been prospectively evaluated in a clinical setting. Additionally, a fair comparison of all the studies were deemed unfeasible owing to the heterogeneity of the studies, development of the AI models, database employed and the study design and quality. WIDER IMPLICATIONS OF THE FINDINGS AI provides considerable promise to the IVF field and embryo selection. However, there needs to be a shift in developers' perception of the clinical outcome from successful implantation towards ongoing pregnancy or live birth. Additionally, existing models focus on locally generated databases and many lack external validation. STUDY FUNDING/COMPETING INTERESTS This study was funded by Monash Data Future Institute. All authors have no conflicts of interest to declare. REGISTRATION NUMBER CRD42021256333.
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Affiliation(s)
- M Salih
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Department of Data Science and Artificial Intelligence, Faculty of Information Technology, Monash University, Clayton, Victoria, Australia
| | - C Austin
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Department of Data Science and Artificial Intelligence, Faculty of Information Technology, Monash University, Clayton, Victoria, Australia
| | - R R Warty
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - C Tiktin
- School of Engineering, RMIT University, Melbourne, Victoria, Australia
| | - D L Rolnik
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Women’s and Newborn Program, Monash Health, Melbourne, Victoria, Australia
| | - M Momeni
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - H Rezatofighi
- Department of Data Science and Artificial Intelligence, Faculty of Information Technology, Monash University, Clayton, Victoria, Australia
- Monash Data Future Institute, Monash University, Clayton, Victoria, Australia
| | - S Reddy
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - V Smith
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - B Vollenhoven
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Women’s and Newborn Program, Monash Health, Melbourne, Victoria, Australia
- Monash IVF, Melbourne, Victoria, Australia
| | - F Horta
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Monash Data Future Institute, Monash University, Clayton, Victoria, Australia
- City Fertility, Melbourne, Victoria, Australia
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Curchoe CL. Proceedings of the first world conference on AI in fertility. J Assist Reprod Genet 2023; 40:215-222. [PMID: 36598733 PMCID: PMC9935785 DOI: 10.1007/s10815-022-02704-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 01/05/2023] Open
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Kumar RS, Sharma S, Halder A, Gupta V. Deep Learning-Based Robust Automated System for Predicting Human Sperm DNA Fragmentation Index. J Hum Reprod Sci 2023; 16:16-21. [PMID: 37305775 PMCID: PMC10256941 DOI: 10.4103/jhrs.jhrs_4_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 06/13/2023] Open
Abstract
Background Determining the DNA fragmentation index (DFI) by the sperm chromatin dispersion (SCD) test involves manual counting of stained sperms with halo and no halo. Aims The aim of this study is to build a robust artificial intelligence-based solution to predict the DFI. Settings and Design This is a retrospective experimental study conducted in a secondary in vitro fertilisation setup. Materials and Methods We obtained 24,415 images from 30 patients after the SCD test using a phase-contrast microscope. We classified the dataset into two, binary (halo/no halo) and multiclass (big/medium/small halo/degraded (DEG)/dust). Our approach consists of a training and prediction phase. The 30 patients' images were divided into training (24) and prediction (6) sets. A pre-processing method M was developed to automatically segment the images to detect sperm-like regions and was annotated by three embryologists. Statistical Analysis Used To interpret the findings, the precision-recall curve and F1 score were utilised. Results Binary and multiclass datasets containing 8887 and 15,528 cropped sperm image regions showed an accuracy of 80.15% versus 75.25%. A precision-recall curve was determined and the binary and multiclass datasets obtained an F1 score of 0.81 versus 0.72. A confusion matrix was applied for predicted and actuals for the multiclass approach where small halo and medium halo confusion were found to be highest. Conclusion Our proposed machine learning model can standardise and aid in arriving at accurate results without using expensive software. It provides accurate information about healthy and DEG sperms in a given sample, thereby attaining better clinical outcomes. The binary approach performed better with our model than the multiclass approach. However, the multiclass approach can highlight the distribution of fragmented and non-fragmented sperms.
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Affiliation(s)
| | - Swapnil Sharma
- Linkedin Technology Information Pvt. Ltd., Mumbai, Maharashtra, India
| | | | - Vipin Gupta
- Linkedin Technology Information Pvt. Ltd., Mumbai, Maharashtra, India
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