Since the first baby was conceived through in vitro fertilization (IVF) in 1978, there have been more than 8 million people born via IVF. The success rates have drastically improved over the last few decades, largely due to technological advancements in medicine, but still only about one-third of patients have successful live births through IVF. Surprising, we know.
The truth is, there are many decisions that go into improving one’s chance at IVF success, and a lot can vary from patient to patient. When it comes to ovarian stimulation during IVF, there are a few common protocols, each of which includes its own set of medications and instructions:
Antagonist protocol (short protocol): This protocol begins with your menstrual cycle and involves using medications called GnRH antagonists to block the production of certain hormones that stimulate the ovaries. This allows the medical team to more precisely control the timing of ovulation and egg retrieval. The antagonist protocol is typically shorter in duration than other protocols (8-14 days), and is better for patients at risk of ovarian hyperstimulation syndrome (OHSS).
Agonist down regulation protocol (long protocol): The agonist down regulation protocol is often referred to as the "long protocol" because it involves a longer period of hormone suppression before starting fertility medication. The goal of this protocol is to down-regulate the ovaries and create a more controlled environment for the growth and development of eggs. Your Reproductive Endocrinologist may choose this protocol, which can take as long as 4-5 weeks, if you are at risk of premature ovulation.
Flare protocol: The flare protocol encourages, rather than suppresses, the production of FSH. It’s a good option for patients who have responded poorly to other protocols, or who are of advanced maternal age.
Mini-IVF: Mini-IVF is a modified version of traditional IVF that involves using lower doses of fertility medication and fewer injections. The goal of Mini-IVF is to produce fewer eggs while still maintaining good fertilization rates and pregnancy outcomes. Mini-IVF may be a good option for those with low ovarian reserve or who have had unsuccessful cycles with more “traditional” IVF protocols.
All four of these protocols have the same purpose: to encourage follicle growth, control the timing of ovulation, and retrieve as many eggs as possible while avoiding OHSS. But how does your Reproductive Endocrinologist and medical team decide which protocol is right for you?
Tailoring IVF protocols to your individual needs
In any IVF process, Reproductive Endocrinologists, nurses, and embryologists use the information they have available to make the best choices on behalf of their patients. And with new artificial intelligence (AI) technology, your medical team can easily view what has worked for patients like you from around the country to help inform their decisions.
The fertility technology company, Alife Health, has built software that can process vast amounts of data (a.k.a. past IVF cycle information from clinics around the country) and show your doctor what protocol has worked for patients similar to you. Ultimately, your doctor knows you best, and can combine this information with their expertise to come up with the best plan of action.
“Alife is creating products that make machine learning accessible to clinicians. An algorithm can't help us if we are unable to put the recommendations into practice, and Alife has a very skilled product team that does just that. By putting insights at the fingertips of decision makers in an interpretable way, the power of machine learning can be unlocked to help patients,” explains Dr. Eduardo Hariton, a Reproductive Endocrinologist and Infertility specialist.
How can AI impact IVF protocols?
The two types of injectable hormones typically used during an IVF protocol are follicle stimulating hormone (FSH) and luteinizing hormone (LH). Physicians have to decide the best dose of gonadotropins for their individual patients during IVF, which can get tricky.
“Too little FSH may result in not enough stimulation and thus few eggs retrieved, while too much FSH can result in ovarian hyperstimulation syndrome (OHSS), a condition caused by an excessive response of the ovaries,” explains data scientist Michael Fanton, PhD.
Typically, patients are prescribed between 100 and 600 international units (IUs) of daily FSH during IVF. For many patients, however, more FSH does not equate more eggs. In other words, a higher FSH dosage does not necessarily improve IVF outcomes. Your doctor’s goal is to suggest an optimal dose of FSH that gets an ideal outcome while reducing the number of injections necessary (which also reduces the overall cost of medications). This is where AI technology can come into play.
Alife recently conducted research with Stim Assist™, their clinical decision support tool that uses AI to help your doctor determine the optimal treatment plan for IVF medication. In the study, the researchers analyzed over 90% of all cycles that occurred in the US between 2014-2019. The results suggest that if Alife’s Stim Assist™ had been used, it may have helped doctors retrieve a higher number of mature eggs and lowered the amount of medication given. More eggs means that there are more opportunities to transfer embryos, and thus a higher chance of a successful pregnancy.
Not only did this study demonstrate that AI technologies can help cut costs for IVF patients, it showed that AI algorithms may ultimately be able to help fertility specialists make more informed, quicker decisions for their patients by sifting through large quantities of data and presenting it in simple, easy-to-access insights.
Why is there a need for improved IVF technologies?
“We have improved significantly at the science aspects of IVF over the last forty-some years, but we still have a long way to go in increasing access to care for all of those who need IVF,” says Dr. Hariton. “AI and machine learning not only offer the prospect of improved outcomes, but also of improved efficiency which can then be translated into lower cost and higher value care.”
New innovative technologies are spearheading the way for using AI to assist doctors in determining the best IVF protocol for you, and that’s pretty cool.
Brighid Flynn is a freelance writer based in Philadelphia where she lives with her husband and puppy. She is just beginning her journey toward motherhood.