Endometriosis is one of the leading causes of female infertility. Oftentimes, a decade delay in diagnosis surprises many women as they discover this condition while starting to build a family. Early intervention, assessment of reproductive health, and new technologies provide women the best opportunities throughout their family-building journeys.
Dr. Assaf Ben-Meir, fertility specialist and co-founder of Fairtility, spoke to DocWire News about valuable insights, and new artificial intelligence solutions for women with endometriosis in the IVF community.
DocWire News: Can you provide us with some background on yourself, and the company, Fairtility?
Dr. Assaf Ben-Meir: Okay. So, as you said, I’m the director of the IVF unit in Hadassah Ein Kerem, and seven years ago we started to do some research on artificial intelligence and how it can help in the fertility field. And after five years of research, we opened a company called Fairtility. And the idea behind Fairtility is that we are trying to find any solution for all of the steps that the couples get through fertility treatment, from the diagnosis, from the beginning, through the protocol treatment, through the IV treatment itself, the embryo selection, which embryo to transfer, and also to try to predict what is the chance to have a baby. This is one of the things that we are still missing in the fertility treatment. And this is what we are trying to do in our company.
Talk to us about endometriosis – how many women does it affect, and what is the impact?
So endometriosis is a disease when the lining of the uterus is implanted outside of the uterus. It can be in the ovaries; it can be in the pelvis; it can be even outside of the abdomen. And the big problem is that we don’t really have a good, simple diagnosis for endometriosis. And we assume that about 5 to 10% of the population has endometriosis. Not all of them have the symptoms, but it’s a very common disease. And the main symptoms are pain during menstruation, pain during intercourse and infertility. And the reason for infertility is there’s about three reasons. First of all, there’s the mechanical issue. So women with endometriosis have adhesions at the pelvis and it can block the tubes. The second reason is that we know that women with endometriosis have a lower quality of the eggs. And the third reason, we also think that in some of the cases, there’s issue with the implantation of the embryo into the lining of the cavity. So those are the reason why there’s fertility problem in some of the women with endometriosis.
And again, in some of the cases, we will have to go through IVF. And another issue of course, in the recent years, is that we recommend patient with endometriosis to have fertility cryo-preservation, so to save eggs or to save embryos for the future. Again, because the quality of the eggs will reduce with time, because in some of the cases, when they will have to do surgery, it will decrease the number of eggs they have, so for all of those reasons, we recommend the patient to have cryo-preservation of eggs.
How do IVF medications affect endometriosis?
So endometriosis is influenced by hormones. We know that, and during the treatment, in some of the cases, the patient may have some more pain than usual, although we must say that in some of the cases, we can give the patient medication that will not increase the hormones a lot. And another thing that we need to know that the treatment itself is short. It’s about two weeks. So usually they’re not really getting worse than usual, unless they have to repeat the treatment again and again and again.
What is embryo quality like in women with endometriosis?
So we know, especially from egg donation programs, we know that when the donor has endometriosis, the chance that the embryo will implant in the recipient woman is lower than when the eggs comes from a normal or a non-endometriosis patient. On contrary, if we are trying to implant the embryo in a woman with endometriosis, the chance for pregnancy is the same as if she doesn’t have any endometriosis. So from that we understand that the main issue is probably the egg itself. So the quality of the eggs are lower and then the chance that the embryo will be implanted is lower. And again, for that reason, we really need to know what is the quality of the egg and what is the quality of the embryo before we implant it or before we give the patient any idea or any information about her future fertility.
How is Fairtility using artificial intelligence to improve IVF outcomes?
We are trying to introduce artificial intelligence into any step of the IVF treatment. Let’s say that the main… We started with what we call embryo selection. So during IVF treatment, we produced several embryos, and now we need to know which one of them we want to transfer. Of course we will not transfer all the embryos that we produced. There’s several of them. Especially in young women, we will not transfer several embryos because we are afraid of multiple pregnancy and the risk with multiple pregnancy. And that’s why we need to find out which is the best embryo that has the highest potential to get a pregnancy.
When we are doing a fertility cryo-preservation, there’s another problem because when we freeze eggs, the only thing that I know about the egg is that it is what we call mature egg; it is ready for fertilization. We cannot give any other score to the eggs what is the potential of this egg. The idea between introducing artificial intelligence into fertility is that we might be able to give more prediction of what is the quality of the eggs. And today we know to predict what is the quality of the embryos. So if the patient decide to freeze embryos, we can tell her what is the chance that those embryos will be implanted and what is the chance that she will have a baby eventually, learn more here.
How we do it? So today the embryos are grown in incubators, what we call time lapse incubators. So those incubators take a snapshot of the embryo development every, let’s say, between 15 to 20 minutes. So after three to five days of incubation, we can get a movie that we will see the development of the embryo. So at the beginning, we just look on those movies and decided how is the progress of the embryos and if it’s a normal progress. The second step was to try to see the timing of the events during the embryo development, when it developed to two cells to three cells to four cells, et cetera, et cetera.
And today, this is what we did in our study and also in the company, today we give the computer the whole movie and the computer looks on all the events, what is the morphology, how the embryo looks like and give us at the end of the day, give us a score to the embryo. That is a very good prediction of what is the chance to have a baby with this embryo. So today, when a patient will freeze her eggs or freeze her embryo with the AI, we will have much more information about the embryos, and we can let her know what is the chance that at the end of the day when she tried to get pregnant with those embryo, what is the chance that she actually will have a child.
So this is the main advantage of AI. The computer can look on much more information about the embryo and not just the morphology or how it’s looked like, also to see the development of the embryo, to get all of this into what we call algorithm. This is the calculation that the computer will do, and eventually we’ll get a score. And this is the tool that we have right now.
Any closing thoughts?
I think in the future, we will have much more information that we can get from the AI from the beginning to understand what is the best protocol for the patient. For the patient that’s sitting in front of you, will be more… They will get AI into the monitoring during the treatment, when to do the egg retrieval. But the main issue, of course, is to understand what is the quality of the egg, or what is the quality of the embryo. And I think for that, we already have a very good tool, a very good predictor to let the patient know what is the chance that you will get pregnant eventually.