embryos . But the risk will go up as patients age and will double after 37 years of age .
The most common abnormalities are aneuploid ones , meaning that the embryos have different copy numbers of chromosomes than normal ones . For example , embryos with Down syndrome have an extra copy of chromosomes .
Is the standard screening method ( PGS or PGT-A ) able to pick up these abnormalities , and can it lead to false positives where an embryo that might lead to a healthy pregnancy is flagged as abnormal ? Adelle Lim : In medicine , we cannot have a 100 percent guarantee . PGT-A is a comprehensive but invasive screening tool that is 99 percent accurate and can give three types of results : normal ( euploid ), abnormal ( aneuploid ), and mosaic , which is in the middle between normal and abnormal . But if there are no other embryos available , sometimes we advise patients to go for mosaic embryo transfer because we can have healthy live births from mosaic embryos . In fact , during PGT-A , we test the cells that form the placenta , which can be abnormal even if the inner cells forming the foetus are genetically normal . This means that the cells tested during PGT-A are not always reflective of the foetus ’ cells . We will not biopsy the cells that are going to form the foetus because we don ’ t want to harm them .
What are the positives of using AI as an alternative to PGT-A ? Adelle Lim : AI is non-invasive because it just processes the embryo images and gives you a prediction , but it ’ s less accurate than PGT-A which takes cells from embryos to count chromosome numbers .
AI is also cheaper than PGT-A because anything involving DNA analysis is very costly . That ’ s why at Alpha we use AI to preselect the best embryos to test with PGT-A to save patients a lot of money .
So we can say that AI gives assistance to embryologists and clinicians to make a better decision . It can be considered a complementary tool to assist fertility experts in speeding up the decisionmaking process .
What ’ s been the initial reception to this procedure from your patients ? Adelle Lim : AI procedures are still a new thing in Malaysia . A lot of people still don ’ t understand what it is but actually in their every day life they are using it without realising it . So the awareness about AI in IVF is still premature . That is why at Alpha we offer AI services at zero cost to our patients .
Do you believe that AI will be a game changer in embryo genetic screening and in fertility medicine in general ?
Embryologists are still needed despite the advances made by AI
Adelle Lim : I believe AI will revolutionise treatment by helping us prioritise which embryos to transfer , thus giving patients the fastest time to pregnancy , which means couples won ’ t need to undergo repeated embryo transfer procedures .
This will also decrease the need for the transfer of multiple embryos . Doctors tend to insert multiple fertilised embryos to achieve a higher success rate . But this practice will lead to multiple pregnancies , which can cause complications , such as preterm labour , further culminating in premature delivery and low birth weight .
Can the use of AI be extended to other areas of fertility medicine in the future ? Adelle Lim : I believe AI can provide a single assistant tool for the whole IVF journey , from ovulation stimulation for egg selection to sperm selection and embryo selection .
Over time , the technology may even improve its accuracy because in AI systems the larger the data the more accurate the prediction . n
GlobalHealthAsiaPacific . com ISSUE 1 | 2023
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