Comment: How cutting-edge femtech can remove the barriers to IVF and close the fertility gap

Hans Gangeskar, CEO of Overture Life, on harnessing lab automation to make IVF more accessible.

As infertility rates continue to rise globally, in vitro fertilisation (IVF) is an increasingly critical aspect of women’s health and reproductive freedom.

The promise that women should be able to choose when and if to have a baby remains unfulfilled without radical technological advances in IVF both to improve outcomes and to reduce prices. At current costs and success rates, IVF remains out of reach for most women due to cost and emotional burden.

IVF has recently reentered the political arena in the US, where most women must pay out of pocket for an IVF cycle can cost in excess of $20,000 (£15,800), and on average it takes 2.5 cycles to have a baby, driving the average cost of an IVF baby to around $50,000 (£39,500).

This is obviously out of reach in most cases. The conversation has centered around better insurance coverage, but that cannot address the underlying lack of capacity. IVF is supply constrained because there are not enough IVF clinics and embryology labs to meet current demand.

The key to expanding access, in the US and globally, is to bring down the cost of each cycle, and drastically reduce the number of cycles necessary.

We need the opposite of the development we have seen in the rest of healthcare, where the price of services increases much faster than inflation.

Driving prices down and quality up to make IVF affordable requires new technology, standardisation and automation.

The costs of infertility and IVF are not just financial, and for many couples the burden of a failed cycle and the stress of the high financial burden combine to reach a threshold where they give up.

Researchers and experts around the world continue to tell us why fertility rates are dropping. Reasons cited range from expense of child rearing, forever chemicals, diseases like cancer and long covid and more.

It is however very clear to us that the time when women want to have children has changed, and this is an area where technology can come in and deliver more reproductive freedom to address fertility obstacles head-on.

Globally, only a fraction of fertility service demand is met, and new technology must deliver lower costs but also better results. Even successful IVF generally takes multiple attempts, with attendant stresses on physical and mental health – 80% of IVF patients report symptoms of clinical depression.

Cutting-edge femtech has the ability to address the fertility gap in novel ways, especially by modernising and miniaturising the embryology lab.

Shrinking costs

One of the main drivers of the high price tag is embryology laboratory expenses, which can account for half of all IVF costs, limiting access in several ways. First, many procedures done today are still manual, resembling ones used 45 years ago. This limits viability rates, driving up the number of cycles needed for a successful IVF.

It also means the procedures remain complex, requiring highly trained staff who are in high demand. This in turn helps make it cost-prohibitive for small facilities to fully staff an embryology lab, thereby capping availability – and over 5 million women in the UK now have limited or no access to local fertility clinics.

Bringing IVF costs down is primarily a question of opening more points of care. We need to make it possible to offer IVF services alongside other medical services making it economically viable to serve only 100 IVF cycles per year, or even as low as 20.

Technology is beginning to enable this potential. In addition, the promise of automation is not just efficiency, it is the ability to standardise and iterate. And this isn’t just the ability to standardize across an industry, but to standardize between shifts in a single clinic.

IVF clinics have pioneered many advances in the field, but it is also a very manual and artisanal practice, making it hard to copy processes from one embryologist to another, let alone from one clinic to the next.

Automated technology helps standardise steps like egg freezing, intracytoplasmic sperm injection (ICSI), and embryo selection, which are prone to human error.

Together, these platforms have been shown to improve viability rates meaningfully – a huge cost savings for patients. It can also shrink the required overhead for a small facility by an order of magnitude, further lowering costs while expanding access.

An automated world

Bringing IVF services to fertility deserts first and foremost requires portability. Microfluidics, a technology popularised in medtech to bring complex processes closer to the point of care, is important for both shrinking and automating vitrification – the freezing and thawing of eggs and embryos.

Because it is a more gentle way of handling cells (eggs), microfluidics reduces osmotic stress on fragile cells, minimising egg and embryo loss. It also enables small, powerful automated devices.

Robotics is also key for any automation paradigm, generally reducing both handling time and process complexity. There is a prime opportunity for improvement when making an embryo, the most challenging task in an embryology lab.

Technology is now in use that can automate the technique known as Piezo-ICSI, a gentle and precise method to inject sperm into an egg that improves both fertilisation and blastocyst development.

Robotic ICSI has already resulted in two live births and has been shown to increase fertilisation rates to 93 per cent, compared to 89 per cent for manual methods.

Of course, the consistency of robotics also removes the potential for human variability and error, removing the potential for fatigue.

Anecdotally, some IVF clinics have noted lower success rates when complex manual procedures are performed by embryologists late in the day.

A robotic platform can also reduce inconsistency between embryologists and between labs, which translate into more consistent, better outcomes.

The third critical piece for automation excellence is advanced analytics, especially when paired with AI techniques. Technology has been deployed to improve on standard preimplantation genetic testing (PGT), which helps identify and select embryos without genetic disease.

However, standard PGT predicts embryo implantation at just 60%, leaving plenty of room for improvement. It also relies on a biopsy to remove cells from the embryo, which carries a small risk of damaging it.

Newer methods utilize metabolomics powered by machine learning. These platforms have been shown to improve implantation prediction accuracy above 80%, and can identify and discard 90% of aneuploid embryos (with chromosomal abnormalities). Because only metabolites produced by the embryo, no invasive biopsy is required, reducing the demand on embryologists while helping to identify stronger embryos.

Given the significant and growing fertility challenges around the world, and the notable gaps in access to treatment driven by cost and geography, it’s clear that we in the fertility field need to do a better job of reaching women everywhere. Because labwork is not patient-facing, its impact can be broadly underestimated or even ignored.

However, the reality is that there are multiple opportunities to improve the embryology lab through automation, improving outcomes and ensuring embryologists can spend more time with more patients.

Hans Gangeskar is CEO of Overture Life, which aims to simplify and automate the complex processes of embryology.