– By Alexander Kotlyar, MD
We live in a world dominated by enhanced computing power and robotic systems. Given the potential of all this technology, it is essential for reproductive physicians and their patients to understand these technologies and determine how they could enhance the care of their patients. Two technological advances which are at this frontier are artificial intelligence and robot-assisted surgery.
The technology and science behind treating infertility are becoming increasingly complex, and the volume of data used to make clinical decisions is expanding on an almost monthly basis. With so much information that we can gather about a couple that is experiencing infertility, their treatment cycle(s), and the embryos they make, it begs the question of how best to use this sea of information to maximize the chance of healthy pregnancy. This is where the new frontier of artificial intelligence (AI) and the subfield of machine learning (ML) comes into play.
ML utilizes algorithms that incorporate demographic, clinical, pathological, and genetic information to find connections and predict clinical outcomes in ways that humans cannot easily achieve. It finds patterns in the data and is constantly refining them to produce ever better predictions; this technology is always learning how to learn better so as to predict outcomes even better.
Reproductive medicine has already started testing the potential of AI in the assessment of eggs and embryos, which can rival the accuracy of embryologists with years of experience. This automation can not only supplement determinations made by embryology staff but can help ensure optimal patient outcomes, minimizing the cost in time and money. AI has also been implanted in the assessment of sperm with its accuracy of correctly identifying well-developed sperm approaching 90%.
AI remains one of the hottest topics in reproductive medicine. As additional data becomes available for the artificial intelligence algorithms, ever-increasing accuracy will be achieved with the promise of ever better clinical outcomes.
In contrast to AI, robotic surgery has a much longer history in reproductive medicine. While the idea of robotic surgery seems relatively new, it has existed for over 50 years and developed as we know it from the department of defense research focused on doing battlefield surgery from miles away.
Over the past several decades, robotic technology grew with improvements in computing power and imaging technology which led to the modern Da Vinci robotic system. Admittedly, this system isn’t an autonomous robot. Any movement by the surgical robot comes from commands made by a specially trained surgeon on a nearby console.
The main advantage of the robot comes from the very fine movements possible with the numerous tools and arms at the surgeon’s disposal. In addition, the robot eliminates a natural tremor or shake in the surgeon’s hands. This makes exquisitely delicate surgeries such as tubal ligation reversals much easier and potentially quicker.
Currently, robotic surgery is performed for a myriad of conditions that impact reproduction in addition to tubal ligation reversal. These include fibroid surgery, surgery to excise and remove endometriosis, and fertility preservation surgeries such as ovarian transposition/transplantation. In a study from The Cleveland Clinic, using the robot for fibroid surgery led to decreased blood loss and length of hospital stay. These clinical advantages combined with improved visualization and dexterity make robotic surgery a fixture of reproductive medicine.
Both of these technologies are still evolving, with a myriad of studies currently underway to better refine and apply AI and robotic surgery. Each holds immense promise for a new age in reproductive medicine.
About the Author
Alexander Kotlyar completed medical school at Dartmouth in 2014. From there, he completed his residency in obstetrics and gynecology at the world-renowned Cleveland Clinic, where he gained experience in the whole spectrum of reproductive surgery, including robotic surgery. In addition, he was involved with the team that performed the first uterine transplant in the United States.
Afterward, he completed his fellowship in Reproductive Endocrinology and Infertility at Yale University. His research focused on finding novel treatments for endometriosis and has been published in leading journals in reproductive medicine. Currently, he is a reproductive endocrinology and infertility specialist at Genesis Fertility/Maimonides Medical Center in Brooklyn, NY.