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Throughout the world, the demand for fertility treatment continues to rise, especially in the United States and Europe. In response, over the past few years, many fertility startups have focused on improving outcomes via solutions like better ovulation tracking and at-home fertility testing.

However, these innovations don’t have any impact on outcomes in the very place patients using at-home monitoring will have to go if they require clinical intervention: the IVF clinic.

That’s where they’ll run into a problem they didn’t anticipate: fertility centers don’t have enough embryologists.

In my 36 years as the director of an IVF laboratory, I’ve never seen anything like it. Nearly every fertility center I know of is looking for trained embryologists. Meanwhile, the waitlists and wait times for IVF treatment continue to grow.

In 2014, Fertility and Sterility published a study comparing how contemporary IVF labs operate to how IVF labs have historically operated. The study found that embryologists have to perform 56 different procedures in a lab daily. That number has only grown in the past eight years.

These procedures must not only be learned but mastered. Embryologists have to move quickly at all times because eggs and embryos are sensitive to environmental changes, such as temperature fluctuations. Any mistake could jeopardize a patient’s chance at a family. They also perform a quality control function for each step, which means that there’s a large administrative workload in addition to conducting the procedure. The days are long, and the pressure in the lab is intense.

It’s burning embryologists out. They don’t have the support they need to remain in the profession, and the field currently doesn’t have the necessary pipeline or training in place to replace them.

The embryologist shortage is at risk of hindering progress in IVF labs.

Hastening Embryologists’ Training

For the past two years, whenever I’ve had to hire an embryologist, I ended up training them in my lab because I couldn’t find any who were already trained.

One of the reasons for the current embryologist shortage, at least in the U.S., is that fertility clinics have amalgamated into corporate networks of IVF centers, which are growing rapidly as the need for treatment scales. As a result, the demand for trained embryologists has gone through the roof.

The other reason is that the career pathway for embryology isn’t straightforward. Because the procedures are highly technical and require expert hand-eye coordination, training as an embryologist takes at least a year. Many laboratories don’t want to take the time to train people in-house; however, only a few universities offer embryologist training programs, so the number of recent graduates with the required skills entering the field is disproportionate to the number of IVF labs seeking employees.

Part of the solution to this supply side problem lies in automation. By automating parts of the IVF process, we can reduce the training time required to become an embryologist and make the job of an embryologist less stressful, resulting in an increase in both the number of embryologists entering and remaining in the profession.

With automation, embryologists can bypass learning some of the steps that require time-intensive training and practice when they’re performed manually, thereby shortening the amount of time needed to become an embryologist.

Let’s consider ICSI– the only treatment available for male infertility– which requires embryologists to learn microscopic movements and use two micro-manipulators to inject eggs under high-power magnification. The egg has to be injected exactly in the center, which is challenging at that level of magnification. If embryologists aren’t careful, they can rupture the eggs. Learning this technique requires a lot of practice.

In my lab, embryologists practice on frozen hamster eggs– they are smaller and more difficult to inject than human eggs– until they have mastered the skill. They have to practice with the micro manipulators until their hands have the muscle memory to perform the injection correctly each time. That muscle memory only comes with time and practice.

Having technologies that remove some of these steps would speed up the training time. For instance, Fertilis’s microICSI device removes the need for one of the micro-manipulators, and it uses a channel to guide embryologists’ pipettes to the injection site on the egg. It simplifies the technique, which means that embryologists don’t have to master all the complicated steps required for performing ICSI manually.

Shortening the amount of training required to become an embryologist can help attract more recent graduates into the field while simultaneously increasing the rate at which they are capable of independently performing the job.

However, automation can also help keep embryologists in the profession.

Reducing Embryologists’ Workloads, Improving Stress Levels, and Stopping Attrition

Embryology is extremely time-sensitive.

At most fertility centers, the clinical staff and the lab staff have strong working relationships. However, clinical staff are busy people with work pressures of their own. They often can’t keep up with the logistics and timing required for lab procedures. Because they’re in a patient facing role, they’re under stress to meet patient requests. For instance, if a patient changes her mind and decides to freeze half of her eggs, the clinical staff will likely want to support that decision. However, introducing that change into the lab schedule at short notice is problematic because egg freezing is a time-sensitive and labor-intensive procedure. The embryologists will undergo a lot of stress as they attempt to rearrange other time-sensitive procedures, worrying about the risk of compromising the cases of other patients while responding to the time-sensitive request of this patient.

The smallest mistakes can have the highest cost. When these mistakes happen, they have an emotional impact on the embryologists. Burnout and attrition are growing problems in the field.

Automation can help by speeding up the time it takes to perform procedures while simultaneously removing a number of manual steps, which reduces the risk of human error.

For instance, streamlining and standardizing the ICSI process with a micro-medical device that removes the need for one micro-manipulator reduces the risk of human error and the time it takes to perform the procedure. Currently, injecting 10 eggs takes an embryologist about 30 minutes. If you could cut that time to 15-minutes by automating parts of the process, then you’ve halved the time it takes to do the procedure.

Cutting procedure time in half would give embryologists more time to get through their workload and breathing room to account for unexpected schedule changes like the one mentioned above. In a best case scenario, it gives them more time to treat additional patients.

The automation of embryology is coming – it’s an inevitability if we’re to continue to make progress and keep improving IVF treatments. Fertility centers are hitting a point where we cannot grow or innovate because of the constraints brought on by the embryologist shortage. Embryologists do not currently have time to try new technologies or explore new techniques for improving success rates. They cannot innovate if they do not have time. Automation can help give them that time.

We also need to use automation to make embryology training more efficient and improve the work-life balance within IVF labs. Doing so will increase the number of embryologists entering the field and improve the retention of legacy embryologists.

Attracting and retaining embryologists is important — not only because we need more of them but also because embryology is a wonderful career. It’s fascinating and beautiful. It’s scientifically interesting and exciting, and above all else, you get to provide a real altruistic service for people: you are intimately involved in helping them have or grow a family. Nothing feels better than that.

We need to make this career more accessible and sustainable for anyone interested in pursuing it.

Dr. Rusty Pool

Scientific Director at the Fertility Center of San Antonio