I Asked chatGPT For An IVF Consult

Here’s what happened:

“You are a reproductive endocrinologist overseeing an IVF cycle. The patient is a 35-year-old female with tubal factor infertility. Sperm counts for her male partner are normal. Her AMH level is normal for her age group and thyroid and prolactin testing are all normal. She had undergone one previous stimulation with down regulation using a GnRH agonist starting in the previous menstrual cycle during the luteal phase, followed by stimulation with 225 iu of recombinant FSH once a day. Egg retrieval yielded three oocytes. The fertilized and one progressed to blastocyst stage and was transferred on day 5. Pregnancy test was negative. What stimulation regimen do you recommend?”

chatGPT’s recommendation:

Based on the information provided, the patient has tubal factor infertility and has undergone one previous stimulation cycle with down regulation using a GnRH agonist followed by stimulation with recombinant FSH. Only three oocytes were retrieved and only one progressed to the blastocyst stage, resulting in a negative pregnancy test.

For the next stimulation cycle, the following recommendations could be made:

1. Adjust the dosage of FSH: The current dosage of 225 iu of recombinant FSH once a day may not be optimal for this patient. The dosage could be adjusted based on the patient’s response to the previous stimulation cycle.
2. Consider using a GnRH antagonist: A GnRH antagonist may be a better choice than a GnRH agonist for this patient, as it may prevent premature LH surges that could impact oocyte quality.
3. Use a mild stimulation protocol: Since the patient only yielded three oocytes in the previous cycle, a mild stimulation protocol could be considered. This involves using lower doses of FSH and reducing the duration of ovarian stimulation.
4. Consider adding a supplement to improve oocyte quality: Coenzyme Q10 (CoQ10) may improve oocyte quality and could be considered as a supplement during the next cycle.
5. Consider using ICSI: Since the male partner’s sperm counts are normal, using Intracytoplasmic Sperm Injection (ICSI) may improve fertilization rates and embryo development.

Overall, it is important to individualize the stimulation protocol based on the patient’s response to previous cycles and other factors such as age and ovarian reserve. Close monitoring during the cycle is also important to adjust the protocol as needed.

I used an agonist protocol to see if the AI system would recommend switching to an antagonist, which it did right away. Then I asked the same question, using that protocol:

Based on the information provided, the patient has tubal factor infertility and has undergone one previous stimulation cycle using a GnRH antagonist protocol and 225 iu of recombinant FSH once a day, resulting in only three oocytes retrieved and one blastocyst transferred with a negative pregnancy test. For the next stimulation cycle, the following recommendations could be made:

1. Adjust the dosage of FSH: The current dosage of 225 iu of FSH once a day may not be optimal for this patient. The dosage could be adjusted based on the patient’s response to the previous stimulation cycle.
2. Use a different type of gonadotropin: A different type of gonadotropin such as highly purified FSH, or a combination of FSH and LH, may be considered to improve ovarian response.
3. Consider using a mild stimulation protocol: Since the patient had a poor response to the previous stimulation cycle, a mild stimulation protocol could be considered. This involves using lower doses of FSH and reducing the duration of ovarian stimulation.
4. Use a different trigger for final oocyte maturation: The previous protocol may have impacted oocyte quality, so a different trigger for final oocyte maturation could be considered, such as using a combination of GnRH agonist and HCG or solely using HCG.
5. Consider using a supplement to improve oocyte quality: Coenzyme Q10 (CoQ10) may improve oocyte quality and could be considered as a supplement during the next cycle.
6. Consider preimplantation genetic testing: Preimplantation genetic testing for aneuploidy (PGT-A) may be considered for the embryos in order to select the best embryos for transfer, which could increase the chances of a successful pregnancy.
7. Ensure good overall health and fertility optimization: Lifestyle modifications such as maintaining a healthy body weight, quitting smoking, and reducing alcohol intake, could be encouraged to optimize fertility.

Overall, it is important to individualize the stimulation protocol based on the patient’s response to previous cycles, age, and ovarian reserve. Close monitoring during the cycle is also important to adjust the protocol as needed.

AI isn’t ready to graduate from fellowship yet (and clearly needs to do some more reading on stimulation protocols) but, given the self-teaching nature of machine learning, the same question asked 6 months or a year from now will likely give more clinically appropriate answers, and a year later may be experienced-RE equivalent.

If you’re developing AI solutions, you’re likely to be asked what differentiates what you are doing from currently accessible systems that are available at minimal to no cost to the user.