The First Commandment of IVF
Keeping Track of Which Embryo Belongs to Which Patient
In 1990, the most common name for a baby girl in the United States was Jessica; the most common last name was Smith. Today, approximately one out of every 6100 thirty-year-old woman in the US is named Jessica Smith.
In the decades since the invention of assisted reproduction and in vitro fertilization (IVF), the discoveries in embryology have leveraged each fertility medication and egg retrieval cycle into multiple embryo transfers over months to years and allowed women and families to proactively manage their family-building, retrieving and storing oocytes when at a time of high fertility potential, mitigating the risks of future illness, infertility, and having the freedom to defer parenthood when present circumstances would not have (permitted it.)
All of these benefits resulted from the development and steady improvement in the pregnancy potential of each embryo created in modern IVF and the ability to successfully freeze, store, and thaw eggs and embryos for future use.
Let’s go back to Jessica Smith.
If one out of every 6000 30-year-old women is named Jessica Smith, then a similar number of 25-year-olds throughout 35-year-olds are also named Jessica Smith.
Let’s assume that of women of reproductive age, about one in 7,000 is named Jessica Smith, which means that one in 7,000 women undergoing IVF is named Jessica Smith. In 2018, US IVF clinics performed 280,000 IVF cycles. If the rate Jessica Smith ratio was the same in the IVF clinics as in the US population, 40 cycles were Jessica Smith cycles.
If the average IVF clinic performs procedures for ten months out of the year, then every 7.5 days, a Jessica Smith embryo is being worked on in an IVF lab somewhere.
Of course, the steady and accelerating accumulation of stored specimens created a new challenge: safely managing this huge and rapidly growing inventory using a primitive and manual system of containers and tracking. Indeed, case reports of both laboratory equipment and storage failure and mistakes in embryo identification demonstrated unequivocally that a better system is needed to manage today’s aggregate (mass) correctly and to prepare for the much larger volumes to come.
Thankfully, the IVF entrepreneurship underground is tackling storage and monitoring, starting with individual laboratories, transforming the inefficient manual system in place today with a mechanized, automated, and ― most importantly ― scalable system that can grow with the industry.
But to truly leverage technology with ambitions to re-engineer IVF into the digital age, we need to transform the nature of our data collection. And that requires foundational steps that transform “stuff we write down” into accurate data.
And the most foundational of those steps is to assign each specimen a unique identity, one that follows the specimen from creation through storage through transport to use, whether in one location or many. As we saw, the chance of having two different sets of Jessica Smith embryos in the same lab simultaneously is pretty slight, but then again, so is the percentage of women who need IVF and get IVF. I have argued in the past that our IVF volume should be, at a minimum, five times what it is today. With no change in the percentage of Jennifer Smiths, that would mean that, more often than not, Jennifer Smith embryos are being worked on in somebody’s lab.
For any company that is part of the infrastructure of US IVF care that facilitates the throughput of patients, their eggs, sperm, and embryos from retrieval, transformation, storage, and eventual use, the industry’s exponential growth validates their business plans.
However, the business can only grow if its perception of safety and competence grows. The confluence of more patients from increased access to new patient populations makes this a more significant challenge with each storage cycle.
