In vitro fertilization (IVF) is a method that enables people who are having fertility issues to become parents. IVF has the potential, but the results are unpredictable. Even worse, there is terrible access to fertility care. Data science can't fix biological issues, but it will improve every decision-making stage in the IVF process. Artificial intelligence can forecast an embryo's likelihood of progressing to the stage of developing a foetal heart, assisting the embryologist in choosing the most suitable embryo for transfer.
In a conversation with Dataquest Dr Nitiz Murdia, Co – founder and MD, Indira IVF tells how technology is helping improve IVF success rate by focusing on evidence-based treatments.
DQ: How has been your company performing over 2022? Please elaborate.
Dr Nitiz:Indira IVF is at a very interesting phase of its business growth. With the advancement in the assisted reproductive technology (ART) sector, the company has been witnessing high growth due to an increase in demand of its world-class specialised treatment. Since 2015 Indira IVF has reported a CAGR of 59.3%, growing from just 4 centres in FY2015 to 104 centres in FY2022; the organisation is now present across 115 centres. In revenue, Indira IVF has seen a 43.5% CAGR since FY2015 and reported a growth of 43.0% in FY2022 from FY2021. Being the largest player in the industry with 16% of market share, Indira IVF is growing at a >20% vis-à-vis the industry growth at 16.6%.
DQ: How are you keeping up with the ever increasing demands for digital transformation specific to your industry?
Dr Nitiz:The basis of ART treatment is technology. Science and technology has been at the crux of any IVF treatment and digital adoption has been the key element that has helped us provide standardised treatment across all our centres. To be updated and ahead of the curve, we have a clear digital transformation strategy in place which we regularly review and update as necessary. We have adopted digital tools such as Electronic Health Records (EHR) systems, telemedicine, cloud-based storage, Artificial Intelligence (AI) and Machine Learning (ML) in our day-to-day processes to streamline every each step of the cycle and improve patient outcomes. Recently, we have tied up with Presagen to roll out the latest Artificial Intelligence (AI) tool ‘Life Whisperer’ at our 100+ clinics across the country. This AI tool aids in improving embryo selection in in-vitro fertilisation, provides increase in pregnancy prediction thus, reducing the number of cycles required for successful conception. This not only helps with increased assurance of pregnancy but also ensures cost saving for patients as they don’t have to undergo multiple cycles. We have invested in training our resources for a better digital adoption across levels. This has allowed us to maintain consistency and improve work efficiency.
DQ: How are you integrating customer experience into IT deliverables? How is it helping in advanced customer experience?
Dr Nitiz:A healthcare ecosystem is highly complex than any other industry. It consists of a variety of parties, factors, and conflicting interests. Customers require convenience as well as control of the healthcare service they seek. As we deploy our digital integration, we are very particular that patients’ data remains safe with us. It has helped us to increase customer satisfaction by enabling personalised experience with integrated patient access and clinical information exchange thus, ensuring transparency and assurance for our patients. Moreover, this has allowed real-time access to relevant patient and clinical information allowing immediate analysis and decision making followed by improved quality of care.
DQ: How are you maturing the enterprise cloud strategy at Indira IVF?
Dr Nitiz: At Indira IVF, cloud-based automation is used to determine treatment plan based on various investigations such as blood and radiology tests. The entire medical record of a patient is automated – that includes treatment plan, package, stage, and timelines. The records are loaded into the system and it auto-generates the report impressions. Medical prescription is also generated from the system after checking all the reports. Once the treatment cycle starts, the system generates day 2 of stimulation. In fact all future visit dates goes to CRM for seamless communication with patients. Our virtual healthcare system has digitalised the clinical work flow by keeping a track of different steps performed; this includes who has performed a particular step the final outcome of the same. An interactive dashboard helps to monitor centre-wise performance and success rate. This empowers us to give standardised treatment across all our centres. The cloud strategy improves care coordination and patient engagement. With the help of cloud technology, we are evolving from traditional IT-led operating model to business-technology model which is the future of healthcare delivery.
DQ: How is the digital adoption and employee training in your company?
Dr Nitiz: In order to provide unified digital operating environment across our centres, we have given due focus on upgrading our resource through various learning and training methods. Apart from on-boarding technology partners who bring in the right strategic lens to evaluate the technological transformation approach, we have invested in building specialised talent who are able to perform the processes with ease. We provide stimulators to our future specialists/learners for practicing each step thoroughly. Our electronic witness system, in addition to ensuring that unrelated samples do not get mixed up, helps determine the time each embryologist spends on a step. If we detect variations in timeline, that is, if anyone is taking more than the required time for a process, we align refresher training sessions with them to bring them at par with others. Also, all staff members at Indira IVF undergo regular digital training to keep up with the digital adoption of the company.
DQ: What are the latest technologies available in ART treatment that is deployed by Indira IVF?
Dr Nitiz: Indira IVF is a technology-first company and we are constantly adding new cutting-edge technologies to make IVF treatments cost-effective, and at the same time, safer. Our “Closed Working Chamber Technology” was imported from Australia in 2011 that mimics the environment of the human body, with the required temperature of about 37˚C, optimum levels of oxygen, and carbon dioxide. When the eggs and sperms are manipulated outside the body, they can experience temperature shock due to the variation in temperature levels compared to the body temperature. This may affect the quality of embryos leading to poor outcomes. The microscopes are placed in these chambers so that eggs and embryos can be fertilised in body-like conditions, eventually producing better quality embryos and providing higher success rates.
The second important technology is electronic witness technology through which we ensure that the process of double-checking is automated in order to avoid the mix-up of unrelated sperm, egg or embryo in the laboratory. We have imported RFID technology in our labs due to which every sample is labelled with an RFID chip and the moment two samples are brought close to each other, if they are of the husband and wife, the RI witness system would detect the same and seeing the procedure through. However, by chance, if one brings a different sample together, the electronic witness system would detect it automatically and would set off the alarm and halt the process.
We are also trying to stay ahead of the curve through artificial intelligence (AI). So far eggs, sperms and embryos have been graded manually through the human eye under microscopes, which has a risk of human error. Using AI to grade embryos, time-lapse pictures are taken of the different stages of the embryo growth, and the software grades the embryo by comparing it with a database of existing embryo images from prior cycles. This software is equipped with machine learning and through its database, it can analyse the best embryo to transfer thus, maximising the chances of pregnancy. In fact, our partnership with Presagen for the AI tool ‘Life Whisperer’ aids in improving embryo selection.
All of these technologies are aligned with our strict SOPs. Our trained embryologists across all our centres in the country and an entirely scalable model make Indira IVF stand apart.
DQ: How does these technologies aid in increasing success rate?
Dr Nitiz: In addition to some of the aforementioned technology that aid improve outcome at smaller checkpoints, it also allows for the genetic testing of embryos before they are implanted in the uterus. This ensures that only genetically robust embryos, with higher chances of implantation and a live birth are used for the treatment. Some of these are:
Assisted Hatching Technique involves creating a small hole in the outer layer of an embryo, which can help to improve the chances of implantation in certain cases.
Time-Lapse Embryo Imaging allows continuous monitoring of embryos so that embryologists select the best embryos for transfer and also can be useful in improving the selection process.
We can freeze embryos for future use through Cryopreservation technique (also popularly, egg freezing/sperm freezing/embryo freezing), which can help to increase the chances of success for couples who need to undergo multiple rounds of IVF. All these technologies can help improve the chances of success for IVF treatment by allowing for the selection of the best embryos for transfer, and by increasing the chances of fertilisation and implantation.
DQ: Does the technology interfaces has any role to play in neutralising treatment cost?
Dr Nitiz:Yes, around 7-8 years back an IVF procedure would cost Rs 3 to Rs 4 lakh per cycle which has now come down to Rs 1.5 to Rs 2 lakh per cycle, due to technology adoption and standardisation of processes. Not only has the cost come down but the success rates have improved as well. Indira IVF has an overall clinical success rate of almost 74% which speaks about the importance of standardisation and use of the best technical protocols prevailing in the industry.
DQ: With the fertility rates decreasing in India, how big of an impact will the use of AI in IVF going to create in the future?
Dr Nitiz: The use of AI in in-vitro fertilization (IVF) has the potential to significantly improve the success rates of fertility treatments in India. AI can be used to analyse large amounts of data, such as medical records and image scans, to identify patterns and predict the chances of success for individual patients. This can help doctors select the most appropriate treatment options and improve the chances of a successful pregnancy. Additionally, AI-assisted embryo selection can be used to identify the most viable embryos for implantation, which can also improve success rates. With lifestyle changes and other issues that has led to vast increase of infertility related problem in young couples in our country, there has been growth in demand of such treatment. Technology has improved both the quality and accessibility of such treatments and so couples are now opening up for availing these treatment. AI helps in accuracy that leads to increased success. However, the use of AI in IVF is still started to grow and more research as well as its implementation are being observed to fully understand its potential.