An ART Cycle of the Future

We want to summarize what we envision the patient experience will look like in the not-so-distant future:

Emma is a young aspiring astronaut who dreams of being on the next shuttle into space. She is 25 years old, single, and plans to have children at a later age. During her pretraining physical and mental health assessment, the doctor reminds her of the option of FP, since Emma might be in space for an extended period with uncertain effects on her fertility. She thinks this is a great idea and asks friends on social media for clinic recommendations. She scrolls through reviews online and realizes that convenience, accessibility, and the “patient experience” are the hallmark characteristics that she is looking for.

She finds “The Fertility Center” and reviews their website. She is excited to see that all relevant information about FP and the process she would have to go through is transparent and clearly stated on the website. Although this clinic is mainly based in the metropolitan city 100 miles away, they have easy telecommunication options that make it the most convenient choice for Emma. She goes to the “New Patient” section and fills out her information on a secure online form. She immediately sees the schedule of availability for new patient appointments and picks a date and time that works for her. After registering, she receives a confirmation email and directions to download a secure app on her phone on which her profile, appointments, medical results, and treatment instructions can all be communicated. Emma is excited that this clinic is so convenient, user-friendly, and discreet, and that she does not have to rely only on telephone calls for information.

Prior to her appointment, she receives a kit to perform at-home fertility testing as deemed appropriate by her personalized fertility evaluation algorithm. The kit contains a device that plugs into her smartphone, which instantly provides laboratory results and uploads them to the clinic’s app. A painless finger stick or salivary sample is all that is required for accurate testing, and the device can even perform a semen analysis. She will continue to use this device for cycle monitoring if she proceeds with egg freezing.

On the day of her appointment, Emma logs into her smartphone app to attend the teleconference appointment with her fertility team. She meets her doctor as well as the administrative assistant, nurse, financial counselor, and wellness coach. The fertility panel test results, which were completed prior to her appointment, are available for review and, as a team, they discuss her fertility goals and options. Using an AI-generated algorithm, her history and initial tests help formulate a personalized treatment plan to optimize her chance of success. Her treatment plan includes not only the medical aspects necessary to achieve her egg freezing goal but also nutrition, exercise, and mental-health counseling to promote overall wellness. By the end of the appointment, Emma has a clear understanding of her next steps with written instructions on how to proceed outlined in her app.

Emma follows her personalized treatment algorithm, which continually provides the best personalized pathway, protocol, and medication dosing for her cycle. Prior to starting, her financial counselor discusses the best strategy to optimize her financial resources. She also receives teleconference teaching on how and when to take the cycle medications and how to perform home monitoring. These videos are recorded and stored in her app, which she can refer to anytime she has questions. Emma is so thankful that the stimulation medications are oral; she had heard that, in the past, patients had to give themselves injections. Emma is sent a home ultrasound monitoring device and instructed on how to use it properly. On the days when she is instructed via the app to do monitoring, she performs a home ultrasound and her follicle growth data is uploaded directly to her chart in the electronic medical record. She also performs a finger stick blood test at home with the smartphone device that analyzes a droplet of blood. All hormone testing is remote, and her ultrasound and bloodwork results are uploaded via the app directly to the clinic. Based on her results, she receives a text via the app from her care team who give her instructions regarding her medications. Emma finds this system extremely easy and convenient to navigate, especially given that the clinic’s physical location is so far away. In the past, patients had to travel almost every day during their cycle to a clinic site for traditional phlebotomy and ultrasound. Emma cannot imagine the inconvenience and cost this would incur to many people – no wonder so few people accessed fertility services in the past. Nowadays, almost everyone Emma knows has had at least a consultation regarding fertility planning. An increasingly broader range of couples and single people are routinely utilizing fertility services with improved accessibility of reproductive clinics in the United States and the world.

The day of her egg retrieval arrives and is performed at a convenient clinic location of her choosing. The process is painless and no longer requires traditional anesthesia, as it had in the past. Advances in other fields of medicine also aid fertility treatment and newly developed oral medication allows the retrieval procedure to be performed painlessly. As part of her holistic wellness care, she also receives acupuncture and massage services that day to help alleviate stress.

Her gametes are processed using specific tagging systems linked to Emma’s personal identification data. The eggs that are retrieved are processed by an embryologist using a microfluidic device, which prepares the eggs for fertilization or freezing. In Emma’s case, her eggs are cryopreserved by the automated system and transferred to a secure storage facility where they will remain until Emma has need of them. All her eggs have a specific tag, which links them to her patient profile and tracks their location, temperature, and gas parameters in the lab, thus ensuring identification. Via this electronic tagging, Emma is also able to track her eggs herself on her smartphone app, which provides her reassurance that they are safe. All data are maintained using block chain technology, which allows her to access information from any location.

Ten years later, Emma has met the love of her life, Liam, and they are ready to start building a family. Incidentally, Liam also froze his sperm at a younger age when his personalized genetic risk assessment determined a high risk of testicular cancer. Together, they return to the clinic where Emma had her eggs frozen to discuss their options for conception. Even though they now live in the city where the clinic is located, they continue to use the teleconferencing option as it is more convenient for their busy schedules. However, Emma has heard from her friends who have visited the clinic that it does not look like a traditional doctor’s office at all, but more like a nice salon or spa. Many clinics are recognizing that patients often do not want to be in an overly medicalized setting, which has led to the delinking of fertility centers from hospital settings, and a change in the aesthetic of the physical spaces. This makes the entire process more comfortable and feel more “natural,” especially since family planning is such an integral part of many people’s lives.

Emma and Liam undergo home fertility testing using a similar device Emma had used when freezing her eggs. However, this time, no blood or saliva sample is even needed – the device simply scans their skin to produce instantaneous results. They are amazed at how far technology has advanced in 10 short years. After meeting with their fertility team – the same team that helped Emma many years ago – they are ready to tackle the next steps as outlined by their personalized treatment algorithm. They opt to use their frozen gametes to create embryos for transfer.

While waiting for her treatment to begin, Emma and Liam feel increasingly anxious about their ability to conceive and upcoming treatment. Their team checks in at regular intervals and discusses their desires, goals, and fears, and how they may impact the treatment. Their wellness coach also shows them both physical and mental exercises to perform to help with anxiety. They appreciate that now there is an increased understanding among medical professionals that the mind and body are intricately linked and, especially in stressful situations such as family building, the care of the whole person is paramount. Many more clinics now employ or partner with psychologists, social workers, nutritionists, acupuncturists, and massage therapists. Mental health and wellness are an integral part of fertility care. Emma and Liam feel grateful for the empathy shown by the clinic staff, as well as the personalized and integrated care they have received. With the support of their team, they feel ready to tackle the next steps.

Emma’s frozen eggs and Liam’s frozen sperm are retrieved from the robotic storage facility and are processed using an automated device that selects the most viable sperm for insemination. The process of fertilization, embryo culture, and embryo assessment are performed within an automated microfluidic platform, which eliminates environmental exposure and human error. All the embryos have a specific tag, which allows Emma and Liam to track the progress of the embryos. This provides them reassurance and also helps them feel connected to the growth of their early embryos. Noninvasive preimplantation genetic and viability marker testing is performed and, while results are pending, the embryos are cryopreserved in an automated machine that stores the embryos. The genetic testing that is performed can comprehensively examine the genome for each embryo and determine the highest implantation potential and healthiest offspring. In combination with the metabolic and morphologic data collected through time-lapse imaging, an AI program amasses and analyzes all the data to rank the embryos for transfer.

Based on Emma’s testing, her personalized treatment algorithm has determined the optimal receptive day for an ET. A single embryo is retrieved according to its ranked viability potential from the automated system and thawed. The transfer goes well and, while Emma is enduring the difficult wait for her pregnancy test, her team has planned a regimen to assist with healthy dietary choices, and physical and mental exercises. Happily, Emma finds out that she is pregnant! After her confirmatory first trimester ultrasound, she is introduced to an obstetrician who works closely with her fertility team. Throughout her pregnancy, she continues to receive wellness support, including nutrition and exercise counseling, mental health exercises, and parenting classes. Emma also joins an online support community and shares her journey with fertility treatment with others. She eventually delivers a healthy newborn.

Emma and Liam truly feel that their success was a team effort, spearheaded by people who cared about both their physical and emotional journey through family building. They feel confident that they can reach their goal of three children with the help of their team. In fact, Emma plans to refer her single younger sister to them to discuss her desires about future fertility. After all, fertility care is not just about treating people who have difficulty conceiving – it is about providing the framework for family building so that it is a natural and routine part of a lifelong journey.