IVF technology: blessing with a pinch
In-vitro fertilization (IVF) is the process by which an egg is extracted from a woman’s body and fertilized outside. IVF is considered the last resort for people with infertility problems, and who have exhausted other means of conceiving.
The resultant embryo is then implanted into the womb, often multiple embryos at once, to maximize the chance of conception. Robert G Edwards, who pioneered the method, was awarded the Nobel Prize for Medicine in 2010, and the fist ‘test-tube baby’ is Louise Brown, born in UK in 1978.
The technology has come as a blessing for people with fertility problems. Success rate is equated with live birth rate, i.e, number of successful births excluding stillbirths and miscarriages. Younger women have better chance at conceiving, and for those who are older than 48, no live births have been recorded.
According to the data available on the Centres for Disease Controls and Prevention(CDC-USA) on Assisted Reproductive Technology(ART), in 2010, “147,260 ART cycles were performed at 443 reporting clinics in the United States during 2010, resulting in 47,090 live births (deliveries of one or more living infants) and 61,564 infants. Although the use of ART is still relatively rare as compared to the potential demand, its use has doubled over the past decade. Today, over 1% of all infants born in the U.S. every year are conceived using ART.”
Concerns and cost
Of course, IVF is an expensive technology, and cannot be afforded by all. In some countries and states, IVF is covered by local Health Trusts and other programmes, where it is free. For example, in the UK, IVF is available free on the National Health Service (NHS), but it is available only in selected areas where local authorities have approved fertility treatments.
On an average, individual tries can be pegged at £4000 and £8000. However, IVF is rarely successful at the first go, and instances of people mortgaging their homes and overdrawing their accounts for going for the treatment are widely reported. Hence, most citizens from developed countries look at countries like India, Cyprus and Mexico for IVF technologies, mainly for cost factors.
However, fertility treatments have been subject to controversies, and IVF is no exception. The process is more intrusive for women, and is often painful. In many cases, artificial stimulation is provided to the woman to manipulate her fertility and ovulation cycle, and these have serious health implications. Hyperstimulation syndrome can be observed in 30% of patients. Harvesting of eggs, if done improperly, can lead to internal damage.
Apart from the usual risks involved with normal pregnancies, IVF pregnancies have added risks, the most significant being that of multiple births. This happens when multiple embryos are implanted together for maximizing the chances of live birth.
Astudy in 2012 showed that singleton pregnancies resulting from IVF have links with chances of birth defects. In 2008, an analysis of the data of the National Birth Defects Study in the US found that certain birth defects were significantly more common in infants conceived through IVF, notably septal heart defects, cleft lip and anorectal atresia. According to a Swiss study, children conceived through IVF display generalized vascular dysfunction.
Moral and social red flags
Japan's government prohibited the use of IVF procedures for couples in which both partners are infected with HIV, despite some hospitals claiming to have successfully removed HIV genes from the sperm. Also, it is still debatable whether women undergoing IVF treatment suffer from more stress than others.
Often, embryos are cryogenically frozen, so that women may have them implanted later. This process is a widely controversial one. There are also many illegal fertility clinics, and reports are available of women who have suffered due to botched up methods and have been mishandled. Cyprus and Crete, for example, have seen some major exposes on such centres.
IVF technology also, comes with a host of social and moral questions. In many cases, parent(s) ask for sperms/eggs from donors with specific attributes- including race, education, physical features and skills. Many concerns have also been raised by activists and health professionals about the method of extraction from donors; and in many cases, it has been reported that people have been held up against their will or kept in medically unviable conditions for extracting gametes. Immigrants, economically poor and marginalized groups are particularly vulnerable.
As medical science advances, IVF technology, too, is getting more refined. Not only will that mean increased chance at success, it will also lead to safer methods; which will not endanger the health of the donors, surrogates or the patients. Awareness is on the rise about the advantages and pitfalls associated with it, and governments and civil society groups are working at making things better.
How UiPath robots are helping with the NHS backlog
The COVID-19 pandemic has caused many hospitals to have logistical nightmares, as backlogs of surgeries built up as a result of cancellations. The BMJ has estimated it will take the UK's National Health Service (NHS) a year and a half to recover.
However software robots can help, by automating computer-based processes such as replenishing inventory, managing patient bookings, and digitising patient files. Mark O’Connor, Public Sector Director for Ireland at UiPath, tells us how they deployed robots at Mater Hospital in Dublin, saving clinicians valuable time.
When Did Mater Hospital implement the software robots - was it specifically to address the challenges of the pandemic?
The need for automation at Mater Hospital pre-existed the pandemic but it was the onset of COVID-19 that got the team to turn to the technology and start introducing software robots into the workflow of doctors and nurses.
The pandemic placed an increased administrative strain on the Infection Prevention and Control (IPC) department at Mater Hospital in Dublin. To combat the problem and ensure that nurses could spend more time with their patients and less time on admin, the IPC deployed its first software robots in March 2020.
The IPC at Mater plans to continue using robots to manage data around drug resistant microbes such as MRSA once the COVID-19 crisis subsides.
What tasks do they perform?
In the IPC at Mater Hospital, software robots have taken the task of reporting COVID-19 test results. Pre-automation, the process created during the 2003 SARS outbreak required a clinician to log into the laboratory system, extract a disease code and then manually enter the results into a data platform. This was hugely time consuming, taking up to three hours of a nurse’s day.
UiPath software robots are now responsible for this task. They process the data in a fraction of the time, distributing patient results in minutes and consequently freeing up to 18 hours of each IPC nurse’s time each week, and up to 936 hours over the course of a year. As a result, the healthcare professionals can spend more time caring for their patients and less time on repetitive tasks and admin work.
Is there any possibility of error with software robots, compared to humans?
By nature, humans are prone to make mistakes, especially when working under pressure, under strict deadlines and while handling a large volume of data while performing repetitive tasks.
Once taught the process, software robots, on the other hand, will follow the same steps every time without the risk of the inevitable human error. Simply speaking, robots can perform data-intensive tasks more quickly and accurately than humans can.
Which members of staff benefit the most, and what can they do with the time saved?
In the case of Mater Hospital, the IPC unit has adopted a robot for every nurse approach. This means that every nurse in the department has access to a robot to help reduce the burden of their admin work. Rather than spending time entering test results, they can focus on the work that requires their human ingenuity, empathy and skill – taking care of their patients.
In other sectors, the story is no different. Every job will have some repetitive nature to it. Whether that be a finance department processing thousands of invoices a day or simply having to send one daily email. If a task is repetitive and data-intensive, the chances are that a software robot can help. Just like with the nurses in the IPC, these employees can then focus on handling exceptions and on work that requires decision making or creativity - the work that people enjoy doing.
How can software robots most benefit healthcare providers both during a pandemic and beyond?
When the COVID-19 outbreak hit, software robots were deployed to lessen the administrative strain healthcare professionals were facing and give them more time to care for an increased number of patients. With hospitals around the world at capacity, every moment with a patient counted.
Now, the NHS and other healthcare providers face a huge backlog of routine surgeries and procedures following cancellations during the pandemic. In the UK alone, 5 million people are waiting for treatment and it’s estimated that this could cause 6,400 excess deaths by the end of next year if the problem isn’t rectified.
Many healthcare organisations have now acquired the skills needed to deploy automation, therefore it will be easier for them to build more robots to respond to the backlog going forwards. Software robots that had been processing registrations at COVID test sites, for example, could now be taught how to schedule procedures, process patient details or even manage procurement and recruitment to help streamline the processes associated with the backlog. The possibilities are vast.
The technology, however, should not be considered a short-term, tactical and reactive solution that can be deployed in times of crisis. Automation has the power to solve systematic problems that healthcare providers face year-round. Hospital managers should consider the wider challenge of dealing with endless repetitive work that saps the energy of professionals and turns attention away from patient care and discuss how investing in a long-term automation project could help alleviate these issues.
How widely adopted is this technology in healthcare at the moment?
Automation was being used in healthcare around the world before the pandemic, but the COVID-19 outbreak has certainly accelerated the trend.
Automation’s reach is wide. From the NHS Shared Business Service in the UK to the Cleveland Clinic in the US and healthcare organisations in the likes of Norway, India and Canada, we see a huge range of healthcare providers deploying automation technology.
Many healthcare providers, however, are still in the early stages of their journeys or are just discovering automation’s potential because of the pandemic. I expect to see the deployment of software robots in healthcare grow over the coming years as its benefits continue to be realised globally.
How do you see this technology evolving in the future?
If one thing is certain, it’s that the technology will continue to evolve and grow over time – and I believe there will come a point in time when all processes that can be automated, will be automated. This is known as the fully automated enterprise.
By joining all automation projects into one enterprise-wide effort, the healthcare industry can tap into the full benefits of the technology. This will involve software robots becoming increasingly intelligent in order to reach and improve more processes. Integrating the capabilities of Artificial Intelligence and Machine Learning into automation, for example, will allow providers to reach non-rule-based processes too.
We are already seeing steps towards this being taken by NHS Shared Business Service, for example. The organisation, which provides non-clinical services to around two-thirds of all NHS provider trusts and every clinical commissioning organisation in the UK, is working to create an entire eco-system of robots. It believes that no automation should be looked at in isolation, but rather the technology should stretch across departments and functions. As such, inefficiencies in the care pathway can be significantly reduced, saving healthcare providers a substantial amount of time and money.