Are we approaching automated assisted reproductive technology? Embryo culture, metabolomics, and cryopreservation

For decades, assisted reproductive technology (ART) procedures have been performed manually thanks to the meticulous work of skilled embryologists. Recently, new technologies have been developed with three main scopes: improving embryo culture conditions; making diagnostic evaluations more consistent and reliable; and allowing ART procedures to become progressively less subjective and operator-dependent. This review aimed to answer the following questions: is automation likely to be successfully incorporated into the in vitro fertilization laboratory and clinical ART in the future? If so, would such automation result in improved outcomes in ART? An electronic search of PubMed was performed to identify articles in English language that addressed automation in ART. Studies were classified in decreasing categories: randomized controlled trials; prospective controlled trials; prospective noncontrolled trials; retrospective studies; and experimental studies. Research and development data from investigators were included. There are a number of separate platforms that have been developed until now to address different parts of the ART process: gradual change of embryo culture medium; noninvasive embryo monitoring with time-lapse or metabolome analysis; and automated vitrification. It is conceivable that future automation enhancements in the in vitro fertilization laboratory may improve consistency and throughput and reduce the risk of human error associated with the performance of repetitive tasks. Nevertheless, a need remains for a platform able to integrate all separate technologies, capable of successfully interconnecting them in a way that assures continued chain of custody for the gametes and embryos. Moreover, controlled trials will be fundamental to demonstrate the usefulness of automation in ART.