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Monday, May 23, 2022

Digital Fertilization

Ovation Fertility focuses on giving couples and individuals the help they need to get pregnant – and soon, it hopes to bring computer technology to the baby business. The Encino-based clinic, which was founded four years ago, has developed artificial intelligence to produce an embryo. The technology utilizes in vitro fertilization, where an egg and sperm cells are combined in a lab to form an embryo. Ovation’s innovation lies in using a computer algorithm to select which sperm cells are most likely to successfully fertilize the egg. Fertility clinics have other methods to screen sperm cells – namely preimplantation genetic testing and embryo biopsy. But Ovation’s technology acts as a “secondary screen” to arrive at the best option for each case. “That’s essentially where Ovation Fertility has helped lead the way, is to layer on this secondary screen which is non-invasive and has built-in machine learning so that the more samples you give it, the more data points you give it, the smarter it gets,” said Nate Snyder, chief executive of Ovation. Visual recognition To validate its software, Ovation worked with Life Whisperer, an Australian tech company, to input 10,000 photos of embryos into a computer. The company also told the computer what the outcome was for every embryo. “The algorithm started picking up little clues from the photographs and associating them with an outcome,” explained Snyder. “It was picking up things that the human eye can’t see; it’s making relationships between different images we couldn’t possibly create.” Using that experience, a lab technician can drop a digital photo of an embryo into the computer application, and then the application will come back with a “confidence level” percentage, comparing and contrasting it with previous images the application knows to be viable or not. Dr. Jason Kofinas, owner of Kofinas Fertility Group in New York, hopes that AI can improve the success rates without sacrificing quality. “Genetic screening is giving us really good success rates,” Kofinas said, while maintaining that for many procedures, nothing can replace a skilled embryologist. For Dr. Matthew “Tex” VerMilyea, in vitro fertilization lab director for Ovation, the AI tool brings much-needed objectivity to the embryo selection process and will hopefully cut down on cost and invasiveness, compared to other methods. “As much as we try to be consistent amongst other embryologists, the subjectivity of the human eye is always present,” said VerMilyea. “We do a lot of embryo biopsy, so we identify the genetic competency of those embryos. The next layer of AI is trying to identify whether or not those embryos have any genetic defects. Being able to do that non-invasively is a huge game changer.” The software is still pending approval by the Food and Drug Administration, but Ovation management expects the tool to be marketable in a matter of months. It’s unclear how much of this process health insurance would cover, however. VerMilyea believes the screening would be relatively inexpensive given the fact that it can determine an embryo’s viability in a matter of seconds and is not an invasive process. Non-organic growth Since 2015, Ovation has grown to a chain of clinics in nine markets across seven states. “We grew slowly for the first year or so because we had to establish our brand. Once we started building up a track record of organic growth, we started to elicit pretty enthusiastic feedback from physicians around the country who saw what was going on within the company and wanted to participate in it,” said Snyder. The company landed a private equity investment and made four acquisitions of four (in vitro fertilization) labs and two genetics labs, across four states. Snyder was recently named a regional finalist for the Ernst & Young Entrepreneur of the Year award for his work with Ovation. Couples in the LGBT community, as well as women aged 35 or older, tend to make up most of Ovation’s clientele. A fair amount of clients also come from overseas, many from countries that outlaw fertility treatment. The process starts with a trip to the local fertility specialist, or reproductive endocrinologist, to figure out the best course of treatment. Conventional protocols vary from a low dose of medication and timed intercourse to in vitro fertilization. Doctors refer patients to Ovation for embryology, related to the study and development of the embryo; andrology, a medical specialty dealing with male reproductive health; surrogacy; donor eggs; long-term storage, or freezing the eggs, sperm or embryos for later use; genetic testing; and physician services through affiliated practices. Just last month Ovation made another acquisition, this time of specialist clinic the Center for Surrogate Parenting Inc. in Encino. For Snyder, backing the science and finding the right talent is central to what the company is focused on, compared to similar fertility brands such as Prelude Fertility Inc. out of Houston or New York-based IntegraMed Inc. “It’s still a very fragmented market, and we are the only company of our size, of our scale, that is focused on the science,” he said. “We differentiate ourselves really by the fact that we want our physicians to remain entrepreneurial and independent.” Access to care Ultimately, Ovation is looking to use its resources, whether that’s lab numbers, talent or tech, to increase accessibility for high-quality fertility care by reducing the cost of a live birth, Snyder said. A working collaboration with scientists in this field, coupled with access to clinics and labs across the nation as well as an openness to pre-market technology is the formula Ovation is using to get the industry where it needs to be. “Providers sometimes don’t have access to the same number of resources that Ovation can provide as a result of the private equity investment and professional management team that we’ve got backing the company,” added Snyder. “We do get a lot of patients that struggle at another provider’s hands and then come to us and are able to get one or two good-quality embryos and achieve a successful pregnancy.” Fertility services currently on the market are very costly and oftentimes invasive, as VerMilyea pointed out with embryo biopsy. Health insurance companies usually cover diagnosing infertility, blood work, ultrasounds and physician visits, but couples or individuals seeking in vitro fertilization have to pay out of pocket. “They’ll cover the diagnosis but not the treatment,” explained Snyder. “There is a trend in the industry for more large, self-insured employers to provide fertility coverage. We are seeing increasing access to fertility treatment through employer coverage. They are leading the way – not the BlueCross/BlueShields of the world, but rather the Facebooks and Googles.” If a couple is paying out of pocket, Snyder suggests going to a higher-priced physician that will yield a successful pregnancy the first time. “The successful outcome, achieving a healthy, live birth, can be less expensive through a higher quality, higher priced physician,” said Snyder. Kofinas at Kofinas Fertility Group noted that paying for innovation is always a challenge. “The cost of implementing the technology is, for the most part, higher than the cost of what is standard for care at that time. Typically, that cost is covered by the patient, unfortunately,” added Kofinas. “As the technology gets cheaper and cheaper, those cost savings are sent to the patient.”

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