Page 9 - GTM-2-2

Global Translational Medicine Clinical algorithms in ART

“mathematical models,” “embryology and algorithms,” “good efforts do not help treat endometriosis-caused infertility,
embryo transfer,” and “artificial intelligence.” Algorithms for which the only options are surgery and/or ART .
[18]
included all published diagnostic, timing, and therapeutic Surgery enhances the chances of conceiving naturally
tools to optimize assisted fertilization program. during the 12–18 ensuing months, irrespective of the
stage of the disease but does not improve ART results .
[18]
3. Results Therefore, ART is the primary option for women whose
We found 44 publications, with 15 papers including infertility is associated with endometriosis and/or over
supporting diagnostic and/or predicting tools to upgrade 35 years of age . However, unfortunately, patients who
[19]
the levels of medical assistance to the ART programs had longer diagnostic delays for endometriosis had more
(Table 2). We excluded the others because they were pre-diagnosis endometriosis-related symptoms and higher
ineffective in improving diagnostic penetrance, clinical pre-diagnosis health-care utilization and costs compared
compliance, and/or prediction capability . The with patients diagnosed earlier after symptom onset,
[16]
elaborations of how the AI tools assist in the particular providing evidence in support of earlier diagnosis . In
[20]
management/diagnosis/treatment of ART-related areas are other words, time to pregnancy is a crucial prognostic factor
as follows: inversely related to the success of the treatments; thus, it is
crucial to anticipate the diagnosis of this disease at present,
3.1. Endometriosis occurring several years after the symptoms appear .
[6]
Endometriosis is a disease-causing pain and infertility , Recently a new validated algorithm was introduced as a
[17]
encountered in nearly 50% of infertile women. Medical screening for the diagnosis of endometriosis based on a

Table 2. Diagnostic and therapeutic algorithms useful in the diagnosis and treatment of infertile couples
Diagnosis/treatment Algorithms References
Endometriosis Presumptive diagnosis by questionnaire [21]
Sperm evaluation according to WHO criteria: WHO Sperm evaluation by WHO criteria, 2021 [25]
Semen Analysis 2021
An ovarian reservoir according to AMH Classification of the ovarian reservoir [26,27]
according to AMH and age
Ovarian reservoir according AFC Classification of ovarian reservoir according to the AFC [44]
Starting dose gonadotropins Gonadotropin starting dose calculator [28]
Trigger time calculation: Day/hour To develop an interpretable machine learning model for [30]
optimizing the day of trigger in terms of mature oocytes (MII),
fertilized oocytes (2PNs), and usable blastocysts
Number of oocytes exposed A prediction tool was developed to aid clinicians in determining [44]
to sperm during ART cycle the optimal number of oocytes to expose to sperm, reducing the
number of unused embryos created, and immediately addressing
current patient and clinician concerns.
ART calculator Blastocyst presumptive calculation from recruited MII oocytes [32]
Nomograms Blastulation rate prediction in specific infertile groups selection [9]
Endometrial receptivity score Endometrial scoring for implantation prediction [34]
Algorithm predicting implantation efficiency Estimation of implantation of euploid and aneuploid embryos [33]
according to the effects of female age and after transfer according to the age of the women and number of
anticipated blastocyst euploidy rates on cumulative embryos transferred
implantation rates
Chance to have a baby Presumptive successful IVF treatment stratified for the infertile [33]
couple’s features [35]
[36]
[37]
The working group achieved consensus on a list of KPIs, PIs, and RIs to ascertain good medical practice in ART [12]
KPIs, PIs, and RIs useful for internal and external
controls of ART treatments
Abbreviations: KPIs: Key performance indicators; PIs: Performance indicators; RIs: Recommendation indicators; ART: Assisted reproductive
technology; AMH: Anti mullerian hormone; AFC: Antral follicular count; MII: Metaphase II, 2PN: 2 pronuclear

Volume 2 Issue 2 (2023) 3 https://doi.org/10.36922/gtm.0308