In this episode, I sit down with Dr. Tex VerMilyea, Vice President of Scientific Advancement for US Fertility and Ovation IVF Laboratories, to explore how artificial intelligence is revolutionizing IVF labs and embryology. Dr. VerMilyea brings a unique perspective shaped by his journey from animal science and bovine embryology to becoming a leader in human IVF research and innovation. His work spans molecular embryology, epigenetics, and now the implementation of cutting-edge AI technologies across a nationwide network of fertility centers. This conversation offers a rare behind-the-scenes look at the technology that’s shaping the future of fertility care.
We dive deep into the practical applications of AI in embryology: from embryo and sperm selection to pregnancy prediction and laboratory workflow optimization. Dr. VerMilyea explains how AI is making embryo assessment more objective and accurate, how robotics will improve lab efficiency and access to care, and why the human touch will always remain essential in the art of embryology. We also discuss what patients should know about how labs balance success rates with safety, the future of non-invasive embryo selection, and what IVF laboratories might look like in five to ten years.
In this episode, we cover:
- How AI is currently being used globally for embryo selection and why FDA approval is still pending in the United States
- The potential for AI to predict pregnancy outcomes and reduce time to pregnancy through data-driven treatment decisions
- How robotics and automation will help IVF labs serve more patients while maintaining quality and reducing human error
- The role of non-invasive technologies in improving patient engagement and experience throughout the IVF journey
- Why selective single embryo transfer has become the standard of care and how technology supports safer outcomes
- What embryologists wish patients understood about the IVF lab and the expertise behind embryo development
- The future of IVF labs, including mobile clinics, at-home monitoring, and the evolving role of embryologists
Resources:
- Dr. Tex VerMilyea on LinkedIn https://www.linkedin.com/in/tex-vermilyea-phd/
- US Fertility Research Page https://www.usfertility.com/
- Ovation Fertility https://www.ovationfertility.com/
Full Transcript:
Dr. Aimee: Today’s conversation is all about where science meets possibility. If you’ve ever wondered how artificial intelligence is shaping IVF labs and the future of embryology, this episode will give you a look behind the scenes of the technology guiding so many of today’s breakthroughs.
This week’s episode is called ‘How AI is Transforming IVF Labs.’ My guest is Dr. Tex VerMilyea, the Vice President of Scientific Advancement for US Fertility and Ovation IVF Laboratories. He’s a leader in the IVF research community, known for pioneering collaborative studies in AI for embryo assessment and for his work advancing laboratory practices across a nationwide network of fertility centers. He brings a rare blend of molecular science, embryology, and operational leadership that’s shaping how patients experience fertility care today.
Tex, welcome to the show.
Dr. Tex VerMilyea: Thank you very much. It’s a pleasure to be here. Thank you for the invitation.
Dr. Aimee: I was so excited that you accepted our invitation. I’ve been wanting to talk to you for so long. You couldn’t be coming on at a better time. You’ve built this remarkable career spanning epigenetics, molecular embryology, and now leadership across US Fertility and Ovation. What first pulled you into this field, and what kept you here?
Dr. Tex VerMilyea: Truth be told, I went to university thinking I was going to be a veterinarian, so I majored in animal science. But along the way, something called organic chemistry made me take a bit of a detour. I was very good in the lab, but lectures and conceptually, I couldn’t hack it. Therefore, I had to think of an alternative. At that time, I was washing bottles in the animal science reproduction lab, and just kind of fell into bovine embryology, working with cow eggs and bull sperm. Luckily, I had an internship during university, in the human embryology laboratory, and just fell right into human IVF. The rest is history since then.
Dr. Aimee: I remember those days, washing those bottles in the organic chemistry lab. We’re all so lucky that you ended up where you ended up. You train in labs across the US, the UK, and Japan, with a foundation in animal science, like you’ve shared, gene expression and chromatin research as well. How did that scientific background shape your perspective when you transitioned into clinical IVF?
Dr. Tex VerMilyea: The animal is a great model, especially in reproduction and how we learn how to do things, not only in the laboratory, but just in general, just biology. When I went down the course of thinking I was still going to stay within the animal space but had exposure to human IVF lab, I was able to make that transition pretty quickly. In addition to just working with people and seeing the fruits of our labor when it came to creating babies, creating family, I did a bit of a detour during my PhD and worked back in the mouse model. But then I decided that I miss that human interaction, working with people, working at the bench, and the human side of things, so I transitioned back into human IVF. I haven’t looked back since. I still do some animal work on the side, but mostly it’s full steam ahead in the human world.
Dr. Aimee: I love it. You’ve worked hands-on as an embryologist at the bench and now collaborate with labs nationwide and globally. How has that combination of roles informed the way you evaluate systems, outcomes, and best practices?
Dr. Tex VerMilyea: I started off in the laboratory and at the bench, so I’ve been in the trenches with fellow embryologists and fellow lab folks, so I know what it takes in a laboratory to do hands-on work. My focus now is how we can do that work better and what technologies we can use. Luckily, I’ve been exposed to a lot of technology across the world, and I’m trying to hone that in and bring that into the laboratory to make our jobs in the lab a bit easier, but also try to reduce risk in the long run, improving pregnancy outcomes.
I think with a background of being at the bench, using my hands, sitting at the microscope for hours and hours, trying to figure out what sort of technologies can be implemented in a noninvasive approach to help us do our jobs better in the lab. That’s been my focus over the last few years.
Dr. Aimee: You’ve led award-nominated research on AI in IVF. How do you explain AI’s current role in IVF and why it matters for patients trying to get pregnant?
Dr. Tex VerMilyea: AI is all around us. People using ChatGPT, people speaking to Alexa, maybe some on their dating apps, swiping left and right, it’s all artificial intelligence. Even if we’re not aware of it, we’re surrounded by it. Taking that technology and bringing that into the laboratory has been a big step, a big process where we’ve had to do a lot of data validation.
Just trying to understand how can we take a simple image of an embryo on day five or day six and compare that image to hundreds and thousands of other photos similar to that embryo that have led to pregnancy success, how can we do that noninvasively by just simply taking a picture of an embryo, which we do already, running that through software to help us identify key features that we as humans can’t identify when we’re looking down a microscope. We’re very subjective in our assessments. When people ask what grade is the embryo, what is the morphological grade, that’s my grading as a human. Looking down a microscope, we can see key features of the embryo and be able to assign a score, but it’s extremely subjective. How can we use technology to make that assessment more objective and perhaps more accurate?
There’s a lot of realms of AI, not only in embryo selection, but also sperm selection, trying to identify that one sperm that is the healthiest of a cohort of sperm. Also, using artificial intelligence to deep dive in our data and help us make data-driven decisions. Hopefully, in the long run, trying to improve pregnancy success. That’s what it’s all about.
Dr. Aimee: Right. Is that happening now, where people are using AI to look at embryos and using that information to guide them as far as which embryo to transfer?
Dr. Tex VerMilyea: Globally, it is, yes. In the United States, we have something called the FDA, and a lot of this technology still needs FDA approval. We’re working with other companies to push that forward and do some large randomized control trials, which have indeed shown an improvement to pregnancy success by using this technology. We’re treading carefully with regulatory bodies.
In the rest of the world, where there’s not so much restriction, AI is being routinely used. We hope to some day be able to use it as a tool in our toolbox, as an adjunct decision motivator, to help us make better decisions, basically. That’s the real key point of a lot of that AI technology.
Dr. Aimee: Right. Do you think that it would potentially replace doing PGT and embryo biopsy for embryos?
Dr. Tex VerMilyea: There have been a lot of studies showing that. We’ve done quite a bit, and I’ve published on that as well. It’s getting pretty close. Now, genetics and chromosomes, that’s biological, and it’s going to be very hard to mimic that. But some early studies have shown that you can get pretty close to identifying which embryo is chromosomally normal just based on some morphological features that AI can pick up that we can’t see with our human eyes.
Dr. Aimee: Do you think that there will ever be a patient-facing software, maybe even ChatGPT at some point can do this, where a patient can upload a photo of their embryo, or is it more complicated than that?
Dr. Tex VerMilyea: I think that’s certainly the way that technology is going. Routinely in the laboratory, a lot of the software that we’re using now is just a static 2-D image, just like a picture of an embryo that a patient may receive at the time of an embryo transfer. Obviously, we want to do that assessment before the embryo is transferred. I don’t know if there will come a day where post-transfer a patient loads up that embryo and says, “What are my chances of pregnancy?” We hope to do that on the front end. But that technology and the usability, the patient’s ability to use that technology, is certainly coming to the forefront, especially when it comes to better treatment and care management.
Dr. Aimee: Correct me if I’m wrong. A lot of your work is helping improve operations, reviewing procedures and outcomes across many IVF labs, and many is an understatement. What trends are emerging, and how is technology helping labs raise the standard of care?
Dr. Tex VerMilyea: Like I mentioned, the data analytics that AI is able to take a lot of unstructured data and put it in a more palatable structured form so that we can run to identify best practices, look at our key performance indicators (KPIs), and allows us to streamline processes in the laboratory and also identify where perhaps we’re slacking a little bit or where we can improve. We’ll also identify what’s working really well so that we can replicate that across our laboratories.
With AI in general, you think of taking a picture and trying to identify which one is better. The same thing can be applied to data management, as well as workflow processes within the laboratory.
Dr. Aimee: Do you think that AI will allow clinics to accept more volume because it’s improving things from an efficiency standpoint?
Dr. Tex VerMilyea: I do. I think the workflow efficiencies that AI will bring into the laboratory, in addition to robotics, will allow us to better serve populations, and hopefully in underserved populations where access is a bit more limited. A lot of times, with IVF, the laboratory can be seen as the bottleneck because we just aren’t able to bring as many patients through or do as many retrievals, or there’s a limitation on laboratory equipment and personnel. I do think that AI will be able to raise the bar when it comes to just the volume that we’re able to put through our laboratories, and hopefully serve more patients in the long run.
Dr. Aimee: Do you think that there could ever be a robot that could do egg retrievals, a robotic egg retrieval arm, like the da Vinci?
Dr. Tex VerMilyea: I think it’s certainly possible. I’m aware of some companies that have already started doing robotic dish making, ICSI, embryo culture, and freezing. There’s a lot of new technology with microfluidics, whereby you simply pour the follicular fluid in the machine, and it will identify and find eggs – eggs that perhaps a human may miss under the microscope. That technology is certainly evolving. I think when you bundle that all together within the laboratory, we’re going to be able to serve more patients, hopefully.
Dr. Aimee: You’ve published extensively. We’ve already talked a little bit about noninvasive approaches in IVF. Which of these developments do you think will have the biggest impact on patient experience in the coming years?
Dr. Tex VerMilyea: I’m very keen on improving the patient experience and patient engagement. I think as a patient, going to an IVF laboratory or going to a fertility clinic, dropping off your eggs, dropping off your sperm, and then coming back, getting a phone in five days saying you have an embryo, then you froze a few, then a month later come back for an embryo transfer, there’s a lot of gaps in that treatment. If we’re able to use technology to not only better educate, but just allow patients to be part of that process, whether it’s through timelapse technology where patients can watch the embryos grow and divide, whether or not it’s through a ChatGPT or an AI agent that can talk to the patient when they have questions and the answers are validated by an embryologist and by a laboratory. I think that sort of technology we’re going to see a lot more. We’re iPhone generation, face-to-face like what we’re doing now is pretty nonexistent. I think through technology to better improve those experiences will certainly be coming more to real life, in addition to this noninvasive approach to embryo and sperm selection and egg selection, potentially.
Dr. Aimee: I agree. I feel like with more technology, people are getting less human contact. The trend in the Bay Area is you do your egg retrieval, you find out how many eggs, and then on day seven, you find out what happened. I give a day zero report, day one, day three, day five, day six, day seven, sending reports, calling patients, reviewing it. I haven’t created an avatar quite yet to explain it, but I think that patients want that information.
I do have patients sometimes that actually say, “I’m going to be better off, just don’t tell me anything, it’s too much for me. Just give me an update on day seven,” but I think it’s nice for patients to have the option.
Dr. Tex VerMilyea: Absolutely.
Dr. Aimee: A lot of centers don’t give patients the option. I get it, when you have so many patients going through, it’s very difficult for the doctor to take the time to go through everyone’s results with them that day. I think it’s better to have someone who knows what they’re talking about than, let’s say, someone who is well-intentioned in the clinic. I’ve seen this before, where a medical assistant will share the information, and that can cause more confusion for the patient. I couldn’t agree with you more. Anything that can help patients just feel heard and feel like they’re part of the process, rather than like an outsider and not understanding what’s going on as it’s happening, is great.
Let’s talk more about advanced technologies in the lab. You’ve worked with tech involving sperm selection, robotics, pregnancy prediction with data optimization. How will this tech impact the overall patient experience?
Dr. Tex VerMilyea: Maybe we start with pregnancy prediction. Again, using massive amounts of data and trying to find similarities of particular patients and maps to other patients with success and without success, being able to give patients a more thorough understanding of what their likelihood is of getting pregnant. Is it going to take one retrieval or is it going to take two retrievals? Do they need five eggs or 20 eggs? Is it a waste of time to do IUI, should they go straight to IVF? This kind of prediction will hopefully allow patients to be served sooner and get the treatment that they need quicker, because, as we all know, the clock is ticking. We definitely want to use these sorts of technologies to decrease the time to pregnancy.
In addition to pregnancy prediction and data mining, robotics is at our forefront. You think through the assembly line of making vehicles, where there were very many manual welders on the assembly line, and now it has all moved to robotics. Yes, humans can do a pretty good job, but unfortunately, as humans, we’re not as consistent and accurate as perhaps a robot is. How can we use that technology to reduce risk, to reduce potential mistakes, but also improve outcomes and perhaps do it better?
We’re now looking at the robots that are potentially coming to IVF laboratories and not necessarily doing the entire procedure, although there are some. What are some of the mundane tasks within the IVF lab that can be done by a robot or done by artificial intelligence that allows the human to then do their user skill sets as an embryologist on something better or something different.
I always say that you can never take the art out of ART. I think it will always require a bit of a human touch, especially with some of the fine finessed skills that we use in a laboratory, but it’s exciting to see where this technology is coming down the pipeline. I think and I hope it will soon be in IVF laboratories and part of a standard of care.
Dr. Aimee: That’s exciting. I also say technology is only as good as the human power behind it.
Dr. Tex VerMilyea: Correct.
Dr. Aimee: We can never say that nothing is risk-free, because there’s always a human behind it. But with the support of the technology that you’re mentioning, I think IVF labs could be even more successful than they are today.
Dr. Tex VerMilyea: That is the hope.
Dr. Aimee: You’ve championed selective single embryo transfer. Luckily, that’s the culture now in most, if not all IVF labs in the United States, if not worldwide. What do you want patients to know about how laboratories balance success rates with safety?
Dr. Tex VerMilyea: That’s at the top of our minds for every egg that comes through the laboratory. We want to decrease the time to pregnancy. Back in the days when the technology maybe wasn’t as advanced as it is now, where our procedures and processes in the laboratory were not as successful as they are now, we would put back multiple embryos and roll the dice and hope that only one would take, but sometimes multiple would take. If anything, I’ve learned in this field that two is not necessarily as good as one. We want to be able to make sure that the patient has success with an embryo transfer, but also not put them at risk or put the potential child at risk by putting more embryos back in the uterus.
Using technology to help us streamline and better identify which one, two, or three embryos are the most prime or the ones most capable of leading to a pregnancy is really our aim. PGT and the ability to count chromosomes and identify which embryos are chromosomally normal or have the correct number of chromosomes certainly has allowed us to preselect or triage which embryos to transfer first. In addition to that, maybe we can use AI technologies and other noninvasive approaches that can help identify which one good embryo is going to lead to a baby. Potentially, maybe there’s more, and with vitrification and with freezing, we have some backups in the freezer to come back to in case we have a failure or if the patient decides to continue on their family-building journey.
Dr. Aimee: I had an idea years ago. Someone else has built it. It’s an AI for the ultrasound machine. You just put the probe in, push a button, it scans everything and then spits out a report. Do you see anything coming in the future for doing ultrasounds?
Dr. Tex VerMilyea: There are some softwares, yes, exactly like you mentioned. I think with a lot of this technology, it’s only going to get better. I keep telling myself that. We have to be patient with some of it. AI is also built on retraining that algorithm and retraining that process. Even though, let’s say, we’ve validated the data and it looks pretty good when we’re comparing that one embryo or that one sperm to 100,000 photos, as we continue to use it, that 100,000 is going to become 200,000, then 300,000. All that’s going to do is allow us to better identify that data and redefine that algorithm. Not that it’s going to be perfect, but it’s going to continue to learn and continue to change.
Yes, there are some ultrasound AI companies that will hopefully lead to more accuracy, as well as speed up the process in the clinic.
Dr. Aimee: I think, hopefully, in the future there will be a company that will actually rent patients a probe so that they can do it from home. I know that there’s a company like that already. Then more people could have access to care, especially patients that live in fertility clinic deserts where there’s no one around them for hours and hours.
Dr. Tex VerMilyea: Absolutely.
Dr. Aimee: What do you wish that patients or fertility doctors better understood about embryology and IVF labs?
Dr. Tex VerMilyea: There’s a lot of Googling about what goes on in the laboratory. I think education is key. We’ve often had patients produce that photo at time of frozen embryo transfer, beautiful blastocyst at time of freezing, and that embryo is still starting to expand, so it still looks like a potential raisin in this moon outer layer. The patient goes home, they go to Google Doctor and compare images and think, “Hey, this isn’t a blastocyst. This looks like a raisin.” Having to have that conversation of the embryo being frozen, it is now starting to warm up and thaw, and it will eventually re-expand, don’t overthink it or get too worried.
I’m keen to help educate and provide answers to those sorts of questions, but sometimes too much information is not going to be helpful. I think being inquisitive in your journey, the embryologists are extremely well trained. The best satisfaction we have is when a patient does get pregnant, or even if a patient gets an embryo and they’ve never been able to have an embryo and have that opportunity. We’re really good at what we do. Again, layering on that technology, we’re only going to do things better and more efficiently.
I think the physicians understand who butters their bread, and that’s the lab team.
Dr. Aimee: So true.
Dr. Tex VerMilyea: Sometimes we’re back in the dungeon, closed off to life in general, but we get on with it, we work well at the bench and really have a passion for what we do. If you have that patient experience and that interaction, it’s obviously a bonus to our jobs. At the end of the day, we come to work ready to make embryos, to build embryos. That’s what gives us great satisfaction.
Dr. Aimee: We do a lot of cheering for our embryologists, we clap for them after the embryo transfer.
Dr. Tex VerMilyea: That’s awesome.
Dr. Aimee: It’s just a natural thing, we’re like, “Thank you!”
Dr. Tex VerMilyea: We need more of that.
Dr. Aimee: So many patients record their transfers, and then sometimes they’ll send me the video. I’ll look at the video, and you can hear us going, “Woohoo!” It’s fun.
Dr. Tex VerMilyea: Cheering them on. That’s great. I appreciate you doing that.
Dr. Aimee: What I’m curious about is what your thoughts are on what the IVF lab will look like in five or even ten years from now?
Dr. Tex VerMilyea: The lab has already evolved so much. Equipment has gotten smaller. We’re using equipment now that is more so built for embryology versus large cell culture like the big box incubators that you’d see in research laboratories and everywhere else. Now we have this small footprint, shoe box size incubators. Some of them have a camera attached that does timelapse and takes a picture every five minutes and makes a video of the embryo growing, so we can go back and look at these morphological events.
I think in the next five years, probably in the US, depending on how the FDA views some of these technologies, it’s going to be a lot more automated and the process a bit quicker. Not so much the embryo growing quicker, but in general, just the treatment plan. I think there’s going to be a lot of cross-talk between the clinic and laboratory, and a better interaction there that allows positive feedback or just more feedback and discussion between the two, really making a joint decision on best treatment and care.
In ten years, maybe there will be robots. The fear for embryologists is that AI and robots are going to replace us and we’re not going to be needed. I highly disagree with that. Maybe it’s true that our skill set may change, maybe we’re becoming more biologists and engineers, or troubleshooters on the backend. But I think anything that can improve the process and not compromise results is certainly a win-win situation for everybody involved.
Maybe in 20 years, it’s going to be a hub-and-spoke model where patients freeze their eggs and collect their sperm at home. They send it to a mother laboratory, a mother ship where the embryos are built. Then, who knows, maybe we’re doing embryo transfers in your La-Z-Boy chair at your house, where a van pulls up and we’re able to do that. I have no idea, but I think access to care is certainly changing.
Dr. Aimee: That’s not too far off, because I’ve had folks reach out with that kind of model, the mobile IVF clinic model, the same model that you’re sharing. I also have thought that because fertility is now so important, obviously, more than ever, just because of what we’re seeing in the world, in society, and those trends as far as people delaying childbearing, that people might even have their own tanks at home for long-term storage. Potentially, there might be like your water comes once a week to drop off your water, they’ll come in and just charge your tank at home for your embryos. Who knows?
Dr. Tex VerMilyea: It’s very possible. I would agree.
Dr. Aimee: Sometimes these ideas have actually become a reality. Maybe not immediately, but we’ll see.
Dr. Tex VerMilyea: That’s right.
Dr. Aimee: I’ve truly enjoyed this conversation. For listeners who want to follow your work or learn more about you and what you’re doing at US Fertility and Ovation, where can they find you?
Dr. Tex VerMilyea: I have a LinkedIn page. Ovation Fertility and US Fertility have a research page that basically shows all of our publications and ongoing studies, engages the patient and educates on all the great things that we continue to do. Look for me at your national and international meetings. You can always find me. I’m the only one there with a cowboy hat on, so I’m pretty easy to find. We’d like to push our research and scientific findings to help better improve the space, giving the patients the best option and possibility for success.
Dr. Aimee: Do you think embryos like a certain kind of music in the IVF lab, has AI figured that out, to grow better?
Dr. Tex VerMilyea: I heard that it’s country music. Most of my labs play country music, so we keep it at that.
Dr. Aimee: I love that. Tex, thank you for joining me today, and thank you for sharing your work. All the links we’ve talked about will be in the show notes.
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