FERTILITY CARE IN LOW- AND MIDDLE- INCOME COUNTRIES: The future use of AI to improve accessibility of assisted reproductive technology in low- and middle-income countries

Abstract People in low- and middle-income countries face many obstacles when trying to access fertility treatments. These challenges include high costs, the need for specialized medical facilities, and cultural beliefs that may discourage seeking help. This paper explores how artificial intelligence (AI) and automation could help overcome some of these barriers and make fertility treatments more widely available. It examines how AI may improve the accuracy, efficiency, and consistency of different steps in fertility treatments, such as choosing the healthiest embryos, analyzing sperm, evaluating eggs, and planning treatment. The paper also discusses how automation could simplify laboratory procedures, from growing embryos and freezing them for future use to the possibility of fully automating the in vitro fertilization (IVF) process, which could help lower costs and make these treatments more accessible. Finally, this paper addresses the ethical and practical challenges associated with using these technologies, including potential biases in AI, equitable access, quality control, data privacy, job implications, and cultural sensitivities.   Lay summary This paper explores how AI and automation could help make fertility treatments more accessible in low- and middle-income countries (LMICs). Many individuals and couples face difficulties conceiving, and assisted reproductive technology (ART) – which includes procedures such as intrauterine insemination (IUI) and IVF – offers them a chance to build a family. However, ART is often out of reach in LMICs due to high costs, the need for specialized medical facilities, and cultural barriers. AI and automation have the potential to improve accuracy, efficiency, and consistency in ART procedures, such as embryo selection, sperm and egg assessment, and treatment planning. Automation could also streamline laboratory processes, including embryo culture and freezing, which may eventually lead to more affordable and scalable fertility treatments. By reducing human error and dependence on highly trained specialists, AI-driven technologies could help lower costs and make ART available to more people. This paper also considers the ethical and practical challenges of using AI in reproductive medicine, including potential biases in AI algorithms, fairness in access to treatment, data privacy, workforce impact, and cultural sensitivities. Fertility treatments can be life-changing for those struggling with infertility due to medical conditions, age, or personal circumstances. They also provide opportunities for same-sex couples and individuals who want to start a family. However, in LMICs, infertility is often surrounded by social stigma, economic hardship, and limited medical resources, making access to ART even more difficult. By integrating AI and automation into reproductive medicine, it may be possible to break down these barriers, reduce costs, and create more inclusive and accessible fertility care. These advancements have the potential to bring hope to millions who dream of parenthood but currently lack the means to pursue it.