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Introduction to Chatbots
In the world of artificial intelligence (AI) the superlative “overnight” is not unwarranted. ChatGPT, is an artificial intelligence powered chat robot (chatbot) with 175 billion parameters in its natural language processing model that has become wildly popular, seemingly overnight.
You have probably heard that ChatGPT is capable of passing business, law, and medical board examinations, has qualified as a level-3 coding engineer at Google (with a $180K starting salary!), diagnosed a rare (1 in 100,000) condition in seconds, can outperform most students in microbiology, and even earn a passable grade in a 12th-grade AP literature test.
I use ChatGPT every day, and it is quickly surpassing my use of other search engines. It responds to my queries with concise, human-like, detailed and referenced answers, solves elaborate problems, and answers intricate questions, and most importantly, it keeps learning from past inquiries to make the answers align to exactly the information I am looking for.
Women’s healthcare —historically underfunded— stands to benefit enormously from new AI technologies as long as the current limitations are understood and overcome. ChatGPT is not yet HIPAA compliant and there are currently many concerns about data privacy and integrity. My working assumption is that it was trained on all the digital data ever produced by humans. However, no one really knows what it was trained on. Lastly, ChatGPT occasionally makes up answers and has been known to completely fabricate references and citations (more on that later as I describe my experience stumping ChatGPT!).
Thinking for US
Academics and teachers have been wringing their hands and shedding bitter tears as they strive to prevent and detect plagiarism that goes beyond simply copying words, to much more complex intellectual phenomena— if you ask the computer to THINK for you, have you plagiarized the essence of humanity?
Can you plagiarize reasoning, planning, problem solving, abstract thinking, the comprehension of complex ideas? Should one believe what an AI tells you? Should you allow a computer to inspire you? Soothe your soul? Write your annual Christmas card? Even as I write this post, I’ve had to revise my anthropomorphic language – did it “write”? Did it “respond” to me? Did it “tell me” something?
With the advent of the “Information Era” we were forced to develop new philosophies for teaching and learning. Our kids (and us!) no longer waste time memorizing information (ie. the periodic table of the elements), instead we are experts at finding information and knowing how to use it. The advent of the AI Era (Augmented Intelligence Era?) will likely call for a similar restructuring of the way we think about education and learning.
The large publishing houses have all adopted a policy that ChatGPT cannot be an author, because it can’t take responsibility for the words it “wrote” i.e., returned. Current best practice dictates that the author should disclose that ChatGPT was used as a tool in writing. However, that seems odd to me. Why should ChatGPT use be disclosed, any more than using the Dewey Decimal System at the public library, or using Google to search for information? I predict that as chatbot AI becomes normalized, that will fall to the wayside as a silly artifact of the early days of AI. (Natch, ChatGPT was used as a tool for writing this post!)
The Information
Humans are driven to build great libraries. Often, we name them after politicians, because they are as much political symbols of progress, enlightenment, and cultural heritage as they are bastions of critical thinking. As a democratizing force driving innovation, the betterment of humanity as a whole, and the empowerment of individuals or populace, they are often the target of political battles. I think of ChatGPT (and now, competing large language models, like Bard) much the same way. But then I immediately think of the State sponsored censorship of books and libraries under dictatorships, and draw mental parallels to the book bans currently underway in the USA. I think of the destruction of libraries and thousands of historical and rare archives, such during the modern Iraq War and Syrian Civil wars, and in ancient times, the multiple cycles of destruction of the Library of Alexandria, (Nalanda, Persepolis, Ebla, and Pergamum). Large language models differ from libraries and search engines, they don’t simply present the information to you for your own syntheses and analysis, but they digest it, think it over, and spit it out in an interpreted fashion. Therefore, not only can they be manipulated, but they can also be stumped as we have tested and proven in this experiment to stump ChatGPT.
The internet was initially conceived as a decentralized and open platform that would be resistant to censorship and tampering, the reality is that it is not immune to such actions. I think of how political rivals use “fake news” to manipulate public opinion, how states censor web access (or use it for surveillance). I think of the proliferation of misinformation about vaccines, GMOs, Lyme Disease and so many other health related topics has harmed and killed so many. I think of the way political rivals can instantly flame a conspiracy theory. And I wonder… what will happen when rival businesses or states start targeting AI tools like ChatGPT or other language models? How will these powerful tools be used to manipulate public discourse, spread misinformation, or exploit biases and weaknesses?
Stumping ChatGPT
I have pontificated enough on the abstract. Now back to the immediate! The fertility field is laden with obscure and highly specific information. I decided to see if I could stump ChatGPT. Most of my questions were answered correctly, instantly, and accurately, however, I was quickly able to reach athe accuracy limits, and cause it to generate incorrect answers.
I asked Chat GPT to describe different cryodevices (bold is my emphasis). “Cryotop: Cryotop is a device developed by the Japanese scientist Masashige Kuwayama in 1999. It consists of a thin, rectangular strip of polypropylene film with 12 or 16 small wells for holding embryos or oocytes. Cryotop is considered a closed system because the wells are sealed with a thin film of oil or mineral oil, which prevents contamination during vitrification. Cryotop is known for its high efficiency and low volume of vitrification solution.”
I asked ChatGPT what the earliest reported sperm donor pregnancy was and it gave me the following information, which I was not able to verify as being correct. On PubMed, the publications of Sherman J.K. date back to 1953, but I could not find this specific reference “Sherman J.K. (1954) Fertility following insemination with frozen human spermatozoa. American Journal of Obstetrics and Gynecology, 68(5), 1295-1297. It claimed “This paper reports the successful birth of John Randolph, the first baby born from frozen sperm, and provides details about the methods used to freeze and thaw the sperm.” I asked if that was correct, and it returned: “As I mentioned in my previous response, the first baby born from frozen sperm was John Randolph, born in January 1954 to a couple in Texas who had been unable to conceive due to the husband’s low sperm count. The husband’s sperm was frozen in liquid nitrogen for a year before being thawed and used for artificial insemination, resulting in the successful birth of their son.”
Lastly, I asked ChatGPT for information about the regulation of anonymous tissue donors, and it returned the following mix of accurate and inaccurate information (bold is the false): “Under FDA regulations, anonymous egg donors must be tested for communicable diseases, including HIV, hepatitis B and C, syphilis, and gonorrhea. Donors must also be screened for genetic disorders that could be passed onto offspring, such as cystic fibrosis and sickle cell anemia. In addition, donors must undergo a medical history review and provide information about their lifestyle habits, such as smoking and drug use.”
ChatGPT Fertility Inspiration
If you are looking for some fertility inspiration, can you turn to Chat GPT for emotional support? Let us know if you feel empowered or inspired when we asked ChatGPT to be the hype man of those suffering from infertility with this final message of support and hope. “If you’re waiting to get pregnant, the journey can be long and difficult. It’s easy to become overwhelmed with the daily routine of charting cycles, taking medications, and undergoing fertility treatments. But as the days get longer and warmer, it’s important to take a step back and appreciate the beauty of the season and the hope it brings. Just as the earth goes through cycles of growth and renewal, so do our bodies. With each new cycle, there’s the possibility of new life. Oocytes, or eggs, undergo a complex process of maturation before they can be fertilized. This process takes several months, and is influenced by a variety of factors, including age, genetics, and lifestyle choices. Spring is also a time for renewal. Take some time for self-care – pamper yourself, whether it’s with a relaxing bubble bath, a massage, or a day out in nature. Focus on activities that bring you joy and relaxation, and don’t forget to connect with loved ones. Our relationships are important for us to maintain a healthy mind and body.
You’re not alone on this journey. Reach out to friends, family, or a professional counselor if you’re feeling overwhelmed or just need a friendly face and listening ear.
As you embrace the season of spring, remember that your journey towards parenthood is also your journey of growth and renewal. Take a deep breath, appreciate the beauty in and around you, and hold on to the hope that your new beginning is just around the corner.”
Were you inspired, terrified, or convinced? Let us know in the comments!
As couples navigate through their fertility journey, you will meet with your physician and begin the process for IVF that includes preparation, stimulation, and monitoring.
In the background is the functioning of the IVF laboratory, where what is actually occurring can be a bit of a mystery. It is after all an almost literal black box! A windowless lab that is under strict lock and key and is often a dark, warm humid atmosphere, just like a human fallopian tube which is the site of fertilization inside the body.
The scientist who combines the sperm and egg and helps the resulting embryos to grow in a controlled environment is called an embryologist. Access to the laboratory or embryologists in most clinics is limited.
An embryologist is a fertility specialist that helps to create embryos to either be used in IVF right away or to be frozen for later use. Embryologists aren’t MDs, but we are highly trained medical professionals, usually holding a Masters’s degree or a Ph.D. due to the specialized nature of our work. Here are ten things we want you to know about IVF!
What is a blastocyst and why is embryo grading important?
A blastocyst describes an embryo stage reached usually after about five days of development post-fertilization. It has about 50-150 cells and has started to develop specific regions with different cellular destinies. The blastocyst is working hard; pumping fluids towards its center, creating a fluid-filled center and expanding like a water filled balloon. Embryo grading is when embryologists grade embryos based on their potential to successfully implant and result in a pregnancy. The criteria varies from clinic to clinic but the goal is always the same-transfer the best embryo! Embryologists have lots of training in grading embryos and make the best decision they can for you and your embryos. New technologies like AiVF‘s artificial intelligence system EMA are replacing the subjective human analysis of blastocysts with data-driven decision making, while bringing automation and full transparency to the process, which can make IVF efficient, accurate, and easy.Why are there so many unknowns about “IVF Add-Ons like EmbryoGlue, PGT-A, Assisted Hatching etc?
In my opinion, this is the result of thirty years of political turmoil in the US. research on embryos and IVF has largely been driven out of the public sphere and into the private sector, entirely supported by commercial interests and individual clinics.A lot of embryos look amazing on Day 3, but do not go on to form blastocysts. Why?
Embryonic gene activation (EGA) is the process by which an embryo begins to transcribe its newly formed genome. Sperm play an essential role in embryonic genome activation and embryonic progression to blastocyst. Embryos often “arrest” at this stage.Why did I get so many abnormal embryos by PGT?
Aneuploidy (abnormal or incorrect chromosome number) is common in humans and is the leading cause of all human birth defects as well as miscarriage. For those new to the terminology, PGT is a genetic test that takes place before embryo transfer, designed to tell you if each embryo is chromosomally healthy. An embryo that is euploid (normal) has 23 pairs of chromosomes and has a better chance at leading to a successful live-birth than an abnormal (aneuploid) embryo. Aneuploid embryos have missing or extra chromosomes and will typically fail to implant, result in a miscarriage, or lead to the birth of a child with a chromosomal disease. Aneuploidy (abnormal or incorrect chromosome number) is common in humans and is the leading cause of all human birth defects as well as miscarriage. We can perform up to three types of preimplantation genetic testing on embryos during the IVF process. Those include: PGT-A, which screens for an abnormal number of chromosomes. PGT–M is the test for individual, or monogenic, diseases. PGT-SR tests for abnormal chromosomal structural rearrangements, like translocation or inversion. PGT begins with a biopsy of an embryo in the blastocyst stage of development, usually on day 5 or 6 of embryo development. The biopsy removes 3 to 10 cells from the trophectoderm, which is the outer layer of cells that will become the placenta as the embryo develops. The biopsy does not remove any cells from the inner cell mass, which develops into the fetus. After these cells are removed, the blastocyst is frozen and stored in the lab. The biopsied cells are sent for laboratory testing. Results are typically returned in a week to 10 days following the biopsy. Besides the two possible PGT results we’ve already talked about– euploid and aneuploid– there are also two others: mosaic and inconclusive. A mosaic embryo consists of both euploid and aneuploid cells. While mosaicism has existed all along, PGT has only been able to recognize mosaicism in embryos within the past three years, so there is still a lot of research ongoing about their potential. What we know now is that about 10-15% of all embryos are mosaic. Embryo biopsy can also yield an “inconclusive’ or “No result”. That means that the trophectoderm biopsy sample was insufficient to be used for PGT or that it did not meet the quality control standards for analysis. A study by Cimadomo et al. (2018) showed that inconclusive results occur about 1.5-5% of the time because the cell sample is not loaded properly and the tube is actually empty, or that the sample was degraded. Inconclusive or no result embryos have a good chance of being “normal”. A large study (Demko et al., 2016) found for women <35 there is about a 60% chance of a blastocyst being euploid (normal) to 30% by age 41. The chance of getting NO euploid (normal) embryos was about 10% for <35 and about 50% by 43.I am disappointed that I didn’t have more eggs.
15 is the optimal number of eggs to retrieve without putting you at risk for #OHSS. More eggs often means lower quality and higher estrogen levels, which can impair implantation in fresh IVF Cycles.IVF has a 100% success rate.
The success rate of IVF is about 40% in couples below the age of 35. Also, the success rate of IVF depends on factors such as age, cause of #infertility, and biological and hormonal conditions. One of the reasons for this, is that although many blastocysts may LOOK morphologically normal, their behavior can differ in surprising and clinically relevant ways. For example, during development, the blastocyst pushes against the surrounding zona pellucida to expand. Some embryos do this with no trouble, while others struggle and go through a series of contractions and expansions. AiVF’s computer vision analysis of time-lapse videos of embryos has shown that blastocyst pumping events have a high negative predictive value for subsequent failed implantation. AiVF’s AI-based digital embryology management platform was able to shed light on this complex question, by showing that contractions and expansions greater than 8 microns in diameter were associated with poor implantation rates independent of other morphokinetic features.IVF is the same thing no matter which clinic you go to.
NOPE! Not all fertility clinics are created equal, so it’s important to do your research to help you make an informed decision. In addition to looking for a clinic with high-qualified #fertilitydoctors, it’s critical to choose a clinic with a superior IVF lab. You can check out a clinic’s success rates at Society of Assisted Reproductive Technology or the Centers for Disease Control and Prevention website.Infertility is a female problem.
Most of the practical and emotional infertility support out there is aimed at women. Maybe because we are the ones being stimmed and undergoing the surgeries. But we need to get the men more involved! It’s a common misconception that women are most affected by infertility. In some cultures “male infertility” is literally unheard of, like culturally it does not exist. In fact, men and women are equally affected. In heterosexual couples, 1/3 of infertility cases are attributed to men, 1/3 to women, and 1/3 are unknown. With regard to our healthcare, often we will be the first to approach an infertility doctor, who will then prescribe a standard work up of invasive tests that have become the norm for women who experience problems conceiving: that includes multiple appointments, multiple hormone tests, internal, transvaginal scans to check your womb for fibroids, and an HSG test, where dye is pushed into your fallopian tubes to see if they were blocked. Only then, does the male partner typically obtain a semen analysis. Sometimes, men may need to modify their lifestyle habits quite a bit, but this is often brought up late, if at all. Some providers argue that assessing lifestyle factors and history, or for physical problems like varicocele, is even more important than the traditional semen analysis. Raising awareness male infertility will help us to get more funding, resources, research, and even donations made by male donors.IVF is only used for individuals/couples struggling with #infertility.
Families with a history of genetic disorders can do IVF with pre-implantation genetic testing to screen their embryos for single gene disorders and to prevent the genetic condition from being passed onto their children. Even fertile couples use IVF to have more control over their family building, such as being able to chose the order of the sex of their children or for optimal timing for their lives and careers. Also, IVF is used by moms and dads who are single by choice and for LGBTQ couples to build their families.Eggs, Sperm and Embryo Myths!
We cannot tell “female” (X- bearing) sperm from male (Y-bearing) sperm. There is a persistent myth that X or Y bearing sperm look different from each other or swim at different rates. These myths are not based on good, solid science! Every egg, sperm and the resulting combination of the two are different. That makes every attempt at IVF using different gametes a different experience. From the embryologist’s point of view, each egg looks different, but we can’t see the DNA with a microscope to select the “good” eggs. Embryologists will care and nurture your gametes, but cannot repair or make an embryo better by culturing it in the laboratory. Some embryos don’t freeze well or survive the thaw, and are just indicators that there is probably something flawed about them or something we don’t yet understand scientifically speaking. Additionally, each embryo is as different as any child resulting from that embryo would be, but we can’t treat each embryo differently. Adhering strictly to IVF lab culture protocols is what elevated assistant reproductive technologies from being an art into being a reproducible science.
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