Automation and autonomy in the IVF laboratory: concepts and implications for embryologists

Automation is regarded as the next phase in the evolution of laboratory IVF. Despite technological advances, most laboratory procedures remain operator-dependent, contributing to variability in performance and outcomes. While automation has improved reproducibility and efficiency in many areas of medicine, its adoption in IVF has been slow. This review examines how automation may be integrated into IVF laboratories through a set of conceptual distinctions. Automation refers to the execution of procedural steps by machine-controlled systems, whereas autonomy describes the degree to which such systems can operate without human intervention. We distinguish between static automation, which maintains or monitors the laboratory environment, and dynamic automation, which directly manipulates biological material. We also introduce the concepts of under-automation and over-automation and consider the relationship between autonomy and technical complexity. These distinctions highlight the unique challenges of IVF, where procedures involve handling irreplaceable cells. Increasing automation does not necessarily imply increasing autonomy. Effective design must balance standardization with human oversight and intervention. Automation in IVF laboratories will likely progress gradually through integration of dynamic systems under continued human supervision. The central challenge will be to improve consistency and laboratory capacity while preserving clinical responsibility, trust in automation, and professional satisfaction.