Rethinking embryology dogma

Nearly five decades after the birth of the first in vitro fertilization child, the embryology laboratory still depends largely on manual, experience-driven techniques shaped by earlier technological constraints. Despite remarkable advances in imaging, bioengineering, and computational analysis, many core procedures remain resistant to redesign. This View and Review calls for a fundamental re-evaluation of laboratory dogma, proposing that future progress in assisted reproduction must rest on exploration, measurable process control, reproducibility, and clinical validation. Emerging automation experiments suggest that delicate procedures such as dish preparation, denudation, and micromanipulation may soon be performed with precision equal to or exceeding that of skilled human operators. Yet feasibility alone does not guarantee benefit; rigorous noninferiority and safety studies are essential. Likewise, static embryo culture, once justified by its simplicity, should be re-examined, considering continuous monitoring, dynamic perfusion, and adaptive control of oxygen, pH, and nutrient composition. These refinements may approximate but not replicate in vivo physiology, offering diverse routes to improve stability and reduce interlaboratory variability. The most rapidly advancing frontier is embryo selection. Traditional morphology and time-lapse assessment are being augmented by high-resolution imaging, metabolic and proteomic profiling, and both invasive and noninvasive genetic testing. Artificial intelligence provides a framework for integrating these data modalities and supporting consistent advice-based evaluation. Its value lies not only in potential superiority to expert judgment, but also in its ability to emulate expertise, accelerate training, and strengthen the reliability of dynamic, forward-looking laboratories. Together, these developments signal a gradual shift from tradition-based practice toward a scientifically engineered system of assisted reproduction. Through the integration of automation replacing or imitating gamete and embryo pipetting, adaptive culture, comprehensive embryo assessment, and validated artificial intelligence tools, the modern in vitro fertilization laboratory may achieve more predictable outcomes, shorten learning curves, and expand access to effective treatment worldwide.