In vitro fertilization (IVF) is one of the fastest developing fields in medicine. Until today, it has been estimated that over 6 million children have been born as a result of IVF treatments. Despite the technical developments of the last decades, there are still problems associated with the treatments that need to be solved such as multiple gestations due to the transfer of many embryos to achieve a pregnancy.
To address the problem of multiple gestations following IVF, more restrictive transfer policies have been recommended and various methods have been studied that could help embryo selection. Single embryo transfer could essentially eliminate multiple pregnancies.
The ability of various screening technologies (preimplantation genetic screening, metabolomics, proteomics) to identify embryo(s) with the highest implantation potential has been evaluated in recent years. Some of these methods require the use of complicated technology, necessitate elective embryo cryopreservation and are associated with significant treatment expenses. Time-lapse monitoring is another tool that has been evaluated as an aid to identify the embryo(s) with the highest implantation potential.
Time-lapse monitoring and technology
Usually, the embryologists remove embryos from the incubator once per day to assess cleavage and morphology, but this type of monitoring only gives them a snapshot of a dynamic process. The embryos do not tolerate removal from optimal culturing conditions, which limits the number of observations that can be made. Time-lapse technology may offer a solution to this problem. With this technology, the embryos can be monitored without removing them from the incubator. A camera is built into the incubator and takes pictures of the embryos at preset intervals. With the help of the proper software, a video can be made that depicts their development. This type of monitoring allows for the collection of much more information on the timing of the cleavages and the dynamics of the morphologic changes.
Various time-lapse systems are currently used. All systems incorporate a digital inverted microscope that takes a picture of the embryos at 5-20 minute, intervals. The images are processed by custom image acquisition and then displayed on a computer screen. The pictures taken at preset intervals are then connected into short films that can be rewound and fast-forwarded for detailed analysis.
Time-lapse technology is expected to improve the embryologist’s ability to select the embryo with the highest implantation potential (even by day 3 or at the blastocyst stage), and this improvement should be translated into an improved clinical outcome. Time-lapse embryo observation allows us to monitor the dynamic events of embryo development as they happen rather than just evaluate snapshots of it. A lot has already been learned of the events of early embryonic development, and it has also been shown that if observations are made only once a day, some of the important changes the embryo undergoes (e.g., changes in fragmentation pattern) will be missed, which may result in the false identification of the best embryo for transfer. While its full impact on clinical care needs to be explored, the technology could be useful for the standardization of the steps of embryo development. Time-lapse technology is just one of the methods that are currently being evaluated for embryo selection. None of these technologies is perfect, and rather than looking at them as competing technologies, we should evaluate how they could complete each other and further improve embryo selection during IVF.
In summary, time-lapse technology provides us with an undisturbed, continuous embryo observation option that can aid embryo selection. However, the full benefit of the technology and its place among the other embryo screening tools remains to be determined with further studies.
As Newlife IVF is always in the front line of the novel technologies, further data are needed in order to ensure that time-lapse should be incorporated in our services, in order to bring our couples one step closer to taking a healthy baby at home.
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