Time lapse imaging: is it time to incorporate this technology into routine clinical practice?

Abstract

Time-lapse imaging (TLI) systems for embryo incubation, assessment and selection are a novel technology available to in vitro fertilization (IVF) clinics. However, there is uncertainty about their clinical and cost-effectiveness and insufficient good quality evidence to warrant their routine use. Despite this, enthusiastic commercial marketing and slipping clinical equipoise have led to the widespread hasty introduction of this technology into practice, often at a considerable expense to the patient. We have reviewed the published literature and aim to summarize the strengths, weaknesses, opportunities and threats of these systems. These specialized incubators provide undisturbed embryo culture conditions and, by almost continuous monitoring of embryo development, generate morphokinetic parameters to aid embryo selection. They are thus hypothesized to improve outcomes following IVF. Although literature reports improved reproductive outcomes, these outcomes are largely surrogate and there is a paucity of studies reporting live births. The use of time lapse systems may reduce early pregnancy loss, increase elective single embryo transfers and limit multiple pregnancies through better embryo selection. However, the quality of the studies and hence the evidence so far, is low to moderate quality. We recommend further research producing robust high-quality evidence for and against the use of these systems.

Effect of GOLPH3 on cumulus granulosa cell apoptosis and ICSI pregnancy outcomes

“…It is considered that GOLPH3 may be serve as a biomarker for the egg quality and used to screen top-quality eggs and embryos, which facilitates the success of ICSI pregnancy. In addition, the combination of analysis of GOLPH3 expression in cumulus granulosa cells and time-lapse incubation for embryo culture is useful to further validated the potential of GOLPH3 expression in the selection of top-quality eggs 47 , 48 .…”

Over Ten-Cell Good Embryo Transfers on Day Three have Equivalent Clinical Outcomes with Those of Eight-Cell Embryos in Female Patients Aged ≤35 Years: A Retrospective Cohort Study

“…It has been suggested that a cumulative embryo classification scheme that encompasses all the above criteria is urgently needed to improve the efficiency of embryo assessment [26][27][28][29]. In recent years, many reports have discussed noninvasive techniques that enable the monitoring of embryos' development without moving them from incubators, using time-lapse imaging, to increase the precision and sensitivity of embryo selection [30][31][32]. Besides the above evaluation criteria, the role of the clinician performing the transfer and the patient's inherent condition (endometrial receptivity) are additional key elements in determining the success of implantation, and should not be ignored [33][34][35][36].…”

Impact of sperm characteristics on time‐lapse embryo morphokinetic parameters and clinical outcome of conventional in vitro fertilization

“…The introduction of time‐lapse imaging technology allows continuous observation of embryo development without removal from controlled and stable incubator condition. This technology offers several potential advantages over conventional methods, including improved culture conditions with decreased frequency of handling and exposure of embryos to the risks of stress from temperature changes, high oxygen exposures, and pH changes in the culture media 1,2 . Also, by serial imaging, more information on embryo development is obtained, allowing morphokinetic monitoring (ie, assessment of the quality of embryos by tracking the timing of events and length of different intervals in embryo development), which adds another dimension to embryo selecting and grading 3 .…”