Does the addition of time lapse morphokinetics in the selection of embryos for transfer improve pregnancy rates A randomized controlled trial

Capsule:
This randomized controlled trial could not detect a statistically significant difference in reproductive outcomes when continuous time-lapse morphokinetic data was added to conventional screening criteria for embryo selection.

Authors:
Linnea R. Goodman, M.D., Jeffrey Goldberg, M.D., Tommaso Falcone, M.D., Cynthia Austin, M.D., Nina Desai, Ph.D., H.C.L.D.

Volume 105, Issue 2, Pages 275-285

Abstract:

Objective:
To determine if the addition of continuous morphokinetic data improves reproductive outcomes when all embryos are cultured in a closed system.

Design:
Prospective, randomized, controlled study.

Setting:
Single academic center.

Patient(s):
A total of 235 patients undergoing fresh autologous IVF cycles with at least four embryos, cultured in the Embryoscope: 116 patients randomized to conventional once-daily morphologic embryo screening (CS) and 119 to additional time-lapse kinetic monitoring (TLM) for selection.

Intervention(s):
TLM versus CS.

Main Outcome Measure(s):
Intrauterine clinical pregnancy (CPR) and implantation (IR) rates.

Result(s):
CPR and IR were similar overall (TLM vs. CS, respectively: CPR 68% vs. 63%; IR 51% vs. 45%) and with blastocyst transfers (CPR 74% vs. 67%; IR 56% vs. 51%). CPR with day 5 transfer was threefold higher than day 3 transfer, but group (TLM vs. CS) was not a significant predictor of clinical pregnancy or implantation. Significantly more multinucleation was detected when CS embryos were retrospectively reviewed with the use of TLM (7.0% vs. 35.3%), and multinucleation was independently associated with decreased rates of implantation. Time to the start of blastulation of <100 hours after insemination and the morphokinetic scoring system used in the TLM group were independently associated with implantation. Conclusion(s):
The addition of time-lapse morphokinetic data did not significantly improve clinical reproductive outcomes in all patients and in those with blastocyst transfers. Absence of multinucleation, timing of blastulation, and morphokinetic score were found to be associated with blastocyst implantation rates.

Clinical Trial Registration Number:
NCT02081859.

  • Daniel J. Kaser, MD

    Dear Dr. Goodman and colleagues,
    Congratulations on this important contribution, which comprehensively evaluates whether addition of time lapse imaging improves implantation and clinical pregnancy rates. Are data available comparing the clinical outcomes for patients who had a day 3 embryo transfer with time lapse selection to those who had a day 5 transfer with selection by conventional morphology?
    Thanks very much for your comments!

    • Linnea Goodman

      Hello Dr. Kaser,
      Great thought! We did not specifically compare those groups, but do have outcome data available for both of those groups. We generally only do a day 3 transfer when the embryo quantity is low or quality is poor, so this may influence those results.
      Thanks for your comment!

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