Choosing the best embryo by time lapse versus standard morphology

Capsule:
Retrospective studies have shown correlation between time-lapse parameters and embryo viability. A recent randomized study has shown improved pregnancy rates. Strict evidence still seems weak.

Authors:
Kirstine Kirkegaard, Ph.D., Aishling Ahlström, Ph.D., Hans Jakob Ingerslev, Dr.Med.Sc., Thorir Hardarson, Ph.D.

Volume 103, Issue 2, Pages 323-332

Abstract:

Within the past few years the morphological evaluation of in vitro fertilized embryos has been extended to include continuous surveillance, enabled by the introduction of time-lapse incubators developed specifically for IVF treatment. As a result time-lapse monitoring has been implemented in many clinics worldwide. The proposed benefits compared with culture in a standard incubator and fixed time-point evaluation are uninterrupted culture, a flexible workflow in the laboratory, and improved embryo selection. The latter is based on the reasonable assumption that more frequent observations will provide substantially more information on the relationship between development, timing, and embryo viability. Several retrospective studies have confirmed a relationship between time-lapse parameters and embryo viability evaluated by developmental competence, aneuploidy, and clinical pregnancy. Furthermore a much anticipated randomized study has shown improved pregnancy rates (PRs) after culture in a time-lapse incubator combined with selection using a hierarchical time-lapse selection model. At present this is the only randomized study on possible benefits of time lapse in human embryology. Strict evidence may still seem too weak to introduce time lapse in routine clinical setting. This aim of this review is therefore to perform a balanced discussion of the evidence for time-lapse monitoring.

  • As the authors point out, time-lapse monitoring (TLM) has several potential benefits compared with standard scoring, but is also expensive. In the field of ART, another likely beneficial but expensive proposed trend is pre-implantation genetic screening (PGS). When clinics consider which technologies to invest in, cost and efficacy have to be considered. Do the authors predict that TLM and PGS will “compete” with each other and one will “win”? Are there reported / ongoing / planned trials comparing the two head-to-head? Or will they co-exist and complement each other?

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