Embryo incubation and selection in a time lapse monitoring system improves pregnancy outcome in comparison with a standard incubator A retrospective cohort study

Capsule:
Logistic regression analyses of retrospective data from ten IVF clinics indicate significant improvement in clinical pregnancy rate (relative +20%), presumably from stable culture conditions and morphokinetic selection, with the use of time-lapse embryo monitoring.

Authors:
Marcos Meseguer, Ph.D., Irene Rubio, Ph.D., Maria Cruz, Ph.D., Natalia Basile, Ph.D., Julian Marcos, Ph.D., Antonio Requena, M.D.

Volume 98, Issue 6, Pages 1481-1489.e10, December 2012

Abstract:

Objective:
To quantify the effect on reproductive outcome of culturing and selecting embryos using a novel time-lapse monitoring system (TMS).

Design:
Retrospective observational cohort study.

Setting:
University-affiliated private center.

Patients:
Donation and autologous ICSI cycles from 10 IVF clinics using similar procedures, cultured in TMS (n=1,390) or in a standard incubator (SI; n=5,915).

Intervention:
None.

Main Outcome Measures:
Clinical pregnancy rate confirmed by ultrasound in week 7.

Results:
A logistic regression analysis, which included all significant confounding factors, was used to evaluate the effect of culturing and selecting embryos using TMS. Comparing clinical pregnancy rates per oocyte retrieval for TMS with SI treatments gave a crude effect of OR=1.190 (CL95 1.058-1.337).Oocyte source, maternal age, day of transfer and number of retrieved oocytes were identified as significant confounding factors. After accounting for confounding factors, the effect of TMS culture was OR=1.201 (CL95: 1.059- 1.363, p=0.0043). Limiting analysis to treatments with embryo transfer and including number of transferred embryos as confounding factor likewise gave a significant effect of TMS with OR=1.157 (CL95: 1.018-1.315, p=0.0254).

Conclusions:
Analysis of retrospective data indicated that culturing and selecting embryos by TMS improved the relative probability of clinical pregnancy significantly (+20.1% per oocyte retrieval, +15.7% per embryo transfer). The elevated clinical pregnancy rate was attributed to a combination of stable culture conditions and the use of morphokinetic parameters for embryo selection.

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