EmbryoScope™ Time-lapse incubation and imaging
What is an EmbryoScope™-Time-lapse incubation and imaging?
Embryos in the laboratory are cultured in incubators which are closed systems in order to maintain a stable environment (temperature, oxygen, CO2 etc…). To observe the embryo development, every 1-2 days, the embryos are removed from the incubator and transferred for a short amount of time in another protected area with a microscope and a camera to observe, capture and grade their quality (such as the number of cells, how quickly they divided etc…). As a result, we only observe a snapshot of the embryo development on 3-5 occasions.
On the other hand, the EmbryoScope™ is a Time-lapse incubator that has a built-in camera and microscope. It captures images of the developing embryos every 10-15 minutes and with the thousands of pictures captured over 3-6 days, it creates a Time-lapse video of embryo development.
In this video Suzanne Cawood, Head of Embryology, explains the time-lapse systems at CRGH for embryos.
What are the benefits of Time-lapse incubation and imaging (EmbryoScope™)?
More information to choose the best embryo to transfer
Due to the almost continuous monitoring of the embryos, we can observe some aberrations in embryo development that would otherwise not be noted when embryos are cultured in conventional incubation. For example, with Time-lapse imaging we can observe whether the fertilized egg divides normally from 1 to 2 cells or abnormally from 1 to 3 cells, which is likely to be missed with a traditional incubator. This happens in up to 1/4 of embryos and would reduce the chances of implantation1,2. Therefore, with this information we could choose to transfer another embryo with higher chances of implantation.
Studies have correlated patterns of embryo development with Known Implantation Data (KID) score in an attempt to predict which embryo would give the best outcome giving a score to each embryo.
More stable environment
With a time-lapse incubator, we also allow uninterrupted and continuous culture of embryos without removing them from the safe environment of the incubator, ensuring a stable environment during their six days of development from fertilisation to blastocyst formation.
Are there any risks?
No, there are no known risks to the woman or the embryos from Time-lapse imaging.
Who would benefit from Time-lapse incubation and imaging (EmbryoScopeTM)?
There is a growing body of evidence that these systems have a positive impact on success rates compared to traditional incubators. In our experience, we believe the following groups of patients may benefit from the use of the EmbryoScopeTM:
Patients with repeated implantation failure:
- We can identify certain embryonic developmental patterns, such as direct or reverse cleavage, and gain more insight into the cause of the failed implantation in order to determine future treatments (CRGH experience).
Patients using surgically retrieved testicular sperm in their treatment cycle3.
Some patients having preimplantation genetic testing for aneuploidy (PGT-A):
- A study has shown a potential benefit of using Time-lapse imaging in selecting the best embryo even when the embryos are considered to have normal chromosomes after genetic screening4.
Potentially all patients having IVF/ICSI treatment:
- A review of the current studies in 2017 (5 randomized trials with 1637 patients most at their 1st or 2nd IVF attempt) showed that the application of time-lapse monitoring was associated with a significantly higher ongoing clinical pregnancy rate (51.0% vs 39.9%), significantly lower early pregnancy loss and a significantly increased live birth rate (44.2% vs 31.3%)5.
- A further review in 2018 suggested that the studies included were of low quality and there was insufficient evidence of differences in live birth, miscarriage, stillbirth or clinical pregnancy between Time-Lapse and conventional incubation6.
Whilst there is inconclusive evidence regarding the use of Time-lapse incubation and imaging (EmbryoScope™) and is optional, the clinic will only offer it when your consultant deems it appropriate for the treatment.
Time Lapse incubation and imaging is outlined as an additional treatment option by the HFEA and has currently been deemed as amber in the HFEA traffic light system for additional treatment options as there is conflicting evidence from randomised controlled trials to show that it is effective at improving the chances of having a baby for most fertility patients. This means that the evidence is not conclusive and further research is required, and the add-on should not be recommended for routine use. Please refer to the treatment add-ons page of the HFEA website7.
Speak to your CRGH doctor if you would like to use time-lapse technology for your embryos.
- Rubio I, Kuhlmann R, Agerholm I, Kirk J, Herroro J, Escriba M et al., Limited implantation success of direct cleavage human zygotes: a time-lapse study. Fertil Steril. 2012 98:1458-63
- Zhan Q, Ye Z, Clarke R, Roswaks Z, Zaninovic N. Direct Unequal Cleavages: Embryo developmental competence, genetic constitution and clinical outcome. PloS one. 2016 11(12): e0166398
- Lammers J, Reignier A, Splingart C, Catteau A, David L, Barriere P et al. Does sperm origin affect embryo morphokinetic parameters? J Assist Reprod Genet. 2015;32:1325-1332.
- Rocafort E, Enciso M, Leza A, Sarasa J, Aizpurua, J, Euploid embryos selected by an automated time-lapse system have superior SET outcomes than selected solely by conventional morphology assessment. J Assist Reprod Genet. 2018;35:1573-1583.
- Pribenszky C, Nilselid AM, Montag M, Time-lapse culture with morphokinetic embryo selection improves pregnancy and live birth chances and reduces early pregnancy loss: a meta-analysis, Reprod Biomed Online. 2017; 35:511-520.
- Armstrong S, Bhide P, Jordan V, Pacey A, Marjoribanks J, Farquhar C. Time‐lapse systems for embryo incubation and assessment in assisted reproduction, Cochrane Database of Systematic Reviews 2018, Issue 5. Art. No.: CD011320.