Cell division in the embryo
Results of a randomized controlled trial, published today in scalpelproviding evidence that the use of time-lapse imaging (TLI) does not improve treatment outcomes for a person undergoing fertility treatment.
One in six adults worldwide suffers from infertility. There are a number of assisted reproductive treatments that can help people with fertility problems have a baby, including in vitro fertilization (IVF). Statistics from Human Fertilization and Embryology Authority (HFEA) Statistics show that more than 100,000 IVF cases were performed in the UK during the period 2022-2023.
When a person undergoes IVF or other established fertility treatment, they may be offered additional treatments. These additional treatments are optional and not necessary and may be offered to help improve the chances of having a child or for other medical reasons. However, the evidence supporting the use of additional treatments for most fertility patients is usually lacking, limited, or very unreliable.
Time-lapse imaging (TLI) is one such technique used in IVF that is offered as an add-on to fertility. Time-lapse imaging takes thousands of time-lapse images of embryos as they develop, creating a continuous view of each embryo as it grows. Some fertility practitioners believe that the information provided by time-lapse imaging — such as growth rate or cell number and appearance — can help select the best embryos for implantation.
In TLI, embryos are not removed from their incubators, thus reducing fluctuations in temperature, humidity, pH, and gas concentrations that may affect development. Standard techniques for evaluating and selecting embryos with the best implantation potential require embryo removal from the incubators.
A double-blind trial, led by Dr Priya Bhide of the Women’s Health Research Unit at Queen Mary University of London and funded by Barts Charity and others, recruited more than 1,500 participants undergoing IVF at seven centres in the UK and Hong Kong.
Participants were randomly assigned to one of three arms of the trial: one group of participants received TLI-based embryo selection, another group received standard static assessment using undisturbed culture, and a third group received conventional assessment using light microscopy and standard embryo culture in standard incubators. Baseline demographic and clinical characteristics of participants were similar across the three arms.
Live birth rates for fetuses from each study arm were 33.7% in the TLI arm, 36.6% in the undisturbed culture arm, and 33.0% in the control arm. Clinical pregnancy rates were 42.2% in the TLI arm, 43.4% in the undisturbed culture arm, and 40.9% in the control arm. None of the other secondary outcomes of clinical efficacy and safety showed significant differences between arms.
Dr. Priya Bhide, a clinical researcher in the Women’s Health Research Unit, Center for Public Health and Policy at the Wolfson Institute for Population Health, said:
“Our experience suggests that TLI does not improve the chances of a live birth in women undergoing IVF and ICSI treatments. This demonstrates that the theoretical benefits of advanced technology do not always translate into improved clinical outcomes. This is important information for all stakeholders: patients, healthcare providers, funders, and policymakers.”
Dr David Chan, Laboratory Director at Prince of Wales Hospital, Chinese University of Hong Kong, said:
“Our experience provides evidence that TLI devices may not be essential equipment in the IVF laboratory, especially for resource-limited IVF laboratories. Laboratories may use the results from this study to reevaluate how they allocate their budget for equipment. Rather than investing heavily in a TLI device, they could focus more on laboratory equipment that has a direct and tangible impact on live birth rates. This approach could help find a better balance between the overall cost of IVF treatments and patient affordability in resource-limited settings.”
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