Cell division in the embryo
The results of a randomized controlled trial, published today in The Lancetprovide 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 suffer from infertility. There are a number of assisted reproductive treatments that can help people with fertility problems have children, including in vitro fertilization (IVF). Statistics from the Human Fertilisation and Embryology Authority (HFEA) shows that more than 100,000 in vitro fertilisation (IVF) treatments took place in the UK between 2022 and 2023.
When a person is undergoing IVF or another proven fertility treatment, they may be offered a treatment ‘top-up’. These top-ups are optional, non-essential treatments that may be offered to improve the chances of having a child or for other medical reasons. However, the evidence to support the use of top-ups for most fertility patients is generally lacking, limited or unreliable.
Time-lapse imaging (TLI) is a technique used in IVF and offered as a fertility adjunct. Time-lapse imaging takes thousands of time-lapse images of embryos as they grow, creating a continuous view of each embryo as it develops. Some fertility practitioners believe that the information provided by time-lapse imaging, such as the rate of development or the number and appearance of cells, can help select the best embryos for implantation.
In TLI, embryos are not removed from their incubator, minimizing fluctuations in temperature, humidity, pH, and gas concentrations that could affect development. Standard techniques for evaluating and selecting embryos with the best implantation potential require that the embryo be removed from the incubator.
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 trial groups: one group of participants underwent embryo selection based on ILT, one group underwent standard static assessment using undisturbed culture, and the third group underwent conventional assessment using a light microscope and standard embryo culture in standard incubators. Baseline demographic and clinical characteristics of participants were similar across the three groups.
Live birth rates for embryos in each study group were 33.7% in the TLI group, 36.6% in the undisturbed culture group, and 33.0% in the control group. Clinical pregnancy rates were 42.2% in the TLI group, 43.4% in the undisturbed culture group, and 40.9% in the control group. None of the other secondary clinical efficacy and safety endpoints demonstrated significant differences between groups.
Dr Priya Bhide, Clinical Lecturer in the Women’s Health Research Unit at the Centre for Public Health and Policy at the Wolfson Institute for Population Health, said:
“Our trial suggests that ILT does not improve the chances of live birth in women undergoing IVF and ICSI. This shows that the theoretical benefits of advanced technology do not always translate into better clinical outcomes. This is important information for all stakeholders: patients, healthcare professionals, funders and policy makers.”
Dr David Chan, Director of the Prince of Wales Hospital Laboratory at the Chinese University of Hong Kong, said:
“Our trial provides evidence that supports that TLI machines may not be essential equipment in IVF laboratories, particularly for resource-limited IVF laboratories. Laboratories can use the results of this study to reevaluate how they allocate their budget to equipment. Instead of investing heavily in the TLI machine, they could focus more on laboratory equipment that has a direct and measurable impact on live birth rates. This approach could help strike a better balance between the overall cost of IVF treatments and affordability for patients in resource-limited settings.”
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