When we look at other industries, a rapid progress and
evolution has resulted in remarkable products, specifically computers and
software. Incidentally, the birth of apple computer and the birth of first IVF baby
Louis Brown were achieved in the same year 1978. Looking back the technology
advances in IVF are also at par with that in computer industry.
IVF Techniques have also evolved over years, with embryo cryopreservation, gamete
cryopreservation, embryo biopsy, Intracytoplasmic sperm injection, assisted hatching
and genetic testing introduced into day to day practice.
Various types
of incubators were introduced in markets, starting from Australia introduced mini-incubator,
called the MINC in 1990. Embryos are routinely cultured till the blastocyst
stage, before they are transferred. However, the pregnancy and live birthrate
did not go parallel with the technology innovations. It could be explained in
many ways, namely aging mothers with poor egg quality and ability to treat
couples with complex infertility causes.
But, embryo
selection does play a part and till now they were selected based on morphology
at pre-defined interval alone. The introduction of TL technology allows us to
continuous monitoring of embryos without compromising the culture environment.
Several different time lapse incubators with automated image capture are in use
by ART specialists.
But, are TL
systems for efficient in selecting good embryos than simple morphology? Few
randomized studies have been conducted till now. One such study by Goodman and
colleagues was published in the February, 2016 issue of Fertility and
Sterility.
This was a
randomized controlled trial with about 300 patients, in which all embryos were
cultured in TL, but in control group they were only assessed once a day and in
experimental group precise timing of various kinetic events (time to pronuclear
fading, two-cell, three-cell, four-cell, five-cell, eight-cell stage, start of
compaction, time to morula/ blastocyst, expanded blastocyst formation) as well
as cleavage anomalies were used to identify the embryo to be transferred.
Embryos were
scored using these markers. It was seen that pregnancy and implantation rates
were higher in TL group, but the difference was not statistically significant.
Multinucleation
and uneven cleavage was seen much more clearly in TL group. So, some
researchers opine that TL is a good for deselecting the embryos, which
otherwise would have been transferred but would not have implanted.
One other RCT
by Rubio et al.,
2014 reported
a clear cut advantage of TL systems over traditional incubators,
with increased implantation rates and ongoing pregnancy rate. But, it did have
many limitations due to methodology and protocols in embryo transfer, using
separate incubators in control and study group. Thereby limiting benefit of the
undisturbed culture conditions or the selection based on morphokinetic
parameters.
In the present
study both control and experimental embryos were cultured in TL incubators
under similar conditions, and only the selection for transfer differed.
However, there may be other factors like morphokinetic parameters, chromosomal
compositions and implantation potential responsible for successful live births
than just selecting some competent embryos.
But, TL embryo
monitoring does offer several benefits like undisturbed embryo culture,
recording of embryo development for quality control, and standardization of
morphologic assessment and when combined with other advance technique like
array CGH does results in improved pregnancy rates.
As time goes by, the high cost of these technologies
significantly decreases and their efficacy will also increase with standardized
guidelines, and combining it with other techniques, the world of morphokinetics
of TL systems is here to stay!
References:
http://humrep.oxfordjournals.org/content/early/2014/10/24/humrep.deu278.full
http://www.fertstert.org/article/S0015-0282(15)02020-8/references
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