Embryo Time-Lapse Imaging 

What is embryo time-lapse imaging?

In IVF, time-lapse imaging is used to monitor embryo development.  Latest digital camera technology captures images of the embryo several times an hour during the whole incubation period.  These images are recorded and saved in sequence producing a ‘movie’ of the embryo development, which can then be viewed in detail, as part of the selection process of the very best embryo/s for transfer.

Midland Fertility’s preliminary data indicates a 10%  increase in clinical pregnancy rates with time-lapse imaging.

What is a time-lapse imaging incubator?

The incubator with an integrated camera, combines time-lapse imaging of the embryo and the latest incubator technology.   It means the development of the embryo can be assessed while maintaining the very best conditions in this state-of-the-art incubator.

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What is the alternative to time-lapse imaging incubation?

Without the time-lapse imaging incubator, embryos continue to be checked at certain time-points throughout their development, usually with single observations on:

  • Day 1 (fertilisation check, the day after egg recovery)
  • Day 3 (5-8 cell stage)
  • Day 5 (blastocyst)

Two further observations occur on the day of embryo transfer.  To carry out these observations, the embryologist removes the dish containing the embryos from the incubator to observe them using a high magnification microscope.  The advantages of more frequent observational checks are carefully balanced with the disadvantages of removing the embryos from their stable incubator environment.

What are the benefits of time-lape imaging to patients?

  • thousands of images are collected for each embryo, rather than only a ‘snap shot’. This gives much more information to monitor the development of each embryo and to detect certain abnormalities which may occur outside of the usual time-points for assessment, and would therefore be missed. It provides the embryologists with more information when choosing the most suitable embryo to transfer – which may be a particular advantage to those patients who are having a single embryo transfer (SET), see below
  • the embryos do not need to be taken out of the incubator other than to change the media (the liquid in which they are cultured), so they benefit from a more stable environment without pH and temperature changes
  • the image sequences can be viewed live or replayed over and over again – but while the embryos remain in the incubator. This gives opportunity for more rigorous assessment and decisions can be more easily verified by other Midland Fertility staff. It also allows for greater training opportunities.
  • for patients who do not conceive, the images may give more information to both the patients and the embryologists about why they may not have implanted. This will be very useful if another treatment cycle is planned

Examples of Time-Lapse Imaging

embryoscope eg1 1to3 vs blast

1 to 3 vs blastocyst – click (left) on link to activate film

The embryo on the left shows abnormal development, dividing from one cell to three cells, instead of from one cell to two, as shown in the embryo on the right.  This embryo on the left would be de-selected for transfer.

embryoscope eg2 3PN vs blast

3 pro-nuclei vs blastocyst – click (left) on link to activate film

The embryo on the left shows abnormal fertilisation with evidence of three pro-nuclei instead of the two pro-nuclei of normal development (ie one from the sperm and one from the egg). The embryo on the right shows normal development.

embryoscope eg3 multinucleated

Multinucleated embryo vs good embryo – click (left) on link to activate film

The embryo on the left shows abnormal development.  The embryo on the right shows preferred development.

Are there any considerations?

There are very few disadvantages to time-lapse imaging incubation, but patients should consider the following:

time-lapse imaging slide
The time-lapse slide can hold up to 12 eggs/embryos
  • each patient opting for time-lapse imaging will be allocated a ‘slide’  which has the capacity to hold 12 eggs/embryos:
    • for ICSI patients, on Day 0 (the day of egg collection) the eggs are placed into the EmbryoScopeTM after the sperm injection.  Vital images are then captured of the fertilisation process.  If a patient has more than 12 eggs for ICSI, the remaining eggs will be placed into the standard incubator.
    • for IVF patients, fertilised eggs are loaded into the time-lapse imaging incubator, once the protective cells which cover the shell of the eggs have been ‘stripped’ away, allowing the camera an unobstructed view through the fertilised egg.  Any other suitable fertilised eggs are frozen at this stage for possible future use
  • the extra time-lapse captured information may indicate that all the embryos in the time-lapse imaging incubator have reduced implantation potential. In this situation, Midland Fertility would discuss the observations with the patient and the potential effect on the chances of successful treatment
  • although the extra information can help to select, or deselect, embryos before transfer, Midland Fertility may still not have the reasons to explain why a pregnancy does not occur
  • Midland Fertility is confident that the current investment in time-lapse imaging incubator is enough to satisfy the initial patient response. However, should the demand be greater than the capacity of the incubators, there may not be enough spaces to accommodate all patients who want to use this facility. A refund of the time-lapse imaging incubator fee will be issued at this time to the patient, if this is the case. Midland Fertility will continuously monitor the need for additional time-lapse imaging incubator investment to minimise the chance of this
  • time-lapse imaging incubation must be booked and paid for before the day of egg collection so the necessary slides can be prepared

For whom is Time-lapse Imaging suitable?

Any patient may benefit from culturing their embryos in the time-lapse imaging incubator, and in particular:

  • younger patients who fall into the single embryo transfer (SET) group, as the embryologists may be able to select the best embryo with greater confidence
  • those patients who have had multiple failed treatments as the extra information may help to identify embryos showing abnormal development

However, the use of time-lapse imaging incubator may be less useful for those patients with only a few eggs at egg collection where fewer embryos develop.  With fewer embryos to choose from, selecting the best embryo(s) for transfer may be more straightforward using current techniques.

Are there any risks?

Worldwide, thousands of cycles of IVF and ICSI have cultured embryos with time-lapse imaging incubator with no detrimental issues being reported.  Like all Midland Fertility incubators, the time-lapse imaging incubators are connected to a 24/7 monitoring system, so lab staff receive an alarm call if the temperature or gas concentrations change.

Will the drugs or treatment be any different?

Culturing embryos in the time-lapse imaging incubator will not require changes to a patient’s treatment plan.

Results

Published results from other units using time-lapse imaging show an increase in the livebirth rate over conventional culture systems, so indicating a decrease in the miscarriage rate.  Some reports show that certain developmental patterns are associated with chromosomal abnormalities within the embryo.

By avoiding the transfer of these embryos, Midland Fertility will work towards achieving the same as these studies and increase the livebirth rate per treatment cycle.

What is included in the cost?

  • the use of a time-lapse imaging incubator to view up to 12 embryos up until the time of embryo transfer
  • following confirmation of the birth of your baby/ies, a flash-drive with the time-lapse imaging of their embryo development

What is not included in the cost?

  • any time-lapse imaging incubation required for any subsequent frozen embryo transfer
  • any other fertility investigations, treatments or preservation services for either partner

Costs

The cost of is for each slide of eggs/embryos cultured in the time-lapse imaging incubator.

Cost (per treatment cycle) for time-lapse imaging at Midland Fertility: £495.00

Go to the Midland Fertility:

Success rates

Using embryo time-lapse imaging incubation, Midland Fertility’s preliminary data indicates a 10% increase in clinical pregnancy rates.

Please go to Success Rates for details of the most recent published results for standard incubation IVF and ICSI cycles.

More information

Also, go to the Midland Fertility Patient Treatment Information page and download:

  • Time-Lapse Imaging
  • IVF
  • ICSI
  • Egg Collection and Fertilisation

LU: 9/6/16/JAA