How are embryos selected without the Embryoscope™?
When you undergo a routine in-vitro fertilisation (IVF) or an intracytoplasmic sperm injection (ICSI) cycle, your embryos will be kept in a strictly controlled environment in heated incubators. The conditions in these incubators mimic the conditions in a woman’s body to provide the embryos with their natural environment. During the period that your embryos are kept in the laboratory, dishes where your embryos are growing are taken out of the incubators at set time points to check embryo development under a microscope. Based on these observations, the embryologists are able to tell which embryos are most likely to result in pregnancy based on morphological observations made on the embryo once or twice a day at important time points. When the Embryologist has finished examining the embryos they must be returned to the temperature controlled incubator as quickly as possible to avoid any potential damage to the embryos.
What is the Embryoscope™?
The Embryoscope™ is an incubator that maintains the necessary physiological conditions required by a living embryo while they are in the IVF laboratory. It has an incorporated time lapse system that has a camera that continuously captures images and records them as a video of the embryonic development. This system allows the embryologist to monitor embryo cell divisions while the embryos are still in the incubator and we can carry out a study of the development of the embryos. Based on recent studies, the cell division pattern of the embryos is becoming a valid alternative for selecting the embryos which have the best potential for implantation. There is growing evidence suggesting that certain cell time points and events are especially important for predicting further development potential, and pregnancy potential of embryos. Using these time points we can choose the best embryos among all the embryos of the patient and also give a lot of information regarding the viability of those embryos. These time points can only be recorded fully if it is done under a time lapse camera and routine observations under the microscope does not allow us to capture all of these time points since they can vary between embryos.
Some retrospective studies have shown that embryos with specific division times and certain development patterns can have up to 15 – 20% better chance of pregnancy. The optimum times for cell division can be checked more easily and the chances of implantation improved in cases in which selection using Embryoscope™ technology is possible.
Advantages of the use of Embryoscope™
- It can improve embryo selection
The Embryoscope™ provides us with information on critical time points regarding embryo development and therefore provides our embryologists with an additional decision-making tool for embryo selection for transfer. In an effort to choose the best embryo in patients who have many embryos present, blastocyst transfers have been used widely in many clinics. However, recent data suggests extended culture may not be the best for embryo viability and the future health of the babies. At a time when more and more literature is accumulating pointing to the importance of a more natural approach and emphasising the transfer of embryos as soon as possible to the mother, the Embryoscope™ could serve as an excellent tool for predicting which are the best embryos for transfer without the need to leave the embryos for extended periods in culture. This could help in preventing any abnormalities related to extended blastocyst culture.
- Predicting chromosomal abnormalities
In addition, there is some evidence to suggest that the Embryoscope™ can be used to help predict which embryos might be chromosomally abnormal. Several studies have shown that chromosomally normal and abnormal embryos behave differently in their division times. We can record this information with the Embryoscope™ and we may be able to use it to predict those embryos that are more likely to be chromosomally normal.
- It can give the parents-to-be more information about the embryo
The time-lapse system can provide us information about the whole development of the embryo. This information can be given to the future parents as videos of the embryo development.
Which patients will benefit from the use of the Embryoscope™?
Although in theory this technology can be applied to any type of patient undergoing IVF treatment, the chances of an improvement in the results are greatest among patients who generate more embryos because there is a better potential for selection. The Embryoscope™ is an embryo-selection tool that helps us more when we have a lot of embryos to choose from.
It can be used in cases where more information about the embryo is desired in situations where there is repeated implantation failure, advanced maternal age and history of recurrent miscarriage. It will help couples and women to make an informed decision about future treatment plan or closure as appropriate.
The Embryscope™ will not be suitable for all patient groups. Please discuss this with your consultant if this technology can be useful to you. Until good quality RCT evidence is available, this technology is offered only in certain circumstances such as repeated implantation failure, after counseling as to its cost effectiveness.
We do not offer this service routinely. We offer this technology in a few cases only. We only have an Embryscope™ in our Birmingham clinic and we offer it free of charge in Birmingham.