| dc.description.abstract | Background: Time-lapse monitoring of human embryos is becoming increasingly
utilized in clinical IVF laboratories. This technology allows for uninterrupted,
continuous observation of embryo development without having to remove embryos
from the controlled environment inside the incubator. Additional information about
embryo development can be obtained and combined with traditional morphological
evaluations. However, few randomized controlled trials have been performed
investigating the efficacy and safety of closed culture systems utilizing time-lapse
technology.
Aim: To investigate in a randomized controlled trial (RCT) if the number of good
quality embryos (GQEs) derived from culture in a closed system (the
EmbryoScopeTM) was superior compared to culture in a conventional culture system.
A further aim was to investigate if one or more morphokinetic variables could predict
live birth after day 2 transfer, when analysed in combination with conventional
morphology and patient variables.
Materials and Methods: A total of 364 patients were randomized to culture until
day 2 in either the EmbryoScope (n=240) or in a conventional incubator (n=124) at
atmospheric O2 and 6% CO2. Only first cycle patients treated with ICSI
(intracytoplasmic sperm injection) were included. In paper I the mean number of
GQEs in each group was the primary endpoint. In paper II, time-lapse images of 207
transferred embryos from patients achieving the same number of live born children
as transferred embryos, or no live birth, were analysed by logistic regression to
determine predictors of live birth among morphological-, morphokinetic- and patient
variables.
Results: In Paper I, no significant difference was found in the mean ± SD number of
GQEs between the groups cultured for two days in a closed (n=240), compared to a
conventional (n=124) culture system (2.41±2.27 vs. 2.19±1.82, p=0.34). In Paper II,
early cleavage and fragmentation grade were the only variables that independently
could predict live birth (OR 4.84 (95% CI: 2.14-10.96) p=0.0002) and (OR 0.46
(95% CI: 0.25-0.84) p=0.012), respectively), early cleavage as a positive predictor
and fragmentation grade as a negative predictor of live birth. No morphokinetic
variables were independently predictive of live birth.
Limitations: The primary outcome of the RCT, number of GQEs on day 2, was a
surrogate variable for live birth (paper I). In addition, only ICSI patients were
included, and different culture dishes for the time-lapse incubator and the
conventional incubator were used.
Conclusion: No benefit was found for the time-lapse system over the conventional
system, with regards to the number of GQEs on day 2. None of the included
morphokinetic variables were predictive of live birth. | sv |
