Effect of embryo selection based morphokinetics on IVF/ICSI outcomes: evidence from a systematic review and meta-analysis of randomized controlled trials

Magdi, Yasmin; Samy, Ahmed; Abbas, Ahmed M.; Ahmed, Mohammed Ahmed Ibrahim; Edris, Yehia; El-Gohary, Ayman; Fawzy, Mohamed

doi:10.1007/s00404-019-05335-1

Cited by 20 publications

(21 citation statements)

References 29 publications

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“…Differing results persist in meta-analyses: Pribenzky’s study [ 33 ], based on 1637 randomized patients, showed reduced early pregnancy loss, higher ongoing pregnancy and live birth rates with time-lapse culture and morphokinetic embryo selection. Magdi et al emphasized a 9% improvement in a live birth with TLS [ 34 ]. In contrast, the updated Cochrane review [ 56 ], including 2955 patients, as well as two other meta-analyses [ 38 , 57 ], reported insufficient evidence to support that TLS is superior to conventional methods for human embryo incubation and selection.…”

Section: Discussionmentioning

confidence: 99%

“…Considering IVF outcomes, it remains controversial whether TLS can help improve pregnancy and live birth rates. Some studies observed significantly higher clinical pregnancy [ 18 , 28 , 29 , 30 ] and live birth rates [ 30 , 31 , 32 , 33 , 34 ] with TLS in comparison with conventional incubators and standard morphological evaluation, while other investigators found no significant differences between the two systems [ 8 , 35 , 36 , 37 , 38 ]. In addition, changes in the strategy employed for ranking embryos when using TLS have been minimally explored [ 39 ].…”

Section: Introductionmentioning

confidence: 99%

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Change in the Strategy of Embryo Selection with Time-Lapse System Implementation—Impact on Clinical Pregnancy Rates

Boucret

Tramon

Saulnier

et al. 2021

JCM

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Time-lapse systems (TLS) and associated algorithms are interesting tools to improve embryo selection. This study aimed to evaluate how TLS and KIDScore™ algorithm changed our practices of embryo selection, as compared to a conventional morphological evaluation, and improved clinical pregnancy rates (CPR). In the study group (year 2020, n = 303 transfers), embryos were cultured in an EmbryoScope+ time-lapse incubator. A first team observed embryos conventionally once a day, while a second team selected the embryos for transfer based on time-lapse recordings. In the control group (year 2019, n = 279 transfers), embryos were selected using the conventional method, and CPR were recorded. In 2020, disagreement between TLS and the conventional method occurred in 32.1% of transfers, more often for early embryos (34.7%) than for blastocysts (20.5%). Irregular morphokinetic events (direct or reverse cleavage, multinucleation, abnormal pronuclei) were detected in 54.9% of the discordant embryos. When it was available, KIDScore™ was decreased for 73.2% of the deselected embryos. Discordant blastocysts mainly corresponded with a decrease in KIDScore™ (90.9%), whereas discordant Day 3 embryos resulted from a decreased KIDScore™ and/or an irregular morphokinetic event. CPR was significantly improved in the TLS group (2020), as compared to the conventional group (2019) (32.3% vs. 21.9%, p = 0.005), even after multivariate analysis. In conclusion, TLS is useful to highlight some embryo development abnormalities and identify embryos with the highest potential for pregnancy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Change in the Strategy of Embryo Selection with Time-Lapse System Implementation—Impact on Clinical Pregnancy Rates

Boucret

Tramon

Saulnier

et al. 2021

JCM

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“…In addition, a lower risk for preterm birth and low birthweight was associated with TLT compared to SI cultures. The meta-analysis by Magdi and colleagues 22 enrolling 2057 patients, observed an improvement in live birth (OR = 1.43; 95% CI, 1.10–1.85; p = 0.007) and a decrease in early pregnancy loss (OR = 0.71; 95% CI, 0.52–0.97; p = 0.03) when TLT was compared to standard evaluation of embryo development, while no significant differences were found for implantation, ongoing, and clinical pregnancy rates. The authors, however, remarked that the quality of the evidence is low and that outcomes should be evaluated with caution due to the statistical and clinical heterogeneity of the data.…”

Section: Time-lapse Systemmentioning

confidence: 99%

The clinical use of time-lapse in human-assisted reproduction

Minasi

Greco

Varricchio

et al. 2020

Clin Med�Insights�Reprod�Health

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A major challenge in the assisted reproduction laboratory is to set up reproducible and efficient criteria to identify the embryo with the highest developmental potential. Over the years, several methods have been used worldwide with this purpose. Initially, standard morphology assessment was the only available strategy. It is now universally recognized that besides being a very subjective embryo selection strategy, morphology evaluation alone has a very poor prognostic value. More recently, the availability of time-lapse incubators allowed a continuous monitoring of human embryo development. This technology has spread quickly and many fertility clinics over the world produced a remarkable amount of data. To date, however, a general consensus on which variables, or combination of variables, should play a central role in embryo selection is still lacking. Many confounding factors, concerning both patient features and clinical and biological procedures, have been observed to influence embryo development. In addition, several studies have reported unexpected positive outcomes, even in the presence of abnormal developmental criteria. While it does not seem that time-lapse technology is ready to entirely replace the more invasive preimplantation genetic testing in identifying the embryo with the highest implantation potential, it is certainly true that its application is rapidly growing, becoming progressively more accurate. Studies involving artificial intelligence and deep-learning models as well as combining morphokinetic with other non-invasive markers of embryo development, are currently ongoing, raising hopes for its successful applicability for clinical purpose in the near future. The present review mainly focuses on data published starting from the first decade of 2000, when time-lapse technology was introduced as a routine clinical practice in the infertility centers.

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“…Data from recent meta-analyses showed conflicting results comparing TLSs with conventional incubators. [8][9][10][11] These meta-analyses included studies with different populations. Confounding factors such as culture conditions (culture medium, O 2 concentration), day of transfer, the number of embryos transferred, fresh or frozen embryo used, oocyte source, patient population, the TLS type and algorithms to predict various clinical outcomes, were inconsistent among the included studies.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Embryo incubation by time-lapse systems versus conventional incubators in Chinese women with diminished ovarian reserve undergoing IVF/ICSI: a study protocol for a randomised controlled trial

Chen

Huang

et al. 2020

BMJ Open

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IntroductionThe time-lapse imaging system (TLS) is a newly developed non-invasive embryo assessment system. Compared with conventional incubators, a TLS provides stable culture conditions and consistent observations of embryo development, thereby potentially improving embryo quality and selection of the best quality embryo. Although TLSs have been routinely used in many in vitro fertilisation (IVF) centres globally, there is insufficient evidence to indicate that TLSs result in higher cumulative live birth rates over conventional incubators. The purpose of this study is to compare the cumulative live birth rates and safety including miscarriage in infertile patients with diminished ovarian reserve (DOR) from both TLSs and conventional incubators.Methods and analysisThis study is a double-blind randomised controlled clinical trial (1:1 treatment ratio of TLSs vs conventional incubator). A total of 730 patients with DOR undergoing the first or second cycle of IVF or intracytoplasmic sperm injection (ICSI) will be enrolled and randomised into two parallel groups. Participants will undergo embryo culture in the TLSs (group A) or the conventional incubators (group B), respectively. Embryos are selected for transfer in both groups by the morphological characteristics. The embryo selection algorithm software is not used in the TLSs. The primary outcome is the cumulative live birth rate of the trial IVF/ICSI cycle within 12 months after randomisation. This study is powered to detect an absolute difference of 10% (35% vs 25%) at the significance level of 0.05% and 80% statistical power based on a two-sided test.Ethics and disseminationThis trial has been approved by the Institutional Ethical Committee of Shanghai First Maternity and Infant Hospital (KS1958). All participants in the trial will provide written informed consent. The study will be conducted according to the principles outlined in the Declaration of Helsinki and its amendments. Results of this study will be disseminated in peer-reviewed scientific journals.Trial registration numberChinese Clinical Trial Registry (ChiCTR1900027746).

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Effect of embryo selection based morphokinetics on IVF/ICSI outcomes: evidence from a systematic review and meta-analysis of randomized controlled trials

Cited by 20 publications

References 29 publications

Change in the Strategy of Embryo Selection with Time-Lapse System Implementation—Impact on Clinical Pregnancy Rates

Change in the Strategy of Embryo Selection with Time-Lapse System Implementation—Impact on Clinical Pregnancy Rates

The clinical use of time-lapse in human-assisted reproduction

Embryo incubation by time-lapse systems versus conventional incubators in Chinese women with diminished ovarian reserve undergoing IVF/ICSI: a study protocol for a randomised controlled trial

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