Should I get Time-lapse imaging as part of my IVF treatment?
When we were going through our IVF treatment, you’re presented with a menu of options for IVF with many add-ons that you can consider. In NHS treatment many of them are not funded but you can add them on and in private treatment you can have the lot. you can read more about the costs of IVF in our highly detailed costs guide We are writing a series of articles on these to help you better understand which options might benefit you. One of the ones that at first glance looks really interesting is time lapse imaging of your fertilised embryo’s as they develop.
What is time lapse imaging for IVF?
Time lapse imaging is based on an old photographic technology where a camera is set up to take images at pre-specified time intervals. In IVF the camera takes photo’s at regular intervals of the fertilised embryo to watch its development. This information about the embryo’s kinetics is then used to select the embryo’s which show the least signs of aneuploidy (an unusual number of chromosomes) which in theory gives the best chance for pregnancy and most importantly live birth.
How does time lapse imaging of an embryo work?
Each system is slightly different, some are incubators built around camera’s others have microscope camera’s inserted, but all of them are designed to not impact the temperature and gas composition of the incubator. This is completely non-invasive and causes no harm to the developing embryo.
Images are taken in 10-minute intervals and an image timeline is created. These images are then read by a computer algorithm which looks specifically at the morphokinetic properties during the fertilisation – cleavage of the zygote – blastocyst and possibly hatching. As shown by the short video below.
Morphokinetic means the structure and shape of the zygote and kinetic is the movement it takes to get there. In normal IVF the embryologist just assesses the morphology of an embryo each day and grades it by their clinic’s preferred standards. Using the time-lapse technology means that the embryologist can grade the movement and very specific points of development which help identify chromosomal problems which may not be clear in normal embryo grading.
The algorithm looks for specific morphokinetic markers which can include
- How long it takes for first cleavage 8.3 minutes – 20.3 minutes
- Time between first and second mitotic division (cell division) 8.9 hours – 13.3 hours
- Time between second and third mitotic division 1 hour – 2.6 hours
- Time to start of blastulation (transformation from cleavage zygote to blastocyst) indicated by the formation of a fluid filled sack
- Time at which the blastocyst is fully developed (with a large fluid filled sack)
Using some or all these markers, the algorithm, coupled with the embryologist, is able to select the embryo which is least likely to have chromosomal defects. The algorithms go further and create full development maps, which indicate a percentage chance of live birth and this can then be used to choose which embryo should be transferred.
What evidence is there that imaging of embryo’s improves live birth rates?
There are a number of headlines which are somewhat extravagant when it comes to the major research into time lapse imaging, these include:
The Guardian article found here which had a sensationalist claim of:
“Doctors in Nottingham who devised the procedure say it could raise live birthrates at their clinic to 78%, around three times the national average for IVF treatment in the UK”
Which is based on one of the the study’s we’re going to discuss but is statistically incorrect and not even close to the result!
A 2013 peer-reviewed study which looked at 88 embryos from 69 couples using time lapse imaging as part of their IVF cycles. The outcome of their IVF treatment was already known at this point. They used the technique to screen for aneuploidy.
42% of these embryo’s implanted and 39% made it live birth (in line with national expected rates) What was interesting is that 73% of those embryo’s that the technology deemed as low risk lead to pregnancy, and 61% led to live birth.
Whilst this is a positive result the interpretation of the statistics in the media was incorrect.
It’s also important to note that this is a very small-scale study and it was mentioned that more research is required, to corroborate and understand the results better.
In 2018 an advancement on this was presented to a conference of assisted reproduction in America the research paper can be found here. It used artificial intelligence to create a map of the embryo’s and determine which were low risk of aneuploidy.
This study looked at 2,182 embryo’s using time lapse technology and fed this through a learning program. This was used to create a decision tree which took into account the embryo quality and patient age as a determinant of pregnancy chance.
The algorithm generated a clear range of pregnancy chances from 13.8% for those over 41 with a poor-quality embryo to 66.3% for those 37 or under with a good quality embryo.
The advantage of this approach is that there is a large discrepancy between how embryologists grade embryo’s and as such there is room for interpretation. This method allows for a very stringent baseline which can be used to assess chances of success based upon a large sample size. For example, where 3 out of 5 embryologists agreed on an embryo grading, STORK (as it is known) agreed with them 95.7% of the time. Whereas embryologists were only in total agreement in 23.8% of embryos.
This was then tested on other data sets of embryos’ which weren’t part of its learning embryos. However, this needs to be done more thoroughly before firm conclusions as to the full predictive nature of the algorithm can be determined.
From the above and other research papers this is one of the IVF addons which appears to be showing that it could have positive impacts on pregnancies and live birth rates (which is what as couples who need this treatment we really care about) However, large scale clinical trials with control groups have yet to be performed and until then it isn’t clear that it does. The potentionl of this addon is reflected in HEFA rating of this treatment as amber.
Are there any risks with time lapse imaging?
Currently there are no identified risks to your embryo through this technology. However, one area which is being looked at is to assess whether the exposure to regular light and certain wavelengths of light do pose any potential risks to embryo development, so this is still an unknown risk factor.
Should I consider getting time lapse imaging as part of my IVF cycle?
Just 6 years ago, it cost around £2,500 just to have these images as part of your cycle and at that point with just a single small study I would have absolutely said no.
However, certain clinics now include this as part of their normal IVF packages, other clinics may offer it as part of an ‘enhanced IVF package option’ or as a standalone feature (it’s often known as a trademark which is embryoscope) with an average price around £750.
This is still expensive, however, with some as we mentioned ‘including’ it or offering an enhanced IVF package (NB// When comparing IVF clinic prices, you need to check EXACTLY what is included so that you can compare apples with apples). It can represent fair value for money.
As we mentioned the evidence show’s that in theory it can help, especially with those who are more likely to have embryo’s with chromosomal problems (i.e. those with multiple failed attempts). However, there is little to no evidence of the real impact on live birth rates across all types of infertility and age brackets and until then the real value for money is hard to determine.
Sitting on the fence isn’t really our style though, I think that if I were to consider including an IVF add-on in one of our cycles which doesn’t quite yet have the clinical research backing it would include this option. I think the price for the complexity and cost of the technology required is fair and if it does turn out to offer the possible increase in successful implantation leading to greater chance of live birth then it could become the new norm in the IVF world.