Remember when mobile phones didn’t exist? Who would have believed that everyone - even school children would be carrying a mobile phone? Technologies have to be initially used by early adopters (the ones always wanting to try new technologies). The same goes with IVF incubators.
The new technology in embryo incubation is time lapse and we at Care Fertility are part of a brave group of early adopters. We believe the early evidence that pregnancy rates are increased by the use of time lapse.
Let’s take a step back: to allow an embryo to develop, embryos are kept in a warm tightly controlled environment called an incubator. But how has developing embryos in an incubator changed over the years?
Originally incubators were like refrigerators with a door which opened at the front. Numerous dishes containing embryos were placed inside the incubator and every time the door was opened the stability of the gas and temperature was disrupted. In addition light was introduced to the incubators and the embryos. This was adverse for embryo development. Care Fertility has never used these incubators for embryo culture though some units in Australia still use these incubators for embryo culture.
A significant development in incubators was the mini-incubator (often called a MINC™) in which each set of embryos are housed in a small separate section so that conditions are disrupted only when the lid of the individual compartment is lifted. Use of mini incubators increased the pregnancy rates as embryos had more stable conditions in which to develop. Mini-incubators have been and remain the standard of care in embryo culture at Care Fertility and in many units around the world.
Time lapse incubators
The next significant breakthrough or improvement is the time lapse incubator. A time lapse incubator has a built in microscope and camera which photographs each individual embryo every 10-12 minutes. Embryos can therefore be assessed in great detail without being disturbed and have uninterrupted culture for up to six days. In addition the extra information obtained allows scientists to more accurately predict which embryos are more likely to be genetically normal and more likely to result in a pregnancy. These incubators are understandably very expensive and therefore an extra cost is incurred if they are used. Care Fertility has been an early adopter of this new technology and has used time lapse since 2015. Interpretation of the videos of embryo development is very time consuming and requires experience and expertise of which Care Fertility is very proud. Time lapse is an optional extra at Care Fertility Greenslopes and is a standard of care at Care Fertility Toowoomba.
When should time-lapse incubators be used?
This is a difficult question to answer as proof of benefit is still not confirmed but from the few available studies the results are encouraging and are starting to indicate a benefit in pregnancy rate. If preimplantation embryo testing (embryo biopsy) is being performed time lapse incubation must be used as it allows the scientists to accurately determine the embryo’s readiness for biopsy without having to repeatedly open the incubator and inspect the embryos under the microscope. Patients who have had poor results in other units have often benefitted from the use of the Embryoscope at Care Fertility. Because of the limited capacity time lapse is not always available.
Above: An Embryoscope made by Vitrolife and in regular use at Care Fertility since 2015
Above: An Embryoslide in which twelve embryos are placed in each individual well. The Embryoslide is then placed into the Embryoscope.
Above: This is an example of a series of photographs taken over six days of a single embryo developing to blastocyst. Care Fertility offers a video of embryo development for an ongoing pregnancy on request.