NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdf

Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.

1. TEMPORAL ODDESSEY:
EXPLORING THE HORIZONS OF
TIME-LAPSE EMRBYO MONITORING
DR. RAHUL SEN
Ph.D. MSc.
CHIEF CONSULTANT EMBRYOLOGIST
NEELKANTH IVF

3. LEARNING OBJECTIVES
ABOUT TIME LAPSE TECHNOLOGY ?
EMBRYO CULTURE SYSTEM TECHNIQUES IN TLT
DOES IT REALLY WORTH TO ADD TIME LAPSE TECHNOLOGY IN A LAB ?
INCORPORATING TIME-LAPSE UNIT IN A ROUTINE LAB?
COMPARING OUTCOMES WITH STANDARD INCUBATORS –CURRENT EVIDENCES
ADDED ADVANTAGES –CURRENT EVIDENCES

4. INTRODUCTION
TheintroductionofTLThasledtotheemergenceof"morphokinetics"assessment,which
integratesmorphologywithkineticstoprovideacomprehensiveframeworkfor
understandingandevaluatingembryoviability
Theincubatorcomponentconsistsof–HighQualityContrastOptics,Microscope,Camera,
CultureDishCompartment,Gaschamber&FunctionPanel.Theimagingsoftware
componentconsistsof–MorphokineticAnnotation&PredictiveAlgorithmtoassess
embryoviability.
TLTallowscontinuousnon-invasiveobservationofembryodevelopmentwithminimal
manipulation,significantlycontributingtounderstanddevelopmentaleventsand
enhancingmorphologyassessmentsofembryo

5. INTRODUCTION
Althoughtime-lapsetechnology(TLT)wasintroducedinARTmanyyearsago(Payne
etal.,1997),itwasnotuntil2010thatTLTshiftedfromamereobservationofhuman
embryoswhileinculture,toaselectionandpredictiontool.
Theyearof2011markedtheofficialintroductionofTLTintheembryology
laboratory,whenembryoimplantationwasshowntobeassociatedwithspecificcell
divisiontimingparameters,introducingtheterm‘morphokinetics’

8. IMPACT ON EMBRYO CULTURE CONDITIONS -
CULTURE MEDIUM & DISHES -
NO LIMITATION WITH UTILIZATION OF CULTURE MEDIUM STRATEGY;
CULTURE DISHES ARE LIMITED AS PRODUCT MANUFACTURER‘S
CO2/ O2 GAS TENSION –CAN HOLD ANY GAS CONCENTRATION
(LOW, ULTRALOW, TRIGAS)
EMBRYO DENSITY –INDIVIDUAL EMBRYO CULTURE APPROACH
SAFETY ISSUES –TYPE OF MICROSCOPY; EXPOSURE TO LIGHT; INBUILT HEATH DISSIPATION

9. SAFETY ISSUES WITH TLT
nosafetyissueshavebeenreportedfollowingembryocultureinTLTincubators,and
obstetricandperinataloutcomes,suchasdurationofgestation,congenitalmalformations
andbirthweight,arecomparable(Costa-Borgesetal.,2016;Insuaetal.,2017;Kovacset
al.,2019)orbetter(Mascarenhasetal.,2019)comparedtostandardincubation.
Conclusions: The strategy of
culturing embryo in time-lapse
incubation systems would not
increase adverse risks of neonatal
outcomes comparing to SI.

10. SETTING UP OF A TIME-LAPSE INCUBATOR IN LAB
WHY, WHAT, WHICH, WHERE, HOW?
ClearlyidentifythereasonstointroduceaTLTsystem
•AssessprosandconsofacquiringaTLTsystem,both
financiallyandoperatively
•Identifywhethermorphokineticparameterswillbe
usedinselection/de-selection/rankingofembryos
•Selectionofsuitabletimelapseequipment
•Evaluatetechnical/customersupportavailable
•Onceintroducedinthelab,findtheappropriate
systemsettings
•TrainingofembryologistswithcurrentevidencesinTLT

11. COMPARING TIME LAPSE WITH STANDARD INCUBATORS
CONNECTS WITH A LOGGER THAT MONITOR LEVEL/PRESSURE OF GASES
INSIDE THE INCUBATOR
EMBRYO ASSESSMENT TO BE DONE MANUALLY AT A SPECIFIC TIME INTERVAL
NO SCOPE FOR AUTOMATION IN NEAR FUTURE
CONNECTS THE INCUBATOR WITH A COMPUTER USING SPECIALLY
DESIGNED SOFTWARE THAT MONITOR ALL STAGES OF EMBRYO
DEVELOPMENT
EMBRYO ASSESSMENT TO BE DONE USING DESIGNED ALGORITHMS, AI
SCOPE FOR AUTOMATION/ UPGRADATION IN FUTURE
LONG TERM STORAGE FOR PICTURES/ VIDEOS –QC, RECORD KEEPING,
DOCUMENTATION PURPOSE (ART ACT 2021)

12. UNDERSTANDING EMBRYO DEVELOPMENT EVENTS
68 hrs44 hrs27 hrs17 hrs 96 hrs 108 hrs
the static ‘snap-shot’ assessment being performed outside of the incubator
Whole embryo development is recorded that can include more information how an embryo
divided in between those fixed time frames

13. `
Fan YL, et. Al., 2016 JARG

14. BLASTOCYST STRINGS
SPONTANEOUS BLASTOCYST COLLAPSE
EBNAR, 2008

15. •Theaimwastostudywhetheralimitedexposureofembryosoutsidetheincubatorhasaneffecton
embryodevelopment,blastocystqualityandeuploidoutcomes.
•796maturesiblingoocytesthatweresplitrandomlybetweentwoincubators:benchtopvs.timelapse
•Thefertilization,cleavage,embryo/blastocystqualities,useableblastocystandeuploidrateswere
assessedtoevaluatetheincubatorperformance.
•Nodifferencesobservedinfertilizationrates,cleavagerateandday3embryoqualityrate.
•Embryosculturedintime-lapsehadasignificantlyhigherblastocystbiopsyrate,increasedeuploid
rate,improvedblastocystquality
•Wefoundthatexposureofembryosoutsidetheincubatormaynegativelyaffecttheinvitroblastocyst
developmentandeuploidrateonDay5.

16. •This large multicentre, single-blinded, randomized controlled study included 1224 participants
randomly assigned (1:1) to the time-lapse or standard incubator group.
•embryo transfer cycle was still significantly higher in the time-lapse group
•The embryo assessment method offered by time-lapse systems rather than an undisturbed
environment may play an important role in improving the implantation rate

19. •Thisconsensuspaperprovidesupdatedrecommendationsoncriteriaandterminologyforassessingoocyte,zygote,cleavage-
stageembryo,morulae,andblastocystdevelopmentthoroughreviewofevidenceaccumulatedoverthepastdecade.
•CriticalinformationgainedfromapplicationofTLThasrevisedtimingsofdevelopmentalmilestones
•ThedocumentrecommendsincorporatingmorphokineticfeaturessincetheintroductionofTLTintotheassessmentcriteria,
caninformandcomplementthestaticobservationapproach.
•Thedocumentsuggeststhatfutureresearchshouldfocusonaddressingtheknowledgegapsinunderstandingtheimpactof
variousfactorsonembryodevelopmentaltiming

20. RESEARCH PROSPECTS
RESEARCH PROSPECTS

21. TRAINING, VALIDATION & EMBRYO GRADING QC

22. COMPARING CLINIC PERFORMANCES –KPI

23. PREDICTING EMBRYO OUTCOMES

24. Embryoculturehasalreadybeenfullyautomatedwithuseoftime-lapseincubatorswhichallowcontinuousmonitoringof
embryodevelopment.
Datageneratedfromtime-lapseincubatorscanbeanalyzedwithmachinelearningtoaidintheselectionofembryoswiththe
highestpregnancypotential.
Additionalinformationaboutembryoviabilitymaybegleanedfromotheromicstechnologieswhichcaneithersamplethe
embryodirectlyorindirectlyviaitsculturemedia.Thetechnologiesinquestionincludegenomic,transcriptomic,proteomic,and
metabolomicanalyses

26. CONCLUSION
Time-lapsesystemshavequicklybecomeacommonfeatureofinvitrofertilizationlaboratoriesallover
theworld.
theallegedbenefitsoftime-lapsetechnologyhavecontinuedtogrow,fromundisturbedculture
conditionsandroundtheclock,noninvasiveobservationstomorerecentcomputer-assistedselectionof
embryosthroughthedevelopmentofalgorithms.
ApplicationsoftimelapsewithMetabolomicprofiling,non-invasivePGTarestillunexplored
Despitetheglobaluptakeoftime-lapsetechnology,itsrealimpactonclinicaloutcomesisstill
controversial.
CanitbeapathwaytohitforUniversalSingleEmbryoTransferPolicy.

27. THANK YOU