Embryo incubation and selection in a time-lapse monitoring system improves pregnancy outcome compared with a standard incubator: a retrospective cohort study

• Published in: Fertility and sterility Vol. 98; no. 6; pp. 1481 - 1489.e10
• Main Authors: Meseguer, Marcos, Ph.D, Rubio, Irene, Ph.D, Cruz, Maria, Ph.D, Basile, Natalia, Ph.D, Marcos, Julian, Ph.D, Requena, Antonio, M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.12.2012; Elsevier
• Subjects: Adult; Biological and medical sciences; clinical pregnancy; cohort studies; confidence interval; culture system; Embryo development; embryo selection; embryo transfer; Embryo Transfer - methods; Embryo Transfer - statistics & numerical data; Female; Fertility Preservation - methods; Fertility Preservation - statistics & numerical data; Fertilization in Vitro - methods; Fertilization in Vitro - statistics & numerical data; Gynecology. Andrology. Obstetrics; Humans; Incubators; Internal Medicine; intracytoplasmic sperm injection; Medical sciences; Middle Aged; monitoring; morphokinetic parameters; Obstetrics and Gynecology; odds ratio; oocytes; patients; Pregnancy; pregnancy outcome; Pregnancy Rate; Prevalence; regression analysis; Spain - epidemiology; Time-Lapse Imaging - methods; Time-Lapse Imaging - statistics & numerical data; time-lapse monitoring; Treatment Outcome; ultrasonics; Young Adult; Spain; embryo selection; time-lapse monitoring; Embryo development; morphokinetic parameters; clinical pregnancy; culture system; Embryo; Prognosis; Incubation; Gynecology; Obstetrics; Standards; Retrospective; Pregnancy; Monitoring system; Surveillance; Cohort study; Development; Comparative study
• ISSN: 0015-0282; 1556-5653
• DOI: 10.1016/j.fertnstert.2012.08.016

Objective To quantify the effect on reproductive outcome of culturing and selecting embryos using a novel time-lapse monitoring system (TMS). Design Retrospective observational cohort study. Setting University-affiliated private center. Patient(s) Donation and autologous intracytoplasmic sperm injection (ICSI) cycles from ten IVF clinics using similar procedures, cultured in TMS (n = 1,390) or in a standard incubator (SI; n = 5,915). Intervention(s) None. Main Outcome Measure(s) Clinical pregnancy rate confirmed by ultrasound in week 7. Result(s) A logistic regression analysis, which included all significant confounding factors, was used to evaluate the effect of culturing and selecting embryos with the use of TMS. Comparing clinical pregnancy rates per oocyte retrieval with TMS and SI treatments gave a crude effect of odds ratio [OR] 1.190 (95% confidence interval [CI] 1.058–1.337). Oocyte source, maternal age, day of transfer, and number of retrieved oocytes were identified as significant confounding factors. After accounting for confounding factors, the effect of TMS culture was OR 1.201 (95% CI 1.059–1.363). Limiting analysis to treatments with embryo transfer and including number of transferred embryos as a confounding factor likewise gave a significant effect of TMS with OR 1.157 (95% CI 1.018–1.315). Conclusion(s) Analysis of retrospective data indicated that culturing and selecting embryos by TMS significantly improved the relative probability of clinical pregnancy (+20.1% per oocyte retrieval, +15.7% per embryo transfer). The elevated clinical pregnancy rate was attributed to a combination of stable culture conditions and the use of morphokinetic parameters for embryo selection.